Diabetes, Large Stomach Pouch Identified as Factors for Poor Weight Loss After Gastric Bypass Surgery

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Title: Diabetes, Large Stomach Pouch Identified as Factors for Poor Weight Loss After Gastric Bypass Surgery
URL: http://www.pslgroup.com/dg/22C5FA.htm
Doctor's Guide
September 15, 2008

CHICAGO -- September 15, 2008 -- Individuals with diabetes and those whose stomach pouches are larger appear less likely to successfully lose weight after gastric bypass surgery, according to a study in the September issue of Archives of Surgery.

"When performed in high-volume centres and with a low rate of complications, gastric bypass provides sustained and meaningful weight loss, significant improvement in quality of life, improvement or resolution of obesity-associated comorbidities and extended life span," the authors wrote.

"However, 5% to 15% of patients do not lose weight successfully, despite perceived precise surgical technique and regular follow-up."

Guilherme M. Campos, MD, University of California San Francisco, San Francisco, California, and colleagues examined data from 361 patients who underwent gastric bypass at 1 institution between 2003 and 2006. Poor weight loss was defined as losing 40% or less of excess body weight after 12 months, and good weight loss as losing more than 40% of excess weight.

Follow-up (12 months) data was available for 310 of the patients, who had an average body mass index (BMI) of 52 before surgery. At follow-up, they had an average BMI of 34 and had lost an average of 60% of their excess body weight.

A total of 38 patients (12.3%) had poor weight loss. After adjusting for other related factors, diabetes and having a larger size of the stomach pouch after gastric bypass surgery were independently associated with poor weight loss.

Individuals with diabetes may take insulin or other drugs that stimulate the production of fat and cholesterol, the authors note. "Other factors that may lead to weight gain in patients with diabetes include a 'protective' increase in caloric intake to treat episodes of hypoglycaemia, reduction of urinary glucose losses, and sodium and water retention that are a direct effect of insulin on the distal tubule in the kidney," the authors wrote.

The restriction on dietary intake imposed by a small stomach pouch is one of the most important aspects of gastric bypass surgery, they note. Surveys suggest that many surgeons estimate pouch size using anatomical landmarks rather than using a sizing balloon.

"As the use of gastric bypass continues to grow, we believe it is critical to stress the importance of and to teach the creation of the small gastric pouch and to better standardise the technique used for pouch creation," the authors wrote.

"We conclude that gastric bypass provides good or excellent weight loss for most patients. However, diabetes mellitus and larger pouch size are independently associated with poor weight loss after gastric bypass. Changes in the use of diabetes medications may reduce the risk of poor weight loss among diabetics undergoing gastric bypass. Detailed attention to the creation of a small gastric pouch is essential for achieving the best results."

SOURCE: Archives of Surgery

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