A Retrospective Study of Bariatric Surgery Patients with Sub-optimal Weight-loss

1. A Retrospective Study of Bariatric Surgery Patients with Sub-optimal Weight-loss Shah Faisal MBBS Mentor Joseph A. Caruana MD

2. Aim and Objective

3. Aim and Objective • Some patients after Roux-en-Y Gastric Bypass undergo “Sub-optimal” Weight Loss (SWL).

4. Aim and Objective • Some patients after Roux-en-Y Gastric Bypass undergo “Sub-optimal” Weight Loss (SWL). • Age, Gender and BMI are the major contributors to weight loss pattern.

5. Aim and Objective • Some patients after Roux-en-Y Gastric Bypass undergo “Sub-optimal” Weight Loss (SWL). • Age, Gender and BMI are the major contributors to weight loss pattern. • Are there any more subtle and/or modifiable variables which play a role?

6. Problem of Obesity

7. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese.

8. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to.

9. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to. • Known association with some common cancers:

10. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to. • Known association with some common cancers: • Liver, kidney, breast, endometrial, prostate, colon…

11. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to. • Known association with some common cancers: • Liver, kidney, breast, endometrial, prostate, colon… • Huge burden on healthcare cost:

12. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to. • Known association with some common cancers: • Liver, kidney, breast, endometrial, prostate, colon… • Huge burden on healthcare cost: • 25 % greater among subjects with a BMI 30 to 34.9

13. Problem of Obesity • Two thirds of individuals living in the US are overweight, and of those, almost half are obese. • DM-2, dyslipidemia, CAD, HTN, OSA are a few of the myriad complications that obesity predisposes to. • Known association with some common cancers. • Liver, kidney, breast, endometrial, prostate, colon… • Huge burden on healthcare cost: • 25 % greater among subjects with a BMI 30 to 34.9 • 44 % greater among those with a BMI > 35

14. Treatment

15. Treatment • Medical treatment:

16. Treatment • Medical treatment: • Diet, exercise and life style modification.

17. Treatment • Medical treatment: • Diet, exercise and life style modification. • Medications.

18. Treatment • Medical treatment: • Diet, exercise and life style modification. • Medications. • Surgical treatment:

19. Treatment • Medical treatment: • Diet, exercise and life style modification. • Medications. • Surgical treatment: • Roux-en-Y Gastric By-pass.

20. Treatment • Medical treatment: • Diet, exercise and life style modification. • Medications. • Surgical treatment: • Roux-en-Y Gastric By-pass. • Adjustable Gastric Banding.

21. Treatment • Medical treatment: • Diet, exercise and life style modification. • Medications. • Surgical treatment: • Roux-en-Y Gastric By-pass. • Adjustable Gastric Banding. • Diet, exercise and life style modification are part of surgical treatment.

22. Dietary and Exercise recommendation after Gastric Bypass

23. Dietary and Exercise recommendation after Gastric Bypass • Diet: • 1200-1400 Cal per day. • 60-80 g protein per day. • 4-5 small meals (especially breakfast). • 32 oz water per day.

24. Dietary and Exercise recommendation after Gastric Bypass • Diet: • 1200-1400 Cal per day. • 60-80 g protein per day. • 4-5 small meals (especially breakfast). • 32 oz water per day. • Exercise: • Walking 30 min/day, five to seven days per week.

25. Roux en Y Gastric By-pass

26. Adjustable Gastric band

27. Weight Loss after Gastric Bypass

28. Weight Loss after Gastric Bypass • How do Age, Gender and BMI influence weight loss?

29. Weight Loss after Gastric Bypass • How do Age, Gender and BMI influence weight loss? • Recent work done by Dr Caruana:

30. Weight Loss after Gastric Bypass • How do Age, Gender and BMI influence weight loss? • Recent work done by Dr Caruana: • Weight Loss Curves.

31. Weight Loss after Gastric Bypass • How do Age, Gender and BMI influence weight loss? • Recent work done by Dr Caruana: • Weight Loss Curves. • Effect of Age, Gender and BMI on weight loss.

32. Weight-Loss Curve-Percentiles 95 90 75 50 25 10 5

33. Effect of Age on Weight Loss Red Lines >41 yr Black Lines <41 yr 95 90 75 50 25 10 5

34. Effect of Gender on Weight Loss Red Lines Females Black Lines Males 95 90 75 50 25 10 5

35. Effect of BMI on Weight Loss Red Lines BMI>55 Black Lines BMI<55 95 90 75 50 25 10 5

36. Sub-Optimal Weight Loss (SWL)

37. Sub-Optimal Weight Loss (SWL) • SWL < 40% (to 50%) Excess Body Weight (EBW) lost.

38. Sub-Optimal Weight Loss (SWL) • SWL < 40% (to 50%) Excess Body Weight (EBW) lost. • EBW is actual weight minus Ideal Body Weight (IBW).

39. Sub-Optimal Weight Loss (SWL) • SWL < 40% (to 50%) Excess Body Weight (EBW) lost. • EBW is actual weight minus Ideal Body Weight (IBW). • IBW from 1983 Metropolitan Height and Weight Tables.

40. Sub-Optimal Weight Loss (SWL) • SWL < 40% (to 50%) Excess Body Weight (EBW) lost. • EBW is actual weight minus Ideal Body Weight (IBW). • IBW from 1983 Metropolitan Height and Weight Tables. • Around 10% (to 20%) of Gastric Bypass patients have SWL:

41. Sub-Optimal Weight Loss (SWL) • SWL < 40% (to 50%) Excess Body Weight (EBW) lost. • EBW is actual weight minus Ideal Body Weight (IBW). • IBW from 1983 Metropolitan Height and Weight Tables. • Around 10% (to 20%) of Gastric Bypass patients have SWL: • Most of the patients actually regain the weight.

42. Methods

43. Methods • Matched Case-Control Study.

44. Methods • Matched Case-Control Study. • Controls matched to cases for Age, Gender & BMI.

45. Methods • Matched Case-Control Study. • Controls matched to cases for Age, Gender & BMI. • Four matched controls for every case.

46. Inclusion/Exclusion Criteria

47. Inclusion/Exclusion Criteria • Gastric bypass between Jan ’00 and Dec ‘07.

48. Inclusion/Exclusion Criteria • Gastric bypass between Jan ’00 and Dec ‘07. • Followed up at 18 (±2) months after surgery.

49. Inclusion/Exclusion Criteria • Gastric bypass between Jan ’00 and Dec ‘07. • Followed up at 18 (±2) months after surgery. • At 18 (± 2) months:

50. Inclusion/Exclusion Criteria • Gastric bypass between Jan ’00 and Dec ‘07. • Followed up at 18 (±2) months after surgery. • At 18 (± 2) months: • If lost < 40% EBW—Case.