nach oben

Erschienen in:

13.10.2020 | 2020 SAGES Oral

Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery

verfasst von: J. C. Chen, Anahita Jalilvand, Vivian Wang, Jennwood Chen, Anand Gupta, Robert Tamer, Kayla Diaz, Muna Tamimi, Bradley Needleman, Sabrena Noria

Erschienen in: Surgical Endoscopy | Ausgabe 10/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Our group has previously demonstrated that low socioeconomic status (SES) independently predicts ≤ 25th percentile weight-loss following bariatric surgery (BS). Given that sociodemographic metrics can be separated into income, education, and race, we sought to investigate how each metric independently impacted weight loss following BS.

Methods

Patients from a single academic institution who underwent bariatric surgery from 2014 to 2016 were retrospectively reviewed. Patients were stratified by income (low/high), education (≤ high school/ ≥ college), and race (black/white) then compared using univariate analysis. Variables significant on univariate analyses were subsequently used for a greedy 1:3 propensity score match with a caliper of 0.2. After matching, groups were balanced on demographics, social/medical/psychological history, and surgery type. Percent excess body weight loss for each post-operative time point was compared using appropriate univariate analyses. A p-value ≤ 0.05 was considered statistically significant.

Results

571 patients were included. Unmatched race analysis demonstrated black patients were significantly younger (p = 0.05), single (p < 0.0001), in a lower income bracket (p < 0.0001), and experienced less weight loss at 2- (p = 0.01), 6- (p = 0.007), 12- (p = 0.008) and 24- (p = 0.007) months post-op. After matching, black patients continued to experience less weight loss at 2- (p = 0.01) and 6- (p = 0.03) months, which trended at 1 year (p = 0.06). Initial income analysis demonstrated patients in the low-income group (LIG) were more likely to be black (p < 0.0001), have ≤ high school education (p = 0.004), a higher preoperative BMI (p = 0.008), and lower postoperative weight loss at 2- (p = 0.001), 6- (p = 0.01), and 12- (p = 0.04) months after surgery. After matching, no differences were observed up to 3-years post-op. Analysis of education demonstrated no effect on weight loss in both unmatched and matched analyses.

Conclusion

Unmatched analysis demonstrated that low income and race impact short-term weight loss after BS. After matching, however, race, not socioeconomic status, predicted weight loss outcomes up to 1-year.

Dalstra JA, Kunst AE, Borrell C et al (2005) Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 34:316–326PubMedCrossRef

Stringhini S, Carmeli C, Jokela M et al (2017) Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet 389:1229–1237PubMedPubMedCentralCrossRef

Lewer D, Jayatunga W, Aldridge RW et al (2020) Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health 5:e33–e41PubMedCrossRef

Muennig P, Franks P, Jia H et al (2005) The income-associated burden of disease in the United States. Soc Sci Med 61:2018–2026PubMedCrossRef

Chetty R, Stepner M, Abraham S et al (2016) The association between income and life expectancy in the United States, 2001–2014. JAMA 315:1750–1766PubMedPubMedCentralCrossRef

Mohammed SH, Habtewold TD, Birhanu MM et al (2019) Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies. BMJ Open 9:e028238PubMedPubMedCentralCrossRef

Adler NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 21:60–76CrossRef

Singh GK, Siahpush M, Hiatt RA et al (2011) Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976–2008. J Community Health 36:94–110PubMedCrossRef

Wang Y, Beydoun MA (2007) The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28PubMedCrossRef

10.

Fan JX, Wen M, Li K (2020) Associations between obesity and neighborhood socioeconomic status: variations by gender and family income status. SSM Popul Health 10:100529PubMedCrossRef

11.

Livingston EH, Ko CY (2004) Socioeconomic characteristics of the population eligible for obesity surgery. Surgery 135:288–296PubMedCrossRef

12.

Martin M, Beekley A, Kjorstad R et al (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis 6:8–15PubMedCrossRef

13.

Keating C, Backholer K, Moodie M et al (2015) Differences in the rates of treatment of severe obesity using bariatric surgery across socioeconomic groups. JAMA Surg 150:367–368PubMedCrossRef

14.

Wallace AE, Young-Xu Y, Hartley D et al (2010) Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg 20:1354–1360PubMedCrossRef

15.

Bhogal SK, Reddigan JI, Rotstein OD et al (2015) Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Obes Surg 25:888–899PubMedCrossRef

16.

Hecht LM, Pester B, Braciszewski JM et al (2020) Socioeconomic and racial disparities in bariatric surgery. Obes Surg 11:1–5

17.

Keith CJ, Gullick AA, Feng K et al (2018) Predictive factors of weight regain following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 32:2232–2238PubMedCrossRef

18.

Winkleby MA, Jatulis DE, Frank E et al (1992) Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 82:816–820PubMedPubMedCentralCrossRef

19.

Dilektasli E, Erol MF, Cayci HM et al (2017) Low educational status and childhood obesity associated with insufficient Mid-term weight loss after sleeve gastrectomy: a retrospective observational cohort study. Obes Surg 27:162–168PubMedCrossRef

20.

Mahoney ST, Strassle PD, Farrell TM et al (2019) Does lower level of education and health literacy affect successful outcomes in bariatric surgery? J Laparoendosc Adv Surg Tech A 29:1011–1015PubMedCrossRef

21.

Akkary E, Nerlinger A, Yu S et al (2009) Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass. Surg Endosc 23:1246–1251PubMedCrossRef

22.

Jalilvand A, Blaszczak A, Dewire J et al (2019) Laparoscopic sleeve gastrectomy is an independent predictor of poor follow-up and reaching ≤ 40% excess body weight loss at 1, 2, and 3 years after bariatric surgery. Surg Endosc 34:2572–2584PubMedCrossRef

23.

Advameg, Inc. “Columbus, OH.” City-Data.com. (2020). http://www.city-data.com/city/Columbus-Ohio.html

24.

U.S. General Services Administration TTS. IMPACT (2020). http://www.data.gov/impact/

25.

Pew Research Center. Social & Demographic Trends (2016). http://www.pewresearch.org/

26.

Doumouras AG, Lee Y, Babe G et al (2020) The hidden cost of an extensive preoperative work-up: predictors of attrition after referral for bariatric surgery in a universal healthcare system. Surg Endosc 34:988–995PubMedCrossRef

27.

Smith ED, Layden BT, Hassan C et al (2018) Surgical treatment of obesity in Latinos and African Americans: future directions and recommendations to reduce disparities in bariatric surgery. Bariatr Surg Pract Patient Care 13:2–11PubMedPubMedCentralCrossRef

28.

Mainous AG, Johnson SP, Saxena SK et al (2013) Inpatient bariatric surgery among eligible black and white men and women in the United States, 1999–2010. Am J Gastroenterol 108:1218–1223PubMedCrossRef

29.

Palli SR, Rizzo JA, Heidrich N (2018) Bariatric surgery coverage: a comprehensive budget impact analysis from a payer perspective. Obes Surg 28:1711–1723PubMedCrossRef

30.

Altieri MS, Yang J, Yin D et al (2019) Patients insured by Medicare and Medicaid undergo lower rates of bariatric surgery. Surg Obes Relat Dis 15:2109–2114PubMedCrossRef

31.

Gould KM, Zeymo A, Chan KS et al (2019) Bariatric surgery among vulnerable populations: the effect of the affordable care act's Medicaid expansion. Surgery 166:820–828PubMedCrossRef

32.

Halloran K, Padwal RS, Johnson-Stoklossa C et al (2011) Income status and approval for bariatric surgery in a publicly funded regional obesity program. Obes Surg 21:373–378PubMedCrossRef

33.

Gullick AA, Graham LA, Richman J et al (2015) Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y gastric bypass. Obes Surg 25:705–711PubMedCrossRef

34.

Admiraal WM, Celik F, Gerdes VE et al (2012) Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care 35:1951–1958PubMedPubMedCentralCrossRef

35.

Kitamura R, Chen R, Trickey A et al (2020) Positive and negative independent predictive factors of weight loss after bariatric surgery in a veteran population. Obes Surg 3:1–7

36.

Turner M, Vigneswaran Y, Dewey E et al (2019) Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass. Surg Obes Relat Dis 15:1943–1948PubMedCrossRef

37.

King RA, Patel KC, Mark VM et al (2019) Role of ethnicity on weight loss and attrition after bariatric surgery. Obes Surg 29:3577–3580PubMedCrossRef

38.

Jambhekar A, Maselli A, Robinson S et al (2018) Demographics and socioeconomic status as predictors of weight loss after laparoscopic sleeve gastrectomy: a prospective cohort study. Int J Surg 54:163–169PubMedCrossRef

39.

Wood MH, Carlin AM, Ghaferi AA et al (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154:e190029PubMedPubMedCentralCrossRef

40.

Ofori A, Keeton J, Booker Q et al (2020) Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study. Surg Obes Relat Dis 16:786–795PubMedPubMedCentralCrossRef

41.

Kim KH, Bursac Z, DiLillo V et al (2009) Stress, race, and body weight. Health Psychol 28:131–135PubMedPubMedCentralCrossRef

42.

Weinsier RL, Hunter GR, Zuckerman PA et al (2000) Energy expenditure and free-living physical activity in black and white women: comparison before and after weight loss. Am J Clin Nutr 71:1138–1146PubMedCrossRef

43.

Carden A, Blum K, Arbaugh CJ et al (2019) Low socioeconomic status is associated with lower weight-loss outcomes 10-years after Roux-en-Y gastric bypass. Surg Endosc 33:454–459PubMedCrossRef

44.

Erdogdu UE, Cayci HM, Tardu A et al (2019) Health literacy and weight loss after bariatric surgery. Obes Surg 29:3948–3953PubMedCrossRef

45.

Marín-León L, Oliveira HB, Barros MB et al (2007) Social inequality and common mental disorders. Braz J Psychiatry 29:250–253PubMedCrossRef

46.

Kurspahić Mujčić A, Mujčić A (2019) The relationship between education and self-reported mental and physical health. Med Glas (Zenica) 16:102–107

47.

Small L, Aplasca A (2016) Child obesity and mental health: a complex interaction. Child Adolesc Psychiatr Clin N Am 25:269–282PubMedCrossRef

48.

Testa G, Granero R, Siragusa C et al (2019) Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity. Eat Weight Disord. https://doi.org/10.1007/s40519-019-00800-xCrossRefPubMed

49.

Pinto-Bastos A, de Lourdes M, Brandão I et al (2019) Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study. Surg Obes Relat Dis 15:1104–1112PubMedCrossRef

50.

Pinto-Bastos A, Conceição EM, Machado PPP (2017) Reoperative bariatric surgery: a systematic review of the reasons for surgery, medical and weight loss outcomes, relevant behavioral factors. Obes Surg 27:2707–2715PubMedCrossRef

51.

Freese KE, Althouse AD, Ramanathan R et al (2017) Presurgery weight loss goals, depressive symptoms, and weight loss among women undergoing bariatric surgery. Bariatr Surg Pract Patient Care 12:67–71PubMedPubMedCentralCrossRef

52.

Ahmed B, King WC, Gourash W et al (2018) Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study. Surgery 164:774–783PubMedCrossRef

53.

Semega J et al (2019) Income and poverty in the United States: 2018. http://www.census.gov/library/publications/2019/demo/p60-266.html

54.

Manning S, Pucci A, Carter NC et al (2015) Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 29:1484–1491PubMedCrossRef

55.

Maciejewski ML, Arterburn DE, Van Scoyoc L et al (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055PubMedPubMedCentralCrossRef

56.

Chu L, Howell B, Steinberg A et al (2019) Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24 months. Pediatr Obes 14:e12519PubMedCrossRef

57.

Ma Y, Pagoto SL, Olendzki BC et al (2006) Predictors of weight status following laparoscopic gastric bypass. Obes Surg 16:1227–1231PubMedCrossRef

58.

Toussi R, Fujioka K, Coleman KJ (2009) Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity (Silver Spring) 17:996–1002CrossRef

59.

Vidal P, Ramón JM, Goday A et al (2014) Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg 24:179–183PubMedCrossRef

Titel: Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery
verfasst von: J. C. Chen
Anahita Jalilvand
Vivian Wang
Jennwood Chen
Anand Gupta
Robert Tamer
Kayla Diaz
Muna Tamimi
Bradley Needleman
Sabrena Noria
Publikationsdatum: 13.10.2020
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 10/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08066-6

Neu im Fachgebiet Chirurgie

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Recycling im OP – möglich, aber teuer

05.05.2024 DCK 2024 Kongressbericht

Auch wenn sich Krankenhäuser nachhaltig und grün geben – sie tragen aktuell erheblich zu den CO₂-Emissionen bei und produzieren jede Menge Müll. Ein Pilotprojekt aus Bonn zeigt, dass viele Op.-Abfälle wiederverwertet werden können.

Im OP der Zukunft läuft nichts mehr ohne Kollege Roboter

04.05.2024 DCK 2024 Kongressbericht

Der OP in der Zukunft wird mit weniger Personal auskommen – nicht, weil die Technik das medizinische Fachpersonal verdrängt, sondern weil der Personalmangel es nötig macht.

Nur selten Nachblutungen nach Abszesstonsillektomie

03.05.2024 Tonsillektomie Nachrichten

In einer Metaanalyse von 18 Studien war die Rate von Nachblutungen nach einer Abszesstonsillektomie mit weniger als 7% recht niedrig. Nur rund 2% der Behandelten mussten nachoperiert werden. Die Therapie scheint damit recht sicher zu sein.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery