title: Weight loss after laparoscopic adjustable gastric band and resolution of the metabolic syndrome and its components.
abstract: Substantial weight loss in the setting of obesity has considerable metabolic benefits. Yet some studies have shown improvements in obesity-related metabolic comorbidities with more modest weight loss. By closely monitoring patients undergoing bariatric surgery, we aimed to determine the effects of weight loss on the metabolic syndrome and its components and determine the weight loss required for their resolution.
  
  
  
  We performed a prospective observational study of obese participants with metabolic syndrome (Adult Treatment Panel III criteria) who underwent laparoscopic adjustable gastric banding. Participants were assessed for all criteria of the metabolic syndrome monthly for the first 9 months, then 3-monthly until 24 months.
  
  
  
  There were 89 participants with adequate longitudinal data. Baseline body mass index was 42.4±6.2 kg m-2with an average age was 48.2±10.7 years. There were 56 (63%) women. Resolution of the metabolic syndrome occurred in 60 of the 89 participants (67%) at 12 months and 60 of the 75 participants (80%) at 24 months. The mean weight loss when metabolic syndrome resolved was 10.9±7.7% total body weight loss (TBWL). The median weight loss at which prevalence of disease halved was 7.0% TBWL (17.5% excess weight loss (EWL)) for hypertriglyceridaemia; 11% TBWL (26.1-28% EWL) for high-density lipoprotein cholesterol and hyperglycaemia; 20% TBWL (59.5% EWL) for hypertension and 29% TBWL (73.3% EWL) for waist circumference. The odds ratio for resolution of the metabolic syndrome with 10-12.5% TBWL was 2.09 (P=0.025), with increasing probability of resolution with more substantial weight loss.
  
  
  
  In obese participants with metabolic syndrome, a weight loss target of 10-12.5% TBWL (25-30% EWL) is a reasonable initial goal associated with significant odds of having metabolic benefits. If minimal improvements are seen with this initial target, additional weight loss substantially increases the probability of resolution.
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.|Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Ooi
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Doyle
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.|Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Tie
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.|Walter and Eliza Hall Institute, Melbourne University, Parkville, Victoria, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Wentworth
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Laurie
authors.affiliation: Department of Epidemiology, SPHPM, Monash University, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Earnest
authors.affiliation: MODI, Monash University, Melbourne, Victoria, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Cowley
authors.affiliation: Melbourne Pathology, East Melbourne, Victoria, Australia.
authors.forename: K
authors.identifier: 0000-0002-3882-166X
authors.initials: K
authors.lastname: Sikaris
authors.affiliation: Diabetes Complications Research Centre, University College, Dublin, Ireland.
authors.forename: C W
authors.initials: CW
authors.lastname: le Roux
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: Burton
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
authors.forename: P E
authors.initials: PE
authors.lastname: O'Brien
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.|Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: W A
authors.initials: WA
authors.lastname: Brown
mesh_terms: D001315:Australia; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D015431:Weight Loss