Endocrine Abstracts (2018) 53 CD2.2 | DOI: 10.1530/endoabs.53.CD2.2

Poor responsiveness after bariatric surgery: clinical and eating behaviour characteristics

Belen Pérez-Pevida1, Madhawi Aldhwayanand1, Rachel Gibson1, Samantha Scholtz1, Alexander D Miras1, Emma McGlone1, Anna Kamocka1, Omar Khan2, Veronica Greener3, Barbara McGowan4, Francesco Rubino5, Steve Bloom1 & Tricia Tan1

1Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK; 2St George’s University Hospitals NHS Foundation Trust, London, UK; 3Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 4Guy’s and StThomas’ NHS Foundation Trust, London, UK; 5King’s College London and King’s College Hospital, London, UK.

Background: Bariatric surgery has been proven to produce substantial weight loss and amelioration of metabolic syndrome-associated co-morbidities. However, at five-year follow-up, only 20–40% of patients maintain diabetes remission and 40% of patients return to their baseline weight. The limiting factor in treating refractory diabetes following obesity surgery is the lack of knowledge about its aetiology.

Aims: Evaluate the eating pattern and clinical characteristics of poor responders after bariatric surgery enrolled in the Gravitas Trial (The GLP1 Receptor Agonist interVentIon for poor responders afTer bariAtric Surgery. EudraCT Number 2014-003923-23).

Methods: Cohort study of 52 patients defined as poor responders after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) surgery. Poor response was defined as failure to achieve diabetes remission (HbA1c >48 mmol/l). The DEBQ was used to assess the presence of restrained, emotional and external eating behaviour.

Results: All data is presented as mean±S.D. 52 patients, 35 (67%) were women, aged 52.4±9.7 year. 7 VSG and 44 RYGB. HbA1c was 57±9 mmol/mol and HOMA-IR: 4.6±5.0. BMI was 36.1±7.0 kg/m2. Patients were followed up for 4.9±2.5 year. There was a weight loss of 32.2±18.9% and weight regain from the lowest weight after surgery of 10.0±7.9 kg. Significant positive correlation between weight regain and time post-surgery (r=0.33; P=0.018). Diabetes duration was 17.2±7.4 years with a post-surgical reduction of HbA1c of −20±17 mmol/mol. There was no change in number of oral glucose-lowering agents pre vs. post surgery. However, the proportion of patients on insulin pre vs. post was reduced (65% vs. 30%). Significant correlation between %weight loss and HbA1c change (r=0.524; P=0.021). No significant difference in weight regain was seen between VSG vs RYGB. With regards to eating behaviour, significant correlation was found between weight regain and emotional eating (r=0.43; P=0.005). Gender difference in restraint were seen (men had significantly less self-control towards food than women, P=0.033).

Conclusions: A correlation between emotional eating and weight regain after bariatric surgery was observed. A prospective study is needed to confirm this link.