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Original Investigation
July 26, 2017

Factors Associated With Achieving a Body Mass Index of Less Than 30 After Bariatric Surgery

Author Affiliations
  • 1Department of Surgery, University of Michigan Health Systems, Ann Arbor
  • 2Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 3Wayne State University, Detroit, Michigan
  • 4Department of Surgery, Henry Ford Health System, Detroit, Michigan
JAMA Surg. Published online July 26, 2017. doi:10.1001/jamasurg.2017.2348
Key Points

Question  Which patients achieve a body mass index (BMI) of less than 30 after bariatric surgery?

Findings  In this study using a statewide clinical registry, 36% of patients achieved a BMI of less than 30 at 1 year after bariatric surgery. Significant predictors for success included a preoperative BMI of less than 40 and undergoing a metabolic procedure such as sleeve gastrectomy, gastric bypass, or duodenal switch.

Meaning  Bariatric surgery is optimal in patients with a BMI of less than 40; delaying surgical treatment for obesity can lead to inferior results.

Abstract

Importance  Achieving a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of less than 30 is an important goal of bariatric surgery, given the increased risk for weight-related morbidity and mortality with a BMI above this threshold.

Objective  To identify predictors for achieving a BMI of less than 30 after bariatric surgery.

Design, Setting, and Participants  This retrospective study used data from the Michigan Bariatric Surgery Collaborative, a statewide quality improvement collaborative that uses a prospectively gathered clinical data registry. A total of 27 320 adults undergoing primary bariatric surgery between June 2006 and May 2015 at teaching and nonteaching hospitals in Michigan were included.

Exposure  Bariatric surgery.

Main Outcomes and Measures  Logistic regression was used to identify predictors for achieving a BMI of less than 30 at 1 year after surgery. Secondary outcome measures included 30-day postoperative complications and 1-year self-reported comorbidity remission.

Results  A total of 9713 patients (36%; mean [SD] age, 46.9 [11.3] years; 16.6% male) achieved a BMI of less than 30 at 1 year after bariatric surgery. A significant predictor for achieving this goal was a preoperative BMI of less than 40 (odds ratio [OR], 12.88; 95% CI, 11.71-14.16; P < .001). Patients who had a sleeve gastrectomy, gastric bypass, or duodenal switch were more likely to achieve a BMI of less than 30 compared with those who underwent adjustable gastric banding (OR, 8.37 [95% CI, 7.44-9.43]; OR, 21.43 [95% CI, 18.98-24.19]; and OR, 82.93 [95% CI, 59.78-115.03], respectively; P < .001). Only 8.5% of patients with a BMI greater than 50 achieved a BMI of less than 30 after bariatric surgery. Patients who achieved a BMI of less than 30 had significantly higher reported rates of medication discontinuation for hyperlipidemia (60.7% vs 43.2%, P < .001), diabetes (insulin: 67.7% vs 50.0%, P < .001; oral medications: 78.5% vs 64.3%, P < .001), and hypertension (54.7% vs 34.6%, P < .001), as well as a significantly higher rate of sleep apnea remission (72.5% vs 49.3%, P < .001) and higher satisfaction rate (92.8% vs 78.0%, P < .001) compared with patients who did not.

Conclusions and Relevance  Patients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after bariatric surgery and are more likely to experience comorbidity remission. Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.

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