Endocrine Abstracts

Introduction: Bariatric surgery continues to stand as the most effective therapeutic intervention in treating severe obesity. However, a portion of patients experiences less satisfactory outcomes, diminishing the overall beneficial impact of this intervention. Identifying predictive factors for unsatisfactory responses to bariatric surgery could represent a crucial step in evaluating candidates, enabling the establishment of personalized care.

Methods: Retrospective cohort study, including patients submitted to bariatric surgery (gastric bypass or vertical gastrectomy) between January 2016 and December 2020. Initial suboptimal clinical response/insufficient weight loss (IWL) assessed based on the criteria of Total Weight Loss (TWL) at nadir <20% and Excess Weight Loss (EWL) at nadir <50%. Late post-operative clinical deterioration/significant weight regain (WR) evaluated by weight gain ≥10 kg compared to the nadir weight. Follow-up over 36 to 60 months. The relationship between IWL and WR was assessed, considering preoperative factors: comorbidities (cardiovascular and psychiatric), anthropometric characteristics, and pharmacology. The statistical evaluation was conducted using the chi-square test, t-test, Mann-Whitney U test.

Results: 98 patients were evaluated, 52% undergoing gastric bypass, 79.6% having a preoperative BMI ≥ 40 kg/m². The prevalence of cardiovascular comorbidities was: 50% hypertension, 51% dyslipidemia and 24.5% diabetes mellitus. Postoperative follow-up was conducted for up to 60 months in 55.1% of the patients. At the nadir weight, TWL was 31.9±8.6%, and EWL was 63.6±18.8%. Insufficient weight loss occurred in 11.2 to 18.4% of patients, and weight regain occurred in 34.7%, median increase of 13.6 (10; 22.6) kg. The following relationships were observed: IWL and dyslipidemia (P=0.03), type of surgery (P=0.017), and use of antiepileptics (P=0.001); WR with preoperative BMI (P=0.005), diagnosis of psychiatric disease (P=0.020), use of antidepressants (P=0.007), and use of antiepileptics (P=0.005). The relationship between the initial suboptimal clinical response and the remission of comorbidities in the postoperative period was assessed. A lower remission rate of diabetes in patients with IWL relationship was observed (P=0.037).

Conclusions: The initial suboptimal clinical response was found to be influenced by the type of surgery, the preexistence of a dyslipidemia diagnosis, and the use of antiepileptic medications. On the other hand, late postoperative clinical deterioration was mainly influenced by psychiatric disease and the use of antidepressants and antiepileptic medications. It was also observed that the occurrence of an initial suboptimal clinical response may impact the rate of remission of diabetes, reinforcing the importance of weight loss in the course of metabolic diseases.