Weight reduction after gastroplasty: the predictive value of surgical, metabolic, and psychological variables

Twenty-one grossly obese patients (mean body weight 126 kg, range 93-190 kg) were treated with gastroplasty ad modum Gomez. Eighteen months after surgery the average weight loss was 30.4 kg (range 1-71 kg); about 80 per cent of this weight loss represented loss of body fat. Mean weight loss of the entire programme, including preoperative weight reduction was 34.4 kg (range 1-71 kg). Dilation of the pouch and/or channel occurred in 14 patients and was generally discovered 6-12 months after operation. The wide range in weight reduction could not be unequivocally attributed to technical-surgical factors. Although the patients with the least weight reduction had all developed channel dilation, several patients with excellent weight loss also showed dilation of the pouch and/or channel. An extensive psychological investigation performed before surgery demonstrated more signs of sensitivity and denial in the unsuccessful patients; the successful ones were more dependent and tended to live in a supportive social environment. The unsuccessful patients were younger and their estimated alcohol consumption was higher. A number of morphological and biochemical variables including body weight, fat cell size, and variables reflecting thyroid function, lipid and glucose metabolism, and adipose tissue metabolism were not related to subsequent weight loss.