Is bariatric surgery effective for co-morbidity resolution in the super-obese patients?

Background: Type 2 diabetes (T2D), obstructive sleep apnea (OSA), hypertension (HTN), and hyperlipidemia (HLD) are common co-morbidities that are strongly associated with obesity. Objective: The purpose of this study was to compare the rate of obesity-related co-morbidity remission and percent total body weight loss of super-obese patients with a body mass index (BMI) ≥50 kg/m² with bariatric patients who have a BMI of 30 to 49.9 kg/m². Setting: Academic hospital, United States. Methods: A retrospective analysis of outcomes of a prospectively maintained database was done on obese patients with a diagnosis of ≥1 co-morbidity (T2D, OSA, HTN, or HLD) who at the time of initial visit had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass at our hospital between 2011 and 2015. The patients were stratified based on their preoperative BMI class, BMI of 30 to 49.9 kg/m² versus BMI ≥50 kg/m². Results: Of the 930 patients, 732 underwent sleeve gastrectomy and 198 underwent Roux-en-Y gastric bypass. The 6-month follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m² (n = 759) versus super-obese patients (n = 171) were 46.0% and 36.7% (P =.348) for T2D; 75.0% and 73.2% (P =.772) for OSA; 35.0% and 22.0% (P =.142) for HTN; and 37.0% and 21.0% (P =.081) for HLD, respectively. The 1-year follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m² versus super-obese patients were 54.2% and 45.5% (P =.460) for T2D; 87.0% and 89.7% (P =.649) for OSA; 37.4% and 23.9% (P =.081) for HTN; and 43.2% and 34.6% (P =.422) for HLD, respectively. Furthermore, there was no difference in the mean percent total weight loss for patients with a preoperative BMI of 30 to 49.9 kg/m² versus the super-obese at the 6-month (21.4%, 20.9%, P =.612) and 1-year (28.0%, 30.7%, P =.107) follow-ups. Conclusion: In our study, preoperative BMI did not have an impact on postoperative co-morbidity remission rates or percent total body weight loss. Future studies should investigate the effect of other factors, such as disease severity and duration.