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Pre-operative predictors of weight loss at 1-year after Lap-Band surgery
J B Dixon1, M E Dixon, P E O'Brien
1Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia. john.dixon@med.monash.edu.au
Insights
Preoperative factors like age, BMI, and insulin resistance predict Lap-Band effectiveness. While some factors correlate with less weight loss, none contraindicate surgery, allowing for realistic goal setting.
Area of Science:
- Bariatric Surgery
- Obesity Medicine
- Metabolic Health
Background:
- The effectiveness of Lap-Band surgery is influenced by various preoperative patient factors.
- Understanding these factors is crucial for predicting weight loss outcomes.
- The study aimed to identify preoperative predictors of success for Lap-Band placement.
Purpose of the Study:
- To evaluate the predictive value of preoperative factors on the effectiveness of Lap-Band surgery.
- To determine the percentage of excess weight loss at one year (%EWL1) as the primary outcome measure.
- To identify patient characteristics associated with varying degrees of weight loss post-surgery.
Main Methods:
- A cohort of 440 patients undergoing Lap-Band placement was studied.
- Preoperative data collected included demographics, medical and weight history, laboratory measures, and SF-36 Health Survey responses.
- Factors were analyzed for correlation with %EWL1, controlling for age and BMI.
Main Results:
- Increasing age and preoperative BMI were significantly associated with lower %EWL1.
- Hyperinsulinemia, insulin resistance, physical limitations, pain, and poorer SF-36 scores correlated with reduced weight loss.
- Regular alcohol consumption was associated with a higher rate of weight loss.
Conclusions:
- Key physical factors influencing Lap-Band effectiveness include age, pain, physical disability, and insulin resistance.
- Despite identifying factors associated with less weight loss, no factor was found to be an absolute contraindication for Lap-Band placement.
- Findings enable setting more realistic weight loss expectations for specific patient subgroups.
Background:
The authors studied a range of preoperative factors for their predictive value of effectiveness of Lap-Band placement, using the percentage of excess weight loss at 1-year as the outcome measure (%EWL1).
Methods:
All factors were measured and recorded prior to surgery. Factors included: patient demographics, family, medical and weight history. Laboratory measures and the responses to the SF-36 Health Survey were also assessed. Factors were assessed for correlation with %EWL1.
Results:
The group (N=440, F:M 383:57) had mean age 40.0+/-9.5 years, weight of 126+/-25 kg, and BMI 45.6+/-7.5 kg/m2 pre-operatively. At 1-year follow-up, the group had mean weight 97.6< or =20 kg, BMI 35.6 = 6.3 kg/m2, and %EWL1 45.8< or =17%. Increasing age (R= -0.13, p<0.01) and preoperative BMI (R=-0.22, p<0.001) were significantly associated with less %EWL1 and all other factors were controlled for these before assessing significance. Important factors associated with a lower %EWL1 included: hyperinsulinemia (R=-0.36, p<0.001), insulin resistance (R=-0.33, p<0.001) and disease associated with insulin resistance, poor physical ability, pain, and poor general health responses to the SF-36 Health Survey. Patients who consumed alcohol regularly had a better rate of weight loss (R= 0.23, p<0.005). Factors that had no influence included gender, a history of mental illness and measures of mental health, previous bariatric surgery, and a history of many medical conditions associated with obesity.
Conclusion:
Important physical factors have been found to influence the rate of weight loss. Those with increased age, pain, physical disability and insulin resistance have a great deal to gain from weight loss. Although this study has identified factors that are associated with less weight loss, we have not found any factor that predicts an unacceptably low weight loss and thus provides a contraindication to Lap-Band placement. The findings of this study allow us to set more realistic goals for the rate of weight loss in specified sub-groups of our patients.