|Year : 2018 | Volume
| Issue : 4 | Page : 136-140
Assessing postsurgery body mass index reduction and identifying factors associated with greater body mass index reduction in a sample of obese patients who underwent weight-loss surgery in Saudi Arabia
Anwar E Ahmed1, Wala R Alanazi2, Rayan A Ahmed3, Wijdan AlJohi4, Doaa A Al Buraikan4, Budor A Al Rasheed4, Bashayr I Al Muqbil4, Amen A Bawazir5, Ali M Al Shehri5, Hamdan Al-Jahdali6
1 King Abdullah International Medical Research Center; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
3 Dar Al Uloom University, Riyadh, Saudi Arabia
4 King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
5 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
6 King Saud Bin Abdulaziz University for Health Sciences; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
|Date of Web Publication||13-Dec-2018|
Dr. Anwar E Ahmed
King Abdullah International Medical Research Center, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Although evidence exists that bariatric surgery can provide substantial weight loss and body mass index (BMI) reduction. However, there is a limited data about this topic among the Saudi population. The purpose of this study was to assess postsurgery BMI and identify factors associated with greater BMI reduction.
Methods: A retrospective study was conducted of 318 obese patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in the period between January 1, 2001 and March 31, 2017. The outcome assessed was a reduction in BMI within 12 months after surgery, and a reduction of ≥20, indicating a greater BMI loss.
Results: Patients with BMI value >40 had markedly decreased from 81.5% at the baseline to 25.6% at 12 months. Greater BMI loss occurred in 12.03% of the patients. Mixed-model and Tukey multiple comparison tests show a great decrease in BMI over time, but no significant differences in BMI between surgery types: LSG and RYGB. According to bivariate logistic analysis, greater BMI reduction was noted in the male gender (odds ratio [OR] = 2.493, P = 0.017) and patients with obstructive sleep apnea (OSA) (OR = 3.130, P = 0.029). A multivariate logistic analysis showed that young age (adjusted OR = 3.755, P = 0.028) and OSA (adjusted OR = 5.034, P = 0.023) were associated with a greater BMI reduction at 12-month postsurgery.
Conclusions: The study has shown that bariatric surgery led to a significant reduction in BMI, which may result in resolving a number of obesity-related comorbidities. Being young and OSA were associated with significant reduction. The procedure types, RYGB and LSG, yielded similar reduction in BMI. It is important to evaluate baseline data as it may influence BMI reduction and aid management.
Keywords: Bariatric surgery, body mass index reduction, obesity, obstructive sleep apnea, young age
|How to cite this article:|
Ahmed AE, Alanazi WR, Ahmed RA, AlJohi W, Al Buraikan DA, Al Rasheed BA, Al Muqbil BI, Bawazir AA, Al Shehri AM, Al-Jahdali H. Assessing postsurgery body mass index reduction and identifying factors associated with greater body mass index reduction in a sample of obese patients who underwent weight-loss surgery in Saudi Arabia. Saudi Surg J 2018;6:136-40
|How to cite this URL:|
Ahmed AE, Alanazi WR, Ahmed RA, AlJohi W, Al Buraikan DA, Al Rasheed BA, Al Muqbil BI, Bawazir AA, Al Shehri AM, Al-Jahdali H. Assessing postsurgery body mass index reduction and identifying factors associated with greater body mass index reduction in a sample of obese patients who underwent weight-loss surgery in Saudi Arabia. Saudi Surg J [serial online] 2018 [cited 2019 Mar 25];6:136-40. Available from: http://www.saudisurgj.org/text.asp?2018/6/4/136/247414
| Introduction|| |
The Middle East region's obesity issue has become the area's largest medical burden and continues to be a growing public health problem due to its impact on health and resources. The rate of obesity appears to be increasing in Saudi Arabia and to vary by age, gender, and regions. With the increased rate of obesity, bariatric surgeries are becoming the most popular and successful interventions in patients with obesity.
A significant decrease in postsurgery body mass index (BMI) has been reported in various bariatric surgery populations and cultural contexts: Germany, USA, Canada, China, and Brazil. Despite that BMI levels of Saudi patients who underwent weight-loss surgery appear to be substantially high,, there are no studies investigating the impact of baseline factors on BMI reduction after surgery. Furthermore, the effectiveness of the different types of weight-loss surgery on reducing BMI remains unaddressed in Saudi Arabia.
Recent Saudi Arabian studies assessed postsurgery weight reduction,, revealed that the surgery resulted in significant weight reduction. These studies lacked determination of postsurgery BMI reduction and its associated factors. This study examines several hypotheses: (1) bariatric surgery may lead to significant BMI reductions 12-month postsurgery, (2) a younger age group and other clinical factors may be associated with a greater reduction of BMI, and (3) The laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) may achieve similar BMI reduction.
The study aim was to assess the postsurgery BMI reduction and identify the factors associated with greater BMI reduction in a sample of obese patients who underwent weight-loss surgery in the period January 1, 2001 and March 31, 2017 at King Abdulaziz Medical City in Riyadh (KAMC-R), Saudi Arabia.
| Methods|| |
A retrospective charts review was conducted of 318 obese patients who underwent surgical weight-reduction LSG or RYGB between January 1, 2001 and March 31, 2017 at KAMC-R, Saudi Arabia. The study obtained ethical approval from the Institutional Review Board at the Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (RC17/138/R).
Data were aggregated from medical charts. The baseline (Visit 0), clinical, and surgery data included information such as gender, age, weight (kg), height (m2), diabetes (Yes/No), OSA (Yes/No), asthma (Yes/No), procedure types (LSG/RYGB), complications (Yes/No) within 12-month postsurgery (Yes/No), emergency department (ED) or hospital admission within 12-month postsurgery (Yes/No), duration of surgery in hours, and length of stay in the hospital in days.
The authors evaluated weight (kg) during 12-month postsurgery for patients who had a visit or multiple visits to the center. Specifically, weight (kg) was collected at four visits following the surgery: Visit 1, Visit 2, Visit 3, and Visit 4. The first primary end-point was changes of BMI over 12-month postsurgery. BMI value was calculated using the formula weight (kg)/height2 (m2) at the baseline (Visit 0) and postsurgery Visits 1, 2, 3, and 4. The second primary end-point was the BMI reduction at 12 months, defined as the difference between the most recent BMI reading at postsurgery visits and the baseline BMI. Greater BMI reduction was defined as a reduction of 20 kg/m2 or more.
The study data were analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Percent and frequency were used to describe categorical variables, while mean, standard deviation, and minimum and maximum were used to describe quantitative variables [Table 1].
|Table 1: Characteristics of obese patients who underwent surgical weight reduction|
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Factors associated with greater odds of BMI reduction of 20 kg/m2 or more were identified using binary logistic regression [Table 2]. Adjusted and unadjusted odds ratio (aOR, OR) with 95% confidence intervals (CI) was calculated to assess the strength of the associations.
|Table 2: Factors associated with greater body mass index reduction, a reduction of ≥20 kg/m2|
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We used repeated measures analysis to assess whether a specific BMI trend exists after surgery. Mixed-model and posthoc Tukey–Kramer multiple comparison tests were performed to assess the changes between baseline BMI and postsurgery BMI values. Furthermore, the interaction effect (procedure type × visit) was assessed, where procedure type was LSG versus RYGB and visit was pre- and postsurgery visits (0, 1, 2, 3, and 4). The significance level was set to 0.05.
| Results|| |
A total of 318 obese patients who underwent weight-reduction surgery (LSG or RYGB) were analyzed. The mean age of patients was 34.7 years (13–64) with a standard deviation of 11.7 years and a majority of 67.6% was female. Mean baseline BMI was 46.7 kg/m2 (32.7–83.1) with a standard deviation of 7.7 kg/m2, whereas the postsurgery mean BMI was 35.02 kg/m2 (15.7–57.2) with a standard deviation of 7.4 kg/m2. Of the sample, 12.03% had greater BMI reduction, a reduction of 20 kg/m2 or more during 12 months. The percent of patients with BMI value >40 had markedly decreased from 81.5% at the baseline to 25.6% within 12 months postsurgery.
Bivariate binary logistic regression model [Table 2] identified that male gender and OSA were associated with a greater BMI reduction. The greater odds of BMI reduction of ≥20 kg/m2 were found in males (OR 2.493, 95% CI 1.179–5.270) and in patients with OSA (OR 3.130, 95% CI 1.126–8.704).
A multiple binary logistic regression model [Table 2] was performed to adjust for multiple factors, young age <35 years (aOR 3.755, 95% CI 1.150–12.259) and obstructive sleep apnea (OSA) (aOR 5.034, 95% CI 1.249–20.299) and were significant independent factors associated with greater odds of BMI reduction of ≥20 kg/m2. The type of procedure did not significantly influence the odds of BMI reduction of ≥20 kg/m2. The odds of BMI reduction of ≥20 kg/m2 were similar for RYGB versus LSG (aOR 1.374, 95% CI 0.323–5.843). The effectiveness of LSG and RYGB in reducing BMI was similar (P = 0.667).
A mixed-model [Table 3] and posthoc Tukey-Kramer multiple comparison indicate a decreasing trend in 12-month postsurgery visits (Visit 1 (P = 0.001), Visit 2 (P = 0.001), Visit 3 (P = 0.001), and Visit 4 (P = 0.001) compared to the baseline (Visit 0). [Figure 1] demonstrates marked decreases over time in BMI at 12-month postsurgery. As indicated above, the surgery in general shows effectiveness in decreasing BMI, but the postsurgery BMI values were similar for RYGB and LSG with no interactions effect (procedure type × visit) (P = 0.452).
| Discussion|| |
The study reported BMI postsurgery outcomes for obese patients who underwent surgical weight reduction (LSG, or RYGB) between January 1, 2001 and March 31, 2017 at KAMC-R, Saudi Arabia. In concordance with many studies in different obese patient populations and cultural contexts,,,,, the female gender represents a majority of (67.6%) of our population.
The procedure induced a substantial BMI reduction (value >40 kg/m2) from 81.5% at the baseline to 25.6% at 12-month postsurgery. Furthermore, the mixed model shows a significant decrease in BMI postsurgery [Figure 1]. This finding is in agreement with several earlier reports with a similar follow-up time of 12-month postsurgery,, indicating that surgical weight reduction resulted in significant weight or BMI reduction in obese patients. These trends suggest that the procedure can be very effective in maintaining ideal BMI during a short follow-up after surgery (i.e., 12-month postsurgery).
In order to maximize favorable outcomes and aid BMI management after surgery, we studied factors related to a greater reduction of BMI, specifically a reduction of ≥20 kg/m2 was considered a target. Younger patients with an age of <35 years were significantly associated with greater reduction of BMI as compared to patients with an age of 35 years or more. This association is consistent with the available literature,,, where a young age was found to be an important factor to reducing weight. However, the effect of age on weight reduction was not detected in a recent study. Another study reported that the procedure might be risky for older patients. It is important, before the procedure, to carefully identify patients who could achieve successful outcomes and a reduction in BMI. The role of older age in not achieving successful outcomes requires further studies.
A significant reduction of BMI was noted in patients with OSA. The linkage of OSA and reduction of postsurgery weight has been also reported in a number of earlier reports.,, OSA is a common comorbidity in obese patients.,, it is important to assess the ultimate health benefit of BMI reduction in patients with OSA in our population.
In the subgroup analysis, male gender was a significant predictor for a greater reduction of BMI. This is in agreement with Tymitz et al., where they reported that the male group had lost significantly more weight than the female group at 6- and 12-month postsurgery. However, in our study, the difference in BMI reduction between males and females was insignificant after controlling for other potential confounders.
The surgery types used to reduce weight have not been adequately assessed in Saudi Arabia. Although a significant BMI reduction was noticed for both surgery types as compared to their baseline BMI values, postsurgery BMI values were similar for the 12-month time span for both procedures. Although some previous reports indicate that at least one procedure appears to achieve greater weight reduction than other procedures,,,,, our report agrees with several other earlier reports where no differences in weight reduction were detected.,, The differences in BMI reduction of the surgery types are still debatable and require further assessment in large prospective studies.
This study has limitations. Findings were based on a chart review and short duration of follow-up to record BMI readings postsurgery. The BMI values for each patient were reviewed retrospectively at the pre- and post-surgery visits rather than using equal time intervals such as baseline, 3, 6, and 12 months. Despite the limitations indicated above, the study assessed a set of predictors of 12-month BMI reduction. As a result, the study identified factors that could contribute to greater reduction in postsurgery BMI, as it may aid management of targeted outcomes.
| Conclusions|| |
The study has shown that bariatric surgery led to a significant reduction in BMI, which may result in resolving a number of obesity-related comorbidities. Being young and OSA were associated with significant reduction. The procedure types, RYGB and LSG, yielded a similar reduction in BMI. It is important to evaluate baseline data as it may influence BMI reduction and aid management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]