Alison E Field1, Thomas H Inge2, Steven H Belle3,4, Geoffrey S Johnson4, Abdus S Wahed4, Walter J Pories5, Konstantinos Spaniolas5, James E Mitchell6, Alfons Pomp7, Gregory F Dakin7, Bruce Wolfe8, Anita P Courcoulas9. 1. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA. 2. Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA. 3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 4. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 5. Departments of Surgery, Biochemistry and Kinesiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. 6. Neuropsychiatric Research Institute, Fargo, North Dakota, USA. 7. Department of Surgery, Division of GI, Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, New York, USA. 8. Department of Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA. 9. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Abstract
OBJECTIVE: The study objective was to empirically identify subgroups of patients with obesity and investigate their association with postoperative weight change. METHODS: A longitudinal analysis of 2,458 adults in the Longitudinal Assessment of Bariatric Surgery (LABS) study was used. Baseline data were used to identify subgroups. The outcome was 3-year weight change after bariatric surgery. RESULTS: We identified four classes (subtypes) of obesity, which could be characterized as diabetes with low rates of high-density lipoprotein (Class 1), disordered eating (Class 2), mixed (Class 3), and extreme obesity with early onset (Class 4). Approximately 98% of participants in Class 1 had diabetes compared with < 40% in the other classes. There were high rates of binge eating in Class 2, and more than 92% of those in this class reported eating when not hungry. Class 4 was characterized by a higher BMI at baseline. Adults in Class 4 lost an average of 25.0% (males) and 30.3% (females) of their baseline weight over 3 years. In contrast with participants in Class 1, those in Classes 2 and 3 had significantly larger 3-year weight losses than their peers in Class 4. CONCLUSIONS: Obesity is a heterogeneous disease. Bariatric surgery may be most beneficial for adults with disordered eating.
OBJECTIVE: The study objective was to empirically identify subgroups of patients with obesity and investigate their association with postoperative weight change. METHODS: A longitudinal analysis of 2,458 adults in the Longitudinal Assessment of Bariatric Surgery (LABS) study was used. Baseline data were used to identify subgroups. The outcome was 3-year weight change after bariatric surgery. RESULTS: We identified four classes (subtypes) of obesity, which could be characterized as diabetes with low rates of high-density lipoprotein (Class 1), disordered eating (Class 2), mixed (Class 3), and extreme obesity with early onset (Class 4). Approximately 98% of participants in Class 1 had diabetes compared with < 40% in the other classes. There were high rates of binge eating in Class 2, and more than 92% of those in this class reported eating when not hungry. Class 4 was characterized by a higher BMI at baseline. Adults in Class 4 lost an average of 25.0% (males) and 30.3% (females) of their baseline weight over 3 years. In contrast with participants in Class 1, those in Classes 2 and 3 had significantly larger 3-year weight losses than their peers in Class 4. CONCLUSIONS:Obesity is a heterogeneous disease. Bariatric surgery may be most beneficial for adults with disordered eating.
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