Predicting Responses to Bariatric and Metabolic Surgery
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HEALTH SERVICES AND PROGRAMS (R WELBOURN AND C BORG, SECTION EDITORS)
Predicting Responses to Bariatric and Metabolic Surgery Anna Belligoli 1 & Silvia Bettini 1 & Gianni Segato 2 & Luca Busetto 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Bariatric surgery is today the most effective therapy for weight loss and reduction of comorbidity burden in patients with severe obesity. However, bariatric surgery does not benefit equally all the patients. A consistent variability in outcomes has been observed. Predicting responses to bariatric surgery could be an important tool in clinical practice, by improving patients’ selection or by identifying patients in which more aggressive follow-up and post-operative intervention should be applied. Predictive factors for weight loss, weight regain, diabetes remission and recurrence are briefly reviewed in this paper. Recent Findings Many pre-operative factors have been proposed as negative or positive predictors of body weight reduction after surgery. However, none of these factors has been consistently demonstrated to have a sufficiently strong predictive power to influence eligibility to bariatric surgery itself. Weight regain can occur after bariatric surgery and its probability seems to be more influenced by post-operative behavioral factors than by pre-operative predictors. Several effective scores have been developed to predict diabetes remission after surgery, however long-term maintenance and diabetes recurrence after surgery seem again more influenced by post-operative behaviors and weight loss maintenance. Summary In general, more attention and active interventions to pre-operative and post-operative eating behaviors and lifestyle modifications are probably more important at the clinical level than the search of pre-operative predictors of long-term outcomes. Keywords Bariatric surgery . Weight loss . Type 2 diabetes . Diabetes remission
Introduction Current guidelines for obesity management in adults strongly recommend bariatric surgery according to body mass index (BMI) levels and associated obesity-related diseases [1, 2]. This wide acceptance and endorsement derives from the recognition of bariatric surgery as the most effective therapy today for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity [3]. Despite its general efficacy, bariatric surgery is not uniformly effective in all patients. Weight loss is generally clinically relevant and stable over time, but some patients could
This article is part of the Topical Collection on Health Services and Programs * Luca Busetto [email protected] 1
Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy
2
Department of Surgery, “San Bortolo” Hospital, Vicenza, Italy
have less satisfactory weight loss since the beginning (primary non responders) or could face significant weight regain over time (secondary non responders). Moreover, bariatric surgery us
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