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/m(2) with bariatric patients who have a BMI of 30 to 49.9 kg/m(2). 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/m(2) versus BMI >= 50 kg/m(2). 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/m(2) (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/m(2) 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/m(2) 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. (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.