Primary Inadequate Weight Loss After Roux-en-Y Gastric Bypass Is not Associated with Poor Cardiovascular or Metabolic Outcomes: Experience from a Single Institution

It is well accepted that bariatric surgery has cardiovascular and metabolic effects independent of weight loss. Weight loss outcomes of patients undergoing Roux-en-Y gastric bypass (RYGB) at a high volume referral center were collected at 1 year postoperatively. Patients with failed primary weight loss were identified. Primary inadequate weight loss was defined as total body weight loss less than 15 %. Changes in hypertension (HTN), dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome profiles were investigated using Student's t test. A total of 2500 patients underwent RYGB from the years 2001-2013 at our institution. One hundred five (4.2 %) patients had primary inadequate weight loss. Within this cohort, 81 (77.1 %) patients had hypertension, 67 (63.8 %) had dyslipidemia, 53 (50.5 %) had type 2 diabetes mellitus, and 66 (62.9 %) patients had metabolic syndrome. At 1 year postoperatively, all metabolic parameters were significantly improved. Measures of metabolic disease included high-density lipoprotein (HDL) (46.3 +/- 11.6 versus 54.1 +/- 12.7 mg/dL, p < 0.01), low-density lipoprotein (LDL) (103.6 +/- 35.8 versus 89.2 +/- 30.0 mg/dL, p < 0.01), triglycerides (177.3 +/- 139.1 versus 117.6 +/- 59.3 mg/dL, p < 0.01), mean plasma glucose (128.9 +/- 55.3 versus 102.7 +/- 27.3 mg/dL, p < 0.01), and hemoglobin A(1)C (7.3 +/- 1.9 versus 6.1 +/- 1.0 %, p < 0.01). HTN was noted to improve in 27 (33.3 %) patients based on a decrease in the number of anti-hypertensives used (1.7 +/- 1.0 versus 1.3 +/- 1.3, p < 0.01), and 21 (31.8 %) patients had resolution of their metabolic syndrome. Improvement in cardiometabolic comorbidities still occurs despite suboptimal weight loss following RYGB.