|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 2020 Jul 15];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|
Click here to view
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|
Click here to view
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.
| References|| |
Vats MG, Mahboub BH, Al Hariri H, Al Zaabi A, Vats D. Obesity and sleep-related breathing disorders in Middle East and UAE. Can Respir J 2016;2016:9673054.
El-Hazmi MA, Warsy AS. Prevalence of obesity in the Saudi population. Ann Saudi Med 1997;17:302-6.
Mofti AB, Al-Saleh MS. Bariatric surgery in Saudi Arabia. Ann Saudi Med 1992;12:440-5.
To VT, Hüttl TP, Lang R, Piotrowski K, Parhofer KG. Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery. Exp Clin Endocrinol Diabetes 2012;120:547-52.
Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al.
Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): A prospective follow-up analysis. Lancet Diabetes Endocrinol 2017;5:165-73.
Gill RS, Majumdar SR, Rueda-Clausen CF, Apte S, Birch DW, Karmali S, et al.
Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: Prospective cohort study. Can J Surg 2016;59:233-41.
Tang Q, Sun Z, Zhang N, Xu G, Song P, Xu L, et al.
Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus: A Randomized controlled trial in China. Medicine (Baltimore) 2016;95:e3522.
Tess BH, Scabim VM, Santo MA, Pereira JC. Obese patients lose weight independently of nutritional follow-up after bariatric surgery. Rev Assoc Med Bras (1992) 2015;61:139-43.
Al-Akwaa AM. Prevalence of helicobacter pylori
infection in a group of morbidly obese Saudi patients undergoing bariatric surgery: A preliminary report. Saudi J Gastroenterol 2010;16:264-7.
] [Full text]
Ahmed A, AlBuraikan D, ALMuqbil B, AlJohi W, Alanazi W, AlRasheed B, et al.
Readmissions and emergency department visits after bariatric surgery at Saudi Arabian hospital: The rates, reasons, and risk factors. Obes Facts 2017;10:432-43.
Al Kadi A, Siddiqui ZR, Malik AM, Al Naami M. Comparison of the efficacy of standard bariatric surgical procedures on Saudi population using the bariatric analysis and reporting outcome system. Saudi Med J 2017;38:251-6.
Al-Shurafa H, Elzaafarany AH, Albenmousa A, Balata MG. Primary experience of bariatric surgery in a newly established private obesity center. Saudi Med J 2016;37:1089-95.
Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg 2012;256:266-73.
Gutierrez-Blanco D, Funes-Romero D, Madiraju S, Perez-Quirante F, Menzo EL, Szomstein S, Rosenthal RJ. Reduction of framingham BMI score after rapid weight loss in severely obese subjects undergoing sleeve gastrectomy: a single institution experience.. Surg Endosc 2018;32:1248-54.
Murphy R, Tsai P, Jüllig M, Liu A, Plank L, Booth M, et al.
Differential changes in gut microbiota after gastric bypass and sleeve gastrectomy bariatric surgery vary according to diabetes remission. Obes Surg 2017;27:917-25.
Agüera Z, García-Ruiz-de-Gordejuela A, Vilarrasa N, Sanchez I, Baño M, Camacho L, et al.
Psychological and personality predictors of weight loss and comorbid metabolic changes after bariatric surgery. Eur Eat Disord Rev 2015;23:509-16.
Ortega E, Morínigo R, Flores L, Moize V, Rios M, Lacy AM, et al.
Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery. Surg Endosc 2012;26:1744-50.
Ochner CN, Teixeira J, Geary N, Asarian L. Greater short-term weight loss in women 20-45 versus 55-65 years of age following bariatric surgery. Obes Surg 2013;23:1650-4.
de Jong MM, Hinnen C. Bariatric surgery in young adults: A multicenter study into weight loss, dietary adherence, and quality of life. Surg Obes Relat Dis 2017;13:1204-10.
Ahmed AE. How does age affect complications following bariatric surgery.
Santiago A, Carpio C, Caballero P, Martín-Duce A, Vesperinas G, Gómez de Terreros F, et al.
Effects of weight loss after bariatric surgery on pulmonary function tests and obstructive sleep apnea in morbidly obese women. Nutr Hosp 2015;32:1050-5.
Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al.
Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A Systematic review and comparison of meta-analyses. Obes Surg 2015;25:1239-50.
Garza CA, Pellikka PA, Somers VK, Sarr MG, Collazo-Clavell ML, Korenfeld Y, et al.
Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol 2010;105:550-6.
de Raaff CA, Coblijn UK, de Vries N, Heymans MW, van den Berg BT, van Tets WF, et al.
Predictive factors for insufficient weight loss after bariatric surgery: Does obstructive sleep apnea influence weight loss? Obes Surg 2016;26:1048-56.
Tymitz K, Kerlakian G, Engel A, Bollmer C. Gender differences in early outcomes following hand-assisted laparoscopic roux-en-Y gastric bypass surgery: Gender differences in bariatric surgery. Obes Surg 2007;17:1588-91.
Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: A meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 2017;31:4331-45.
Lee JH, Nguyen QN, Le QA. Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy. Surg Obes Relat Dis 2016;12:997-1002.
Pekkarinen T, Mustonen H, Sane T, Jaser N, Juuti A, Leivonen M, et al.
Long-term effect of gastric bypass and sleeve gastrectomy on severe obesity: Do preoperative weight loss and binge eating behavior predict the outcome of bariatric surgery? Obes Surg 2016;26:2161-7.
Musella M, Apers J, Rheinwalt K, Ribeiro R, Manno E, Greco F, et al.
Efficacy of bariatric surgery in type 2 diabetes mellitus remission: The role of mini gastric bypass/One anastomosis gastric bypass and sleeve gastrectomy at 1 year of follow-up. A European survey. Obes Surg 2016;26:933-40.
Maffazioli GD, Stanford FC, Campoverde Reyes KJ, Stanley TL, Singhal V, Corey KE, et al.
Comparing outcomes of two types of bariatric surgery in an adolescent obese population: Roux-en-Y gastric bypass vs. Sleeve gastrectomy. Front Pediatr 2016;4:78.
de Barros F, Setúbal S, Martinho JM, Monteiro AB. Early endocrine and metabolic changes after bariatric surgery in grade III morbidly obese patients: A Randomized clinical trial comparing sleeve gastrectomy and gastric bypass. Metab Syndr Relat Disord 2015;13:264-71.
Huang CK, Garg A, Kuao HC, Chang PC, Hsin MC. Bariatric surgery in old age: A comparative study of laparoscopic roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence. J Biomed Res 2015;29:118-24.
[Table 1], [Table 2], [Table 3]