For patients with massive weight loss after bariatric surgery, subsequent body contouring to remove excess skin is not itself associated with long-term weight loss and does not impart a clinically significant, long-term sustained weight loss benefit according to researchers from the Montefiore Medical Center, Bronx, NY.
"In contrast to previous studies, we found that body contouring procedures do not lead to improved weight loss or weight maintenance after bariatric surgery," said Dr Teresa Benacquista, Montefiore Medical Center, and co-author of the study. "Rather, the reported benefits of body contouring appear to be in improving quality of life."
Body contouring refers to a range of surgical procedures to remove excess skin in patients with major weight loss, with the aim of improving the patient's appearance, reducing discomfort and improving physical function. Previous studies have suggested that patients who undergo body contouring have more sustained weight loss over time, although some studies have reported conflicting results.
This study reported in the paper, ‘Analysis of Body Contouring and Sustained Weight Loss in a Diverse, Urban Population: A 7-Year Retrospective Review’, published in the Plastic & Reconstructive Surgery journal, included 2,531 patients who underwent bariatric surgery between 2009 and 2012. Of these, 350 patients underwent body contouring a median of two years later. Another 364 patients consulted with plastic surgeons about body contouring, but did not proceed to surgery. The remaining 1,817 patients had neither body contouring nor a consultation.
At follow-up, patients who underwent body contouring did indeed have more sustained weight loss. After one year, average body mass index (BMI) was about 3kg/m2 lower in the body contouring group, compared to patients who had bariatric surgery only. By seven years, BMI was 5kg/m2 lower for patients who underwent body contouring.
However, weight loss was also greater for patients who had a consultation but did not proceed with body contouring. For this group, average BMI was 1.5 kg/m2 lower at one year compared to patients without a consultation, and 2.3 kg/m2 lower after seven years.
Further analysis focused on 259 patients from the consultation group who had sufficient weight loss to be considered candidates for body contouring. For these patients, average BMI after seven years was about the same as for patients who underwent body contouring: 31 versus 30 kg/m2, compared to 35kg/m2 for those with no consultation or body contouring. Analysis by percentage of excess body weight lost showed a similar pattern.
Weight loss was also affected by the type of bariatric surgery: patients undergoing sleeve gastrectomy had lower sustained weight loss, compared to gastric bypass. Among body contouring patients, average difference in excess body weight loss was about eight percent at seven years' follow-up.
“Given the similarity of the mean BMI and EBWL responses between the body contouring group and the plastic surgery consultation group, we conclude that the impact of body contouring on weight loss is likely minimal, and the difference in weight loss as compared with the bariatric-only group is secondary to individual patient factors,” the authors write.
In the authors’ study population, patients identifying as black had significantly worse sustained weight loss. Black patients had lower sustained weight loss, compared to other racial/ethnic groups. In contrast to previous studies of weight loss after bariatric surgery, most patients in the new analysis identified as Black (about 29%) or Hispanic/Latinx (62%).
“Our findings suggest that in a chiefly minority race, urban population, body contouring after bariatric surgery does not impart a clinically significant, long-term sustained weight loss benefit” the authors concluded. “The benefit of body contouring in massive weight loss patients is likely psychosocial, and improves physical functionality. In addition, we observed gastric bypass procedures to be associated with improved long-term weight loss as compared with sleeve gastrectomy.”
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