The long weight: association between distressed communities index and long-term weight outcomes following bariatric surgery

Alexandra J Johns; M Siobhan Luce; Mason J Kaneski; Ryan A Lowery; Barbara Jachniewicz; Angela Salas; Randi McCreary; Raquel M Russell; Victoria Lyo; Mohammed R Ali; Shushmita M Ahmed

doi:10.1007/s00464-023-10158-y

The long weight: association between distressed communities index and long-term weight outcomes following bariatric surgery

Surg Endosc. 2023 Sep;37(9):7218-7225. doi: 10.1007/s00464-023-10158-y. Epub 2023 Jun 27.

Authors

Alexandra J Johns¹, M Siobhan Luce¹, Mason J Kaneski², Ryan A Lowery³, Barbara Jachniewicz³, Angela Salas³, Randi McCreary³, Raquel M Russell³, Victoria Lyo^{1

2

4}, Mohammed R Ali^{1

2

4}, Shushmita M Ahmed^{5

6

7}

Affiliations

¹ Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA.
² Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA.
³ University of California, Davis Health, Sacramento, USA.
⁴ Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA.
⁵ Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA. smahm@ucdavis.edu.
⁶ Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA. smahm@ucdavis.edu.
⁷ Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA. smahm@ucdavis.edu.

Abstract

Background: Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes.

Methods: Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups.

Results: Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41-2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72-1.35).

Conclusions: While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater weight recurrence among this population.

Keywords: Bariatric surgery; Long-term weight loss; Socioeconomic status; Weight recurrence.

MeSH terms

Bariatric Surgery*
Gastrectomy
Gastric Bypass*
Humans
Laparoscopy*
Obesity, Morbid* / surgery
Retrospective Studies
Treatment Outcome
Weight Loss