Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

Background: Although adjustable gastric banding is increasingly proposed for massively obese patients, little is known about the modifications of resting metabolic rate and substrate oxidation or about metabolic determinants of weight loss following this type of bariatric surgery. Objectives: To evaluate the relationships between excess weight loss, resting metabolic rate (RMR) and substrate oxidation, and to identify metabolic predictive factors of weight loss after adjustable gastric banding. Subjects: Seventy-three obese nondiabetic women aged 39.1 +/- 10.4 years (18.4-64.8). Design: Resting metabolic rate and substrate oxidation (indirect calorimetry), body composition (bio-impedance), lipid profile and insulin sensitivity indexes were assessed before and after (13.3 +/- 6.0 months, range 6.0-31.1) adjustable gastric banding. Patients were classified according to postsurgery time: group A (6-12 months, n=39); group B (12-18 months, n=21); group C (> 18 months, n=13). Metabolic parameters associated with the percentage of excess weight lost (EWL) 1 year after surgery were analyzed in univariate and multivariate regressions. Results: Mean weight loss was 26.2 +/- 11.4 kg. Mean fat mass loss was 17.3 +/- 8.1 kg. All biological parameters associated with excess weight improved after surgery. Excess weight lost at 1 year was 45.9 +/- 17.1% in group A, 47.4 +/- 17.1% in group B and 51.4 +/- 18.5% in group C (P=NS). Resting metabolic rate/fat-free mass (FFM) slightly decreased (28.9 +/- 3.26 vs 30.3 +/- 2.8, P < 0.00001) and RMR/body weight slightly increased (18.5 +/- 2.8 vs 17.3 +/- 1.9, P < 0.00001) after surgery. Respiratory quotient (0.81 +/- 0.06 vs 0.82 +/- 0.05) and FFM-adjusted lipid oxidation (1.10 +/- 0.41 vs 1.05 +/- 0.33 mg/min/kg FFM) were not significantly modified after surgery. In multiple linear regression analysis, difference in RMR/body weight, difference in energy sparing, baseline BMI and postsurgery time, were significantly and independently correlated with EWL (total R-2=72.5%). Conclusions: Adjustable gastric banding promotes gradual but sustained weight loss and is associated with long-term conservation of lipid oxidation and energy expenditure. The individual variability in energy sparing mechanisms predicts weight loss during the first year after surgery.