Table 4.
Predictors of response to metabolic and bariatric surgery.
| Author | Inclusion criteria | n | Study design | Predictors of response |
|---|---|---|---|---|
| Roux-en-Y gastric bypass | ||||
| Al-Khyatt and colleagues100 | Adults, receiving RYGB | 227 | Retrospective cohort study assessing predictors of 1-year EWL | Higher BMI, older age, presence of DM, and preoperative weight gain predicted lower 1-year EWL |
| Faria and colleagues101 | Adults, receiving RYGB | 163 | Prospective cohort study assessing fasting glycemia as predictor of weight loss | Baseline BMI and fasting blood glucose >100 mg/dl inversely correlated with probability of achieving >80% EWL or >35% weight loss after 1 year; effect not detectable in participants on oral antidiabetic medications following RYGB |
| Guajardo-Salinas and colleagues102 | Adults, BMI ⩾ 40 kg/m2 receiving RYGB | 75 | Retrospective study examining predictors of weight loss following RYGB, comparing Whites and Hispanics | No difference in EWL and BMI between Whites and Hispanics after 1 year; higher HDL and lower SBP pre-RYGB significantly predicted EWL at 12 months in Whites; lower Fibrospect score pre-RYGB predicted higher EWL at 12 months in Hispanics |
| Hatoum and colleagues103 | Patients, receiving RYGB | 848 | Prospective study to determine if there is a significant genetic contribution to weight loss following RYGB through genotyping; first-degree relatives, nongenetically related cohabiting pairs, and nonrelated pairs were compared | First-degree relative pairs had similar response to surgery; similarity not seen in cohabiting or unrelated individuals |
| Lent and colleagues104 | Patients, receiving RYGB | 3125 | Retrospective study examining weight trajectories of patients receiving RYGB to identify clinical, behavioral, and demographic features of patients by weight loss trajectory | Those with below average weight loss trajectory more likely to be male and have DM, and less likely to have a smoking history or taking sleeping medications. Lower initial weight loss post-surgery associated with greater chance of poorer weight outcomes |
| Livhits and colleagues105 | Patients, receiving RYGB | 197 | Retrospective cohort study assessing predictors of weight regain (⩾15% from lowest weight to weight at survey completion, average 45 months after RYGB) | Low physical activity and self-esteem, and higher eating disinhibition, associated with weight regain |
| Mirshahi and colleagues106 | Patients, receiving RYGB | 1433 | Prospective cohort study assessing MC4R genotype and its relationship with weight loss and clinical phenotypes during a 4-year period before/after RYGB | I125L allele carriers lost 9% more weight compared with noncarriers, continued rapid weight loss longer, regained less weight, and had a lower presurgery HOMA |
| Novais and colleagues107 | Adult females, receiving RYGB | 351 | Prospective cohort study assessing association between 12 gene polymorphisms and 1-year %EWL | 5-HT2C gene polymorphism rs3813929 (TT genotype) predicted greater 1-year %EWL |
| Ryder and colleagues108 | Adolescents, receiving RYGB | 50 | Retrospective study assessing psychosocial factors associated with long-term weight loss maintenance | Greater quality of life at 5–12 years associated with better weight loss maintenance at 5–12 years |
| Sillen and Andersson109 | Patients, receiving RYGB | 281 | Retrospective analysis, assessing preoperative factors predictive of successful weight loss (EWL ⩾ 60%) 1–3 years following RYGB | Earlier onset of obesity and higher preoperative BMI associated with unsuccessful weight loss at 1 year; preoperative psychiatric disorders, DM, hypertension, and higher BMI associated with unsuccessful weight loss at 2 years |
| Still and colleagues110 | Caucasian adults, BMI ⩾ 35 kg/m2, receiving RYGB | 1001 | Prospective cohort study assessing relationship between SNPs in/near FTO, INSIG2, MC4R, and PCSK1 and weight loss | Increasing numbers of SNP alleles near FTO, INSIG2, MC4R, and PCSK1 associated with decreased weight loss |
| Still and colleagues111 | Patients, receiving RYGB | 2365 | Retrospective analysis of a prospectively recruited cohort study assessing clinical factors associated with weight loss | Higher baseline BMI and preoperative weight loss, iron deficiency, use of any DM medications, nonuse of bupropion, no history of smoking, age >50 years, and presence of fibrosis on liver biopsy associated with poorer long-term (>36 month) weight loss |
| ter Braak and colleagues112 | Adults, ⩾ 1 year follow-up data available, receiving RYGB | 112 | Retrospective, case-control study comparing nonresponders (% alterable weight loss <10th percentile) to responders (% alterable weight loss 25–75th percentile) in perceived social support and stressful life events | Perceived social support able to classify 84% of participants correctly as responders versus nonresponders; stressful life events not related to weight loss |
| Vitolo and colleagues113 | Adults with severe obesity, receiving RYGB | 100 | Prospective cohort study assessing relationship between SNPs rs2241766 for adiponectin gene, rs490683 for ghrelin receptor, rs696217 and rs27647 for the preproghrelin/ghrelin gene, and rs1126535 for the CD40L gene and weight loss at 6, 26, and 52 weeks following RYGB | Carrying G to T substitution in rs696217 (preproghrelin gene) associated with improved weight loss response; carrying rs1126535 C allele (CD40L gene) associated with worse weight loss response |
| Biliopancreatic diversion, adjustable gastric banding, sleeve gastroplasty, sleeve gastrectomy | ||||
| Dixon and colleagues115 | Adults, BMI ⩾ 35 kg/m2, significant medical, physical, or psychosocial disabilities, attempted weight loss by other means for ⩾5 years | 440 | Prospective cohort study assessing preoperative predictors of weight loss 1 year after AGB | Older age; higher BMI; insulin resistance; and diseases associated with insulin resistance, poor physical activity, and pain associated with decreased EWL at 1 year |
| Janse Van Vuuren and colleagues114 | Adults, receiving SG | 106 | Prospective cohort study assessing if post-surgery food cravings predict weight loss outcomes at 6–8 months | Emotional food cravings experienced 4–6 weeks following SG predicted poorer weight loss outcomes at 6 months |
| Lopez-Nava and colleagues119 | Adults, receiving sleeve gastroplasty | 248 | Retrospective analysis assessing long-term outcomes, reproducibility, and predictors of weight loss response | Percent weight loss at 6 months predicted percent weight loss at 24 months |
| Sysko and colleagues116 | Adolescents (14–18 years), receiving AGB | 101 | Prospective cohort study assessing presurgical psychological predictors of 1 year weight loss after AGB | Baseline loss of control eating and higher family conflict predicted decreased weight loss rate over 1 year |
| Valera-Mora and colleagues118 | Adults, receiving BPD | 107 | Prospective cohort study assessing predictors of weight loss and reversal of comorbidities at 2 years | Older age and presence of DM negatively predicted, and initial fat mass positively predicted, weight loss at 2 years |
| Wood and Ogden117 | Adults, receiving AGB | 49 | Prospective cohort study assessing if pre- and postoperative binge eating behaviors predict weight loss | Decrease in binge eating as a consequence of having AGB predicted postoperative weight loss |
| Studies involving multiple surgical procedures | ||||
| de Hollanda and colleagues120 | Adults, ⩾30 month follow-up data available, receiving RYGB or SG | 658 | Retrospective analysis comparing participants experiencing EWL ⩾ 50% versus <50% | EWL < 50% at 1 year associated with higher baseline BMI and presence of presurgical T2DM |
| Konttinen and colleagues121 | Adults, BMI ⩾ 34 kg/m2 (males) or BMI ⩾ 38 kg/m2 (females), receiving gastric banding, vertical banded gastroplasty, gastric bypass | 3926 | Prospective matched interventional trial comparing participants undergoing bariatric surgery with conventional weight loss intervention | Pretreatment eating behaviors unrelated to weight changes after bariatric surgery; participants with lower levels of 6-month and 1-year disinhibition and hunger and who experienced larger 1-year decreases in these behaviors lost more weight 2, 6, and 10 years after surgery |
| Manning and colleagues122 | Adults, BMI ⩾ 40 kg/m2 or ⩾ 35 kg/m2 with ⩾1 obesity-related comorbidities, receiving RYGB or SG | 1456 | Retrospective cross-sectional study assessing if early postoperative weight loss predicts maximal weight loss | Weight loss velocity from 3–6 months independent predictor of maximal percent weight loss |
| Miller-Matero and colleagues123 | Adults, receiving RYGB or SG | 101 | Retrospective analysis assessing if preoperative problematic eating behaviors predicted 1-year weight loss | Higher levels of eating in response to anger/frustration and depression correlated with decreased weight loss; higher number of food addiction symptoms increased likelihood participants experienced less weight loss |
| Subramaniam and colleagues124 | Adults, receiving RYGB, SG, or one anastomosis gastric bypass-mini gastric bypass | 57 | Prospective cohort study assessing pre- and postsurgical predictors of weight loss following bariatric surgery | Older age, higher BMI, and greater emotional eating and external eating predicted less weight loss |
AGB, adjustable gastric banding; BMI, body mass index; BPD, biliopancreatic diversion; DM, diabetes mellitus; EWL, excess weight loss; FTO, fat mass and obesity-associated protein; HDL, High-density lipoprotein; HOMA, homeostatic model assessment; INSIG2, insulin-induced gene 2; MC4R, melanocortin 4 receptor; PCSK1, proprotein convertase subtilisin/kexin type 1; RYGB, Roux-en-Y gastric bypass; SBP, systolic blood pressure; SG, sleeve gastrectomy; SNP, single nucleotide polymorphism; T2DM, type 2 diabetes mellitus.