HbA1c and psychologic variables predict body weight reduction up to 3 years after sleeve-gastrectomy

Context: Sleeve gastrectomy (SG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss represents a clinical problem. We have shown that metabolic and psychologic variables at baseline may explain more than 30% of the variability of the response in the short term following the surgical procedure. Objective: To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) 3 years after surgery. Design: Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2020. Patients: A total of 86 obese patients underwent SG with pre-surgery evaluation and follow-up to 3 years after surgery. Results: Patients who achieved a %TWL higher than the observed median (≥33.4%) were younger (39±10 vs 47±10 years; p<0.001), with a lower HbA1c (5.6±0.5 vs 6.2±1.1%; p<0.02), lower systolic blood pressure (120±10 vs 131±16 mmHg; p<0.003), higher proportion of active smokers (42.9 vs 18.6%; p<0.05) and with a lower score in the impulsiveness scale (17.7±3.2 vs 19.5±3.5; p<0.02; p<0.001), compared with patients with a %TWL<33.4%. Multivariable stepwise regression analysis showed that younger age, lower score of impulsiveness, and lower HbA1c were associated with higher %TWL, explaining 30% of the weight loss (R2: 0.303; beta -0.216; p<0.03). Conclusion: HbA1c and psychologic features at baseline were independently associated with weight loss up to 3 years following the procedure, and explained a non-negligible effect on the response to SG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for SG.