title: Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium.
abstract: BACKGROUND
  Limited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change.
  
  
  METHODS
  Ten hospitals in 6 geographically diverse clinical centers in the United States.
  
  
  METHODS
  Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively.
  
  
  RESULTS
  The median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%-38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%-23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m(2) for RYGB and 44 kg/m(2) for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band circumference had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex.
  
  
  CONCLUSIONS
  Few baseline variables were associated with 3-year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual's chance of a successful weight loss outcome after bariatric surgery.
  
  
  BACKGROUND
  NCT00465829, ClinicalTrials.gov.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: courcoulasap@upmc.edu.
authors.forename: Anita P
authors.initials: AP
authors.lastname: Courcoulas
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Christian
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Robert W
authors.initials: RW
authors.lastname: O'Rourke
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Greg
authors.initials: G
authors.lastname: Dakin
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: E
authors.initials: E
authors.lastname: Patchen Dellinger
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: School of Nursing, Duquesne University, Pittsburgh, Pennsylvania.
authors.forename: Ph D
authors.initials: PD
authors.lastname: Melissa Kalarchian
authors.affiliation: Department of Neuroscience, Neuropsychiatric Research Institute, Fargo, North Dakota.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, Legacy Good Samaritan Hospital, Portland, Oregon.
authors.forename: Emma
authors.initials: E
authors.lastname: Patterson
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.affiliation: Department of Pharmaceutical Sciences North Dakota State University, Fargo, North Dakota.
authors.forename: Kristine
authors.initials: K
authors.lastname: Steffen
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wolfe
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015430:Weight Gain / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology*
keywords: Bariatric surgery; Cohort study; Diabetes; LABS; Predictors; Weight change
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