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Predictors of insufficient weight loss after bariatric surgery
| Summary: | Background: Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for severe obesity and related health issues. However, many patients experience inadequate weight loss (IWL), which affects surgical success, metabolic improvement, and satisfaction. IWL definitions vary widely, from less than 50% excess weight loss (%EWL) to less than 20% total weight loss (%TWL), making it hard to compare studies and develop reliable predictive models. This study aims to systematically define IWL and identify important predictors to enhance patient counseling. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science for observational studies examining factors linked to IWL after primary MBS. Random-effects models summarized risk ratios (RRs) and mean differences (MDs). Heterogeneity was evaluated with the I² statistic and Cochran's Q test. Results: The analysis included 65 studies with 26,804 patients. IWL prevalence was 27% (95% CI: 23-33%) when using %EWL<50 and 20% (95% CI: 12-32%) with %TWL<20. Despite differences, several preoperative factors-such as type 2 diabetes, hypertension, and baseline BMI-were consistently associated with IWL across both definitions. Psychiatric disorders were linked to IWL only in models based on %TWL. Intraoperatively, Roux-en-Y gastric bypass (RYGB) reduced IWL risk in %TWL studies (RR=0.71), but not in %EWL studies. Postoperatively, higher nadir BMI was strongly associated with IWL (MD=7.94; 95% CI [6.16, 9.72]). Conclusion: Variations in IWL definitions significantly impact prevalence estimates and predictor identification. While some preoperative factors are consistent, how BMI and psychiatric comorbidities influence IWL varies by definition. RYGB appears protective in %TWL cases. Nadir BMI is a reliable postoperative indicator. Standardizing IWL criteria is crucial to improve predictions and surgical outcomes. |
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| Subject: | Medicina clínica Clinical medicine |
| Country: | Portugal |
| Document type: | master thesis |
| Access type: | Open |
| Associated institution: | Repositório Aberto da Universidade do Porto |
| Language: | Portuguese |
| Origin: | Repositório Aberto da Universidade do Porto |
| Summary: | Background: Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for severe obesity and related health issues. However, many patients experience inadequate weight loss (IWL), which affects surgical success, metabolic improvement, and satisfaction. IWL definitions vary widely, from less than 50% excess weight loss (%EWL) to less than 20% total weight loss (%TWL), making it hard to compare studies and develop reliable predictive models. This study aims to systematically define IWL and identify important predictors to enhance patient counseling. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science for observational studies examining factors linked to IWL after primary MBS. Random-effects models summarized risk ratios (RRs) and mean differences (MDs). Heterogeneity was evaluated with the I² statistic and Cochran's Q test. Results: The analysis included 65 studies with 26,804 patients. IWL prevalence was 27% (95% CI: 23-33%) when using %EWL<50 and 20% (95% CI: 12-32%) with %TWL<20. Despite differences, several preoperative factors-such as type 2 diabetes, hypertension, and baseline BMI-were consistently associated with IWL across both definitions. Psychiatric disorders were linked to IWL only in models based on %TWL. Intraoperatively, Roux-en-Y gastric bypass (RYGB) reduced IWL risk in %TWL studies (RR=0.71), but not in %EWL studies. Postoperatively, higher nadir BMI was strongly associated with IWL (MD=7.94; 95% CI [6.16, 9.72]). Conclusion: Variations in IWL definitions significantly impact prevalence estimates and predictor identification. While some preoperative factors are consistent, how BMI and psychiatric comorbidities influence IWL varies by definition. RYGB appears protective in %TWL cases. Nadir BMI is a reliable postoperative indicator. Standardizing IWL criteria is crucial to improve predictions and surgical outcomes. |
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