Background: It is well known that bariatric surgery provides excellent weight loss and resolution of comorbid conditions. We propose an additional benefit: Because body proportion is an independent predictor of diabetes and cardiovascular risk, we hypothesize that bariatric surgery results in improved body proportion and may thus improve health risk independent of overall weight loss and resolution of comorbid conditions.
Methods: A total of 168 patients underwent laparoscopic bariatric surgery at our institution from December 2006 to September 2009. Prospective data gathered preoperatively and at 3, 6, and 12 months postoperatively included body mass index (BMI); excess weight loss (EWL); waist-hip ratio (WHR); and discontinuation of hypertensive, hyperlipidemic, and diabetic medications.
Results: Of the 168 patients, 122 underwent Roux-en-Y gastric bypass, 40 gastric band, and 6 gastric sleeve procedures. Mean preoperative BMI was 48.6 kg/m(2) (SD = 7.8 kg/m(2)). Mean EWL was 33.7 lbs (SD = 11.9 lbs) at 3 months, 46.35 lbs (SD = 15.58 lbs) at 6 months, and 52.48 lbs (SD = 24.19 lbs) at 1 year. Mean WHR was 0.91 (SD = 0.1) preoperatively, 0.87 (SD = 0.1) at 3 months (P < .0001), 0.87 (SD = 0.09) at 6 months (P < .0001), and 0.86 (SD = 0.1) at 1 year (P = .0006). At 1-year follow-up, 52% of patients had discontinued hypertensive medications, 64% had discontinued diabetic medications, and 56% had discontinued hyperlipidemic medications.
Conclusions: Along with well-known improvements in overall weight and comorbid conditions, bariatric surgery significantly improves body proportion, which may decrease health risk. Continued follow-up will determine if this change is long term or if patients will revert to preoperative WHRs. Future studies with sufficient power to study individual bariatric procedures will determine which procedures, if any, provide patients with the greatest improvement in WHR and if inferior WHR results are associated with cardiovascular events.
Keywords: Bariatric surgery; body mass index; waist-hip ratio.