Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals

• Published in: Surgery for obesity and related diseases Vol. 12; no. 1; pp. 49 - 56
• Main Authors: Pelascini, Elise, M.D, Disse, Emmanuel, M.D., Ph.D, Pasquer, Arnaud, M.D, Poncet, Gilles, M.D., Ph.D, Gouillat, Christian, M.D., Ph.D, Robert, Maud, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016; Elsevier
• Subjects: Adult; Blood Glucose - metabolism; Body Mass Index; Female; Follow-Up Studies; France - epidemiology; Gastric bypass; Gastric Bypass - adverse effects; Gastroenterology and Hepatology; Humans; Incidence; Insulin Resistance; Laparoscopy; Life Sciences; Male; Metabolic Diseases - blood; Metabolic Diseases - epidemiology; Metabolic Diseases - etiology; Metabolic disorders; Metabolically healthy; Middle Aged; Morbid obesity; Obesity phenotype; Obesity, Morbid - complications; Obesity, Morbid - physiopathology; Obesity, Morbid - surgery; Postoperative Complications - blood; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Period; Retrospective Studies; Surgery; Time Factors; Weight loss; Weight Loss - physiology; Metabolically healthy; Morbid obesity; Obesity phenotype; Metabolic disorders; Gastric bypass; Weight loss
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2015.04.024

Abstract Background A subgroup of obese patients without metabolic disorders has been identified and defined as metabolically healthy but morbidly obese (MHMO). Objectives To compare Roux-en-Y gastric bypass (RYGB) outcomes between MHMO and metabolically unhealthy morbidly obese (MUMO) patients to assess whether the obesity phenotype could affect the results. Setting A university-affiliated tertiary care center. Methods One hundred nineteen consecutive patients underwent RYGB; 102 completed the 2-year follow-up and were divided into 2 groups (MHMO and MUMO) according to Wildman criteria, including blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting blood sugar, C-reactive protein (CRP), and homeostasis model assessment of insulin resistance (HOMA-IR). Weight loss and metabolic parameter changes were analyzed. Results Twenty-one of 102 (20.6%) patients were identified as MHMO; they were mostly women (90.5%) and were significantly younger than MUMO patients (39.4±9.1 yr versus 47.2±10, P = .001); 12.6% were lost to follow-up. MHMO phenotype was significantly associated with a greater percentage of excess body mass index loss ( P = .03), independent of gender, age, and redo procedures. All metabolic parameters were significantly improved 2 years after surgery in the MUMO group. HOMA-IR, CRP, and triglycerides were significantly lower 2 years after surgery in the MHMO group, whereas fasting blood sugar and HDL-C were unchanged. At 2 years of follow-up, 92.3% of the population was metabolically healthy. Conclusions RYGB is an effective procedure to achieve weight loss and had a strong positive metabolic effect in both MHMO and MUMO phenotypes. RYGB led to an increase of the metabolically healthy status and may prevent or delay the onset of metabolic disorders.