title: Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals.
abstract: BACKGROUND
  A subgroup of obese patients without metabolic disorders has been identified and defined as metabolically healthy but morbidly obese (MHMO).
  
  
  OBJECTIVE
  To compare Roux-en-Y gastric bypass (RYGB) outcomes between MHMO and metabolically unhealthy morbidly obese (MUMO) patients to assess whether the obesity phenotype could affect the results.
  
  
  METHODS
  A university-affiliated tertiary care center.
  
  
  METHODS
  One hundred nineteen consecutive patients underwent RYGB; 102 completed the 2-year follow-up and were divided into 2 groups (MHMO and MUMO) according to Wildman criteria, including blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting blood sugar, C-reactive protein (CRP), and homeostasis model assessment of insulin resistance (HOMA-IR). Weight loss and metabolic parameter changes were analyzed.
  
  
  RESULTS
  Twenty-one of 102 (20.6%) patients were identified as MHMO; they were mostly women (90.5%) and were significantly younger than MUMO patients (39.4 ± 9.1 yr versus 47.2 ± 10, P = .001); 12.6% were lost to follow-up. MHMO phenotype was significantly associated with a greater percentage of excess body mass index loss (P = .03), independent of gender, age, and redo procedures. All metabolic parameters were significantly improved 2 years after surgery in the MUMO group. HOMA-IR, CRP, and triglycerides were significantly lower 2 years after surgery in the MHMO group, whereas fasting blood sugar and HDL-C were unchanged. At 2 years of follow-up, 92.3% of the population was metabolically healthy.
  
  
  CONCLUSIONS
  RYGB is an effective procedure to achieve weight loss and had a strong positive metabolic effect in both MHMO and MUMO phenotypes. RYGB led to an increase of the metabolically healthy status and may prevent or delay the onset of metabolic disorders.
authors.affiliation: Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Pelascini
authors.affiliation: Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Disse
authors.affiliation: Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pasquer
authors.affiliation: Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Poncet
authors.affiliation: Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Gouillat
authors.affiliation: Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France. Electronic address: maud.robert@chu-lyon.fr.
authors.forename: Maud
authors.initials: M
authors.lastname: Robert
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D010535:Laparoscopy; D008297:Male; D008659:Metabolic Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D015431:Weight Loss / Q000502:physiology*
chemical_list: D001786:Blood Glucose
keywords: Gastric bypass; Metabolic disorders; Metabolically healthy; Morbid obesity; Obesity phenotype; Weight loss