Gastric Bypass Surgery–Related Weight Loss Greater for Those With Family Support

Patients who undergo gastric bypass surgery with the support of family members tend to lose significantly greater amounts of excess weight and have greater resolution of comorbidities than those who have the surgery on their own, according to a study presented here at the American Society for Metabolic and Bariatric Surgery 27th Annual Meeting.

With obesity commonly running in families, it is not unusual for 2 or more members of a family to have bariatric surgery at the same time to lend each other support.
"I'd say about 8% to 10% of our bariatric surgery patients are family members," said lead author of the study Gus J. Slotman, MD, clinical professor of surgery at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School in Newark.

"The patients seemed to appreciate being able to go through the experience with a sibling or family member, and we decided to investigate whether there are measurable benefits to the outcome when the procedure is done with a family member," Dr. Slotman explained.

The investigators evaluated the office records of 91 patients from 41 families having 2 or more Roux-en-Y gastric bypass surgeries in the family and compared them with the records of 91 other gastric bypass patients, case-matching the patients by age (±5 years), sex, and body mass index (±5 kg/m2).

Patients in the families group included 75 women (82%) and 16 men (18%) who were siblings, parent and child, spouses, cousins, grandmother and granddaughter, in-laws, or aunt or uncle and nephew or niece.

Six of the families had more than 2 gastric bypass patients, and 1 family had 5.

The rates of diabetes, sleep apnea, hypertension, and gastroesophageal reflux disease were equal in the family and control groups before the surgery.

In looking at complications, medical follow-up, body mass index, percentage of weight loss, and resolution of comorbidities at 6 months, 1 year, and 2 years postsurgery, the researchers found significant differences between the groups.

The percentage of excess weight loss at 6 months was 55% for family members and 48.5% for control participants (P = .003). At 1 year, excess weight loss was 81% among family members and 60% among control participants (P = .002). Furthermore, 45% of family members had an excess weight loss of more than 80% compared with 19% of control participants (P = .002).

In the subgroup of siblings, the rate of excess weight loss at 1 year was particularly high, at 86% for siblings compared with 60% in control participants — a weight loss that was about 40% greater for those with family involvement than for individuals (P < .0001).

In addition to greater weight loss, the family members also showed greater improvements in obesity-related diseases. About 65% of family members experienced resolution of type 2 diabetes after a year compared with 31% of control participants, and 60% of family members had a resolution of hypertension compared with 33% of control participants.

Resolution of sleep apnea among family members was 70%, and resolution of gastroesophageal reflux disease was 63%, compared with 23% and 41%, respectively, for the control group.

"I was surprised by how dramatic the differences in weight loss were, and that the improvement in comorbidities was even more dramatic than the weight loss," Dr. Slotman told Medscape General Surgery. "The resolution among family members was nearly double the rate of resolution for the controls in type 2 diabetes, hypertension, and sleep apnea."

Younger adults were likely to lose more weight than their parents.

Importantly, family member adherence to office follow-up visits was also higher than that of control participants, with a rate of 89% among family members at 6 months compared with 83% among control participants, and a rate of 83.5% at 1 year compared with just 58% among control participants (P = .002).

Dr. Slotman speculated that one of the reasons for the higher weight loss seen among siblings may have to do with the simple factor of sibling rivalry. "I've had siblings tell me it really came down to competition."

Bariatric surgeon Marina Kurian, MD, who moderated the session, said she has also seen benefits from family members going through surgeries together, but time can often take its toll in undermining the momentum.

"The study did show that after 2 years, some of the differences in improvement declined, and I think that suggests that sibling rivalry sometimes only goes so far," said Dr. Kurian, who is medical director of the New York University Weight Management Program in New York City.

"People will be either competitive against each other or supportive of each other, and you can be on track for a certain amount of time. But then life happens, like a death, a loss of a job, a stressful job, or a relationship issue, and patients can wind up going back to their prior food-related coping mechanisms."

That's where the compliance issues can be particularly important, she added. "The patients who I think ultimately do better are the ones who continue to come back to see either their surgeon or their dietician, and try to get [long-term] counseling."

The findings also help underscore the benefits that have previously been suggested in data on support groups in general — family or otherwise — Dr. Kurian said.

"I think most data shows that when you attend support groups, your weight loss is improved," she said. "It's not just a matter of being among other people who 'get' you, but of being exposed to other patients' experiences and getting ideas on different methods that may work for you."

Dr. Slotman and Dr. Kurian have disclosed no relevant financial relationships.


Source(s): Nancy Melville (Las Vegas, Nevada), Medscape. American Society for Metabolic and Bariatric Surgery 27th Annual Meeting: Abstract PL-207. Presented June 25, 2010.
Post Date: June 28, 2010