Elsevier

Surgery for Obesity and Related Diseases

Volume 5, Issue 5, September–October 2009, Pages 582-587
Surgery for Obesity and Related Diseases

Original article
Comparison of weight loss and body composition changes with four surgical procedures

https://doi.org/10.1016/j.soard.2009.04.001Get rights and content

Abstract

Background

A paucity of information is available on the comparative body composition changes after bariatric procedures. The present study reports on the body mass index (BMI) and body composition changes after 4 procedures by a single group.

Methods

At the initial consultation, the weight and body composition of the patients undergoing 4 different bariatric procedures were measured by bioimpedance (Tanita 310). Follow-up examinations were performed at 1 year and at subsequent visits after surgery. Analysis of variance was used to compare the postprocedure BMI and body composition. Analysis of covariance was used to adjust for baseline differences.

Results

A total of 101 gastric bypass (GB) patients were evaluated at 19.1 ± 10.6 months, 49 biliopancreatic diversion with the duodenal switch (BPD/DS) patients at 27.5 ± 16.3 months, 41 adjustable gastric band (AGB) patients at 21.4 ± 9.2 months, and 30 sleeve gastrectomy (SG) patients at 16.7 ± 5.6 months (P <.0001). No differences were found in patient age or gender among the 4 groups. The mean preoperative BMI was significantly different among the 4 groups (P <.0001): 61.4 kg/m2, 53.2, 46.7, and 44.3 kg/m2 for the SG, BPD/DS, GB, and AGB group, respectively. The postoperative BMI adjusted for baseline differences was 27.8 (difference 23.6 ± 8.3), 32.5 (difference 15.6 ± 5.0), 37.2 (difference 18.2 ± 8.2), and 39.5 kg/m2 (difference 7.5 ± 4.3) for the BPD/DS, GB, SG, and AGB groups, respectively (P <.0001). The percentage of excess weight loss was 84%, 70%, 49%, and 38% for the BPD/DS, GB, SG, and AGB groups, respectively (P <.0001). The postoperative percentage of body fat adjusted for baseline differences was 25.7% (23.9% ± 7.0%) 32.7% (16.1% ± 10.5%) 37.7% (16.7% ± 5.6%), and 42% (6.0% ± 6.8%) for the BPD/DS, GB, SG, and AGB groups, respectively (P <.0001). The lean body mass changes were reciprocal.

Conclusion

Although the BPD/DS procedure reduced the BMI the most effectively and promoted fat loss, all the procedures produced weight loss. The AGB procedure resulted in less body fat loss within 21.5 months than SG within 16.7 months. Longer term observation is indicated.

Section snippets

Methods

At their initial surgical consultation requesting weight loss surgery, all patients who qualified according to National Institutes of Health guidelines [4] were asked to review and sign an informed consent form describing the research protocol, which had institutional review board approval. The patients were weighed and measured, and underwent body composition analysis by the bioimpedance method using the Tanita 310 (Tanita Corporation of America, Arlington Heights, IL). This bioimpedance

Results

After surgery, 101, 49, 41, and 30 patients who had undergone GB, BPD/DS, AGB, and SG were evaluated at 19.1 ± 10.6, 27.5 ± 16.3, 21.4 ± 9.2, and 16.7 ± 5.6 months, respectively (P <.0001 by analysis of variance). No statistically significant differences were found among the 4 groups in age or gender (Table 1). The preoperative mean BMI was significantly different (P <.0001) at 61.4, 53.2, 46.7, and 44.3 kg/m2 for the SG, BPD/DS, GB, and AGB group, respectively (Fig. 1). For comparison in Fig. 1

Discussion

Because surgical procedures are continually evolving, the process of evaluating efficacy is an ongoing process. In 2004, when Buchwald et al. [2] published their meta-analysis, they combined laparoscopic and open procedures. Because the benefits of laparoscopic procedures have been defined and surgical competence has been developed to routinely use laparoscopic techniques, the focus of the present analysis was restricted to laparoscopic procedures performed as the first bariatric surgery. The

Conclusion

After 4 surgical procedures, the patients, who had no differences in age or gender distribution, demonstrated significant differences in BMI change and percentage of fat loss with lean body mass retention. Adjusting for baseline differences in the surgical groups did not change the statistical significance. For all patients, a high correlation was found for BMI change and fat loss. Larger patients who underwent SG and BPD/DS had greater changes in BMI, which did not have a high correlation with

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

The authors wish to acknowledge the support of the Tanita Healthy Weight Community Trust as a grant-in-aid providing for the completion of the data collection, statistical consultations involved in the analysis of the data, and the preparation of this report.

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