Pre-operative predictors of weight loss at 1-year after Lap-Band surgery.
BACKGROUND
The authors studied a range of preoperative factors for their predictive value of effectiveness of Lap-Band placement, using the percentage of excess weight loss at 1-year as the outcome measure (%EWL1).


METHODS
All factors were measured and recorded prior to surgery. Factors included: patient demographics, family, medical and weight history. Laboratory measures and the responses to the SF-36 Health Survey were also assessed. Factors were assessed for correlation with %EWL1.


RESULTS
The group (N=440, F:M 383:57) had mean age 40.0+/-9.5 years, weight of 126+/-25 kg, and BMI 45.6+/-7.5 kg/m2 pre-operatively. At 1-year follow-up, the group had mean weight 97.6< or =20 kg, BMI 35.6 = 6.3 kg/m2, and %EWL1 45.8< or =17%. Increasing age (R= -0.13, p<0.01) and preoperative BMI (R=-0.22, p<0.001) were significantly associated with less %EWL1 and all other factors were controlled for these before assessing significance. Important factors associated with a lower %EWL1 included: hyperinsulinemia (R=-0.36, p<0.001), insulin resistance (R=-0.33, p<0.001) and disease associated with insulin resistance, poor physical ability, pain, and poor general health responses to the SF-36 Health Survey. Patients who consumed alcohol regularly had a better rate of weight loss (R= 0.23, p<0.005). Factors that had no influence included gender, a history of mental illness and measures of mental health, previous bariatric surgery, and a history of many medical conditions associated with obesity.


CONCLUSIONS
Important physical factors have been found to influence the rate of weight loss. Those with increased age, pain, physical disability and insulin resistance have a great deal to gain from weight loss. Although this study has identified factors that are associated with less weight loss, we have not found any factor that predicts an unacceptably low weight loss and thus provides a contraindication to Lap-Band placement. The findings of this study allow us to set more realistic goals for the rate of weight loss in specified sub-groups of our patients.
Dixon
J B
JB
Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia. john.dixon@med.monash.edu.au
Dixon
M E
ME
O'Brien
P E
PE
D000328:Adult; D000428:Alcohol Drinking; D015992:Body Mass Index; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D012307:Risk Factors; D012907:Smoking; D016896:Treatment Outcome; D015431:Weight Loss