New Study Suggests Weight-Loss Surgery Patients Do Better if They Stick to Scheduled Follow Up Visits
Diabetes, High Blood Pressure and High Cholesterol Improve or Resolve at Higher Rates
Article ID: 664189
Released: 4-Nov-2016 1:00 AM EDT
Source Newsroom: American Society for Metabolic and Bariatric Surgery (ASMBS)
Newswise — NEW ORLEANS – NOV. 4, 2016 – Weight-loss surgery patients who stick to a schedule of 3-, 6- and 12-month follow-up visits with their doctors see greater improvements or remission of their diabetes, high blood pressure and high cholesterol than patients who skip their visits, according to new research* presented today at ObesityWeek 2016, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).
In the study, researchers from the Brody School of Medicine at East Carolina University in Greenville, NC reviewed the results of 38,613 patients who had the three follow-up visits (complete follow-up) and compared them to the results of 12,468 patients who only had one or two follow-ups (incomplete follow-up). Patient data was obtained from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2012.
After one year, 62.3 percent of patients with complete follow-up saw their type 2 diabetes go into remission, while those who missed a visit or two had a remission rate of 57.5 percent. The rate of improvement in diabetes was also better for those who made all three visits (74.6% vs. 68.9%). The differences between the two groups also held for high blood pressure and lipid abnormalities including high cholesterol.
“This study shows there is great value in seeing patients at routine intervals after surgery in terms of health outcomes,” said Andrea Schwoerer, MD, a study co-author, currently at Carolinas Medical Center. “Unfortunately, many patients, reportedly as many as 50 percent, are lost to follow-up and therefore may not benefit as much as they can from weight-loss surgery, no matter how well it was performed.”
Hypertension improved in 63.2 percent of the patients in the complete follow-up group and 58.1 percent in the incomplete follow-up group. The difference in resolution rates in the groups was less, but still statistically significant (46.1% vs. 42%). The trend also held for lipid abnormalities, with these improving for 55 percent of patients completing follow up versus 51.1 percent for those who did not. Remission rates were,42.8% vs. 41.1% respectively, a small, but still statistically significant difference.
“We cannot stress enough the importance of follow-up visits and post-operative care,” said Stacy Brethauer, MD President-elect, ASMBS and bariatric surgeon at the Cleveland Clinic in Ohio, who was not involved in the study. “It could mean the difference between a good and a great result. The most committed patients do best, and we need to find ways to keep all patients engaged for the long-term.”
People with obesity and severe obesity have higher rates of heart disease, diabetes, some cancers, arthritis, sleep apnea, high blood pressure and dozens of other diseases and conditions. Studies have shown individuals with a BMI greater than 30 have a 50 to 100 percent greater risk of premature death compared to healthy weight individuals. ,
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent.
According to the Centers for Disease Control and Prevention (CDC), in 2011–2014, the prevalence of obesity was just over 36 percent in adults, with a higher prevalence among women than men (38.3% vs. 34.3%) and older than younger adults (37% vs. 32.3%). Obese is medically defined as having a body mass index (BMI), a measure of height to weight, that's more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information, visit www.asmbs.org.
*The effect of close postoperative follow-up on comorbidity improvement after bariatric surgery
Andrea SchwoererCharlotte NC1, Kevin Kasten Charlotte NC1, Adam Celio Greenville NC1, Walter Pories Greenville NC1, Konstantinos Spaniolas Stony Brook NY1 Department of Surgery, Carolinas Medical Center; Department of Surgery, Stony Brook Medicine; Department of Surgery, Brody School of Medicine at East Carolina University1
 Office of the Surgeon General – U.S. Department of Health and Human Services. (2004). Overweight and obesity: health consequences. Accessed October 2013 from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html
 Kaplan, L. M. (2003). Body weight regulation and obesity. Journal of Gastrointestinal Surgery. 7(4) pp. 443-51. Doi:10.1016/S1091-255X(03)00047-7.
 Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997
 Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp
 Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445