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Erschienen in: Obesity Surgery 6/2011

01.06.2011 | Clinical Research

Relative Outcome Measures for Bariatric Surgery. Evidence Against Excess Weight Loss and Excess Body Mass Index Loss from a Series of Laparoscopic Roux-en-Y Gastric Bypass Patients

verfasst von: Arnold van de Laar, Laura de Caluwé, Bruno Dillemans

Erschienen in: Obesity Surgery | Ausgabe 6/2011

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Abstract

Background

Bariatric results expressed in the relative measure excess weight loss (%EWL) vary significantly by initial body mass index (BMI): the heavier the patient, the lower the %EWL. We examine if this variation is caused by using a wrong outcome measure and argue that no relative weight loss measure can express bariatric or metabolic goals unequivocally.

Methods

Nadir weight loss results after laparoscopic gastric bypass in 168 women with initial BMI ≥35 to <60 kg/m2 are calculated for %EWL and 61 different relative measures using the formula 100% × (initial BMI − nadir BMI) / (initial BMI − a), with a ranging from −30 to +30. Standard deviations are compared mutually and with those reported in the literature. For each relative measure, the significance of any variation by initial BMI is determined with the Mann–Whitney U test.

Results

Mean initial BMI was 44.9 ± 6.7 (35.0–59.7) kg/m2. Mean nadir BMI was 28.8 ± 5.8 (18.5–44.4) kg/m2. Mean nadir excess BMI loss (%EBL; a = 25) was 87.0 ± 28.0 (19.4–155.1)%. Mean nadir (total) weight loss (%TWL; a = 0) was 35.9 ± 8.5 (9.5–57.1)%. Mean nadir %EWL was 77.3 ± 22.8 (17.7–135.2)%. The smallest variation coefficient was 23.7% at a ranging from −1 to +3, including %TWL (a = 0). This is lower than variation coefficients of %EWL results in our series and in the literature. Variation by initial BMI is significant using relative measures with a ≥3, including %EBL and %EWL (both p < 0.0001) and not significant with a <3, including %TWL (p = 0.13).

Conclusions

In contrast to their widespread use, %EBL and %EWL are not suited for comparing different patients or nonrandomized groups. They cause variation by initial BMI, which disappears using %TWL. In general, absolute terms should be preferred for bariatric outcome and goals. The power of bariatric procedures is best represented by their mean %TWL value.
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Metadaten
Titel
Relative Outcome Measures for Bariatric Surgery. Evidence Against Excess Weight Loss and Excess Body Mass Index Loss from a Series of Laparoscopic Roux-en-Y Gastric Bypass Patients
verfasst von
Arnold van de Laar
Laura de Caluwé
Bruno Dillemans
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 6/2011
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0347-0

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