RYGB is effective in men with individualised follow-up protocols

Roux-en-Y gastric bypass (RYGB) is effective in men with obesity, demonstrating substantial excess weight loss and significant long-term improvements in obesity-related comorbidities, according to researchers from Brazil. However, the researchers emphasise the need to individualise follow-up protocols, targeted education, and culturally sensitive interventions to improve engagement, adherence, and long-term outcomes in male bariatric patients.

The researchers from the University of Brasília and Hospital Santa Lúcia, Brasília, Distrito Federal, Brazil, explained that whilst men constitute a minority of bariatric surgery patients - despite facing a high burden of obesity-related complications - little is known about factors influencing long-term weight outcomes in male patients. As a result, they sought to identify clinical and behavioural determinants of weight loss maintenance, and weight regain in men after RYGB. The analysis aimed to contribute to sex-specific understanding of postoperative outcomes, thereby informing more personalised strategies for long-term success.

For the study, they retrospectively reviewed 100 men with obesity who underwent laparoscopic RYGB between 2013 and 2016. Inclusion was limited to those with ≥ 2 years of postoperative follow-up, subsequently, 43 male patients were available for analysis. Clinical variables (age and comorbidities), behavioural factors (exercise and dumping syndrome - DS), and weight data were collected. Poisson regression identified factors associated with achieving normal body mass index (BMI) and significant weight regain. A linear regression model assessed predictors of percent excess weight loss (%EWL).

Outcomes

The mean age of the included 43 patients was 39.7 years (40 ± 11), with an average follow-up of 48.3 months (48 ± 22). Among the included cohort, the mean percentage of excess weight loss (%EWL) achieved was 84.5% (85 ± 19), with 27.9% of patients reaching a normal BMI. Of the 43 participants, the majority presented multiple obesity complications preoperatively, including diabetes mellitus (67%), hypertension (69.7%) and dyslipidaemia (57.1%). Twenty-one of 43 patients reported DS (48,8%).

Half of the participants (50%) reported dumping syndrome (DS) post-RYGB, and its presence was significantly associated with achieving a normal BMI (p=0.03). No other measured factors (eg, age, comorbidity burden, or exercise) emerged as significant predictors of normal BMI in this cohort.

In the initial simple Poisson regression analysis, no variable showed a statistically significant association (p < 0.05) with achieving a normal BMI. However, in the multiple Poisson regression model, only the presence of DS was significantly associated with this outcome. Men who reported DS had a 186% higher chance (PR of 2.86) of achieving a normal BMI compared to those without it, after adjusting for other covariates (p=0.0309).

Only the length of postoperative follow-up showed a significant correlation (p<0.0001). In the simple Poisson regression model, follow-up time was the only variable significantly associated with weight regain >15% relative to the lowest recorded weight (p<0.05). This association remained significant in the multiple Poisson regression model. Each additional month of follow-up was associated with a 4% increase in the prevalence of weight regain >15%, independent of other variables (p<0.0001).

In the initial simple Poisson regression analysis, only follow-up time was significantly associated with the occurrence of weight regain ≥ 20% TWL (p<0.05). In the subsequent multiple Poisson regression model, both follow-up time and achieving a normal BMI were significantly associated with this outcome.

Each additional year of follow-up was associated with a 4% increase in the chances of significant weight regain (≥20% TWL), after adjusting for other variables (p=0.0003). Additionally, men who reached a normal BMI had a 155% higher (PR of 2.55) chance of weight regain ≥20% TWL compared to those who did not, independent of other covariates (p=0.0205).

Initially, in the simple linear regression analysis, only the variable normal BMI showed a statistically significant association (p<0.05) with EWL. Subsequently, in the multiple linear regression model, normal BMI remained the only variable significantly associated with EWL. Men who achieved a normal BMI had, on average, a 30.30% greater excess weight loss compared to those who did not, after adjusting for other variables (p<0.0001).

“As expected, men who had a higher %EWL achieved more frequently a normal BMI after surgery. Despite significant preoperative comorbidity burden, male patients achieved substantial excess weight loss (mean %EWL 84.5%) and a notable reduction in BMI over follow-up period, reinforcing the efficacy of RYGB in our study population,” the authors noted. “As shown in previous studies, male BMS candidates can benefit from focused interventions for longer follow-up, psychological support, and behavioural adherence to mitigate weight regain.”

The findings were reported in the paper, ‘Determinants of Weight Loss and Regain in Men After Roux-En-Y Gastric Bypass: A Retrospective Analysis’, published in the journal Diabetes, Metabolic Syndrome and Obesity. To access this paper, please click here