Key points
- Two years after surgery, about 1 in 5 men had not reached the benchmark of at least 20% total body weight loss, compared with roughly 1 in 11 premenopausal women.
- Prior to surgery, men and postmenopausal women presented with more health conditions than premenopausal women.
- Men and postmenopausal women experienced more complications after surgery than premenopausal women, including higher postoperative bleeding rates.
Even with the rise of GLP-1-based drugs, bariatric weight-loss surgery remains an effective intervention for many people living with obesity. But does everyone benefit from the surgery equally?
Research published in Clinical Nutrition by Mireille Serlie, MD, PhD, professor of medicine (endocrinology and metabolism) at Yale School of Medicine and colleagues, evaluated sex differences in health status before and outcomes after bariatric surgery among men, premenopausal women, and postmenopausal women. Bariatric surgery, also called metabolic surgery, is an operation that alters a person’s digestive system to help them lose weight
The researchers found that overall, men had more health conditions going into surgery and lost less weight after surgery. Postmenopausal women showed a similar pattern but to a lesser extent
For the study, Serlie and colleagues used the national bariatric surgery registry in the Netherlands, which included more than 17,000 participants who underwent one of two types of bariatric surgery, gastric bypass or sleeve gastrectomy. Nearly two-thirds of the participants were premenopausal women, 22% were men, and 16% were postmenopausal women. Serlie was drawn to examining these distinct groups because historically, studies on bariatric surgery comprised mostly female patients in their 40s, which may not be representative of the overall population with obesity, she says.
We can’t define success just based on weight loss
Prior to the procedure, men and postmenopausal women had more health conditions, such as hypertension, type 2 diabetes and dyslipidemia, than premenopausal women. Notably, the men were younger than the postmenopausal women and closer in age to the premenopausal group yet carried a comparable disease burden. Postmenopausal women experienced more postoperative complications within 30 days after the surgery than premenopausal women, and men and postmenopausal women had higher postoperative bleeding rates.
Two years after surgery, about 1 in 5 men had not reached a commonly used benchmark for successful weight loss, a loss of at least 20% of total body weight, compared with roughly 1 in 11 premenopausal women. Whether that benchmark is the right measure of success is a separate question, and one Serlie thinks deserves more attention
Fat distribution matters
One plausible explanation for the higher prevalence of cardiometabolic disease in men and postmenopausal women undergoing bariatric surgery is increased visceral fat, says Serlie
Visceral fat is packed deep in the abdomen around and between the organs, manifesting as a higher waist circumference. This type of fat distribution is associated with a higher risk for developing conditions such as cardiovascular disease or diabetes, as opposed to subcutaneous fat, which is directly under the skin
Surgery eligibility is primarily driven by BMI; however, there is a movement to consider waist circumference because of the associated risks While men with larger waist circumferences may not have as high of a BMI, Serlie recommends that clinicians consider weight loss interventions sooner in men before obesity-related health conditions develop
Serlie and colleagues are now studying determinants of weight loss success after bariatric surgery. They also plan to look at metabolic benefits beyond weight loss. “We can’t define success just based on weight loss,” she says. “Weight loss is obviously a goal, but the ultimate goal is to improve health.”
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Endocrinology and Metabolism, one of 10 sections in the Yale Department of Internal Medicine, improves the health of individuals with endocrine and metabolic diseases by advancing scientific knowledge, applying new information to patient care, and training the nextgeneration of physicians and scientists to become leaders in the field. To learn more, visit Endocrinology and Metabolism
