Alison E. Field, ScD Professor and Chair of Epidemiology Brown University School of Public Heath Providence, RI

Who Does Better After Bariatric Surgery? Interview with:

Alison E. Field, ScD Professor and Chair of Epidemiology Brown University School of Public Heath Providence, RI

Dr. Field

Alison E. Field, ScD
Professor and Chair of Epidemiology
Brown University School of Public Heath
Providence, RI What is the background for this study?  

Response: In the United States, approximately 40% of adults are obese. There are a range of treatment options, but relatively few people are able to lose weight and maintain the loss. The most effective treatment is bariatric surgery, but even among patients who have undergone bariatric surgery, there is a range in weight change patterns after surgery. This suggests that not all people with obesity are similar. There may be different causes and optimal treatment plans that vary by obesity subgroup. Our goal was to identify subgroups and to examine if they differed in terms of weight loss after bariatric surgery. What are the main findings? 

Response: We found clear evidence for four subtypes.

  • In one group 98% of the participants had diabetes in contrast to the other groups where the prevalence of diabetes was approximately 30%.
  • In another group most people engaged in disordered eating or other forms of eating for reasons other than hunger.
  • Another group had been obese since childhood. This group had the highest BMI at age 18 with an average of 32 compared to an average around 25 for the other three groups. A BMI above 30 is considered obese while 25 is the cut-off for overweight. This group also had the highest pre-surgery BMI, an average of 58 compared to around 45 for the other three groups.
  • The last group of patients was more mixed in their profile. Metabolically they were fairly average, but they had very low levels of disordered eating — only 7.2 percent reported eating when they weren’t hungry compared to 92% in the disordered eating subgroup.

Overall, men lost an average of 25 percent of their pre-surgery weight and women lost an average of 30 percent of their pre-surgery weight. We found that patients in the disordered eating subgroup and the mixed group benefited the most from bariatric surgery. What should readers take away from your report?

Response: There may not be one best approach to treating obesity. We need to move towards a precision medicine approach where we examine subgroups of obesity and determine the optimal treatment for each subgroup. What recommendations do you have for future research as a result of this work? 

Response: We need to focus less on the average results in a study and focus more on looking into the characteristics of people for whom a particular therapy is most effective. We also need  studies examining if subtype-specific treatments of obesity result in larger weight losses and weight losses that can be maintained over time.

I have no disclosures. 

Alison E. Field, Thomas H. Inge, Steven H. Belle, Geoffrey S. Johnson, Abdus S. Wahed, Walter J. Pories, Konstantinos Spaniolas, James E. Mitchell, Alfons Pomp, Gregory F. Dakin, Bruce Wolfe, Anita P. Courcoulas. Association of Obesity Subtypes in the Longitudinal Assessment of Bariatric Surgery Study and 3-Year Postoperative Weight Change. Obesity, 2018; DOI: 10.1002/oby.2228 

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Last Updated on November 14, 2018 by Marie Benz MD FAAD