Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial

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Abstract

Objective: Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. Methods: In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30–39.9 kg/m 2 , we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. Results: Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL − 5.2%, AGB − 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB − 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB − 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB − 12.38%, RYGB − 7.29%, p = 0.15). Conclusions: At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. Clinical Trial Registration: NCTDK089557 – ClinicalTrials.gov.

Original languageEnglish (US)
JournalObesity Surgery
DOIs
StatePublished - Jan 1 2019

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Body Composition
Weight Loss
Gastric Bypass
Intra-Abdominal Fat
Stomach
Body Mass Index
Fats
Bariatric Surgery
Photon Absorptiometry
Adiposity
African Americans
Type 2 Diabetes Mellitus
Tomography
Clinical Trials

Keywords

  • Bariatric surgery
  • Body composition
  • Clinical trial
  • Weight loss

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

@article{a64edf95ee944e27a2dfd6667bf31130,
title = "Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial",
abstract = "Objective: Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. Methods: In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30–39.9 kg/m 2 , we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10{\%}WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. Results: Twelve female participants (75{\%} African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL − 5.2{\%}, AGB − 10.3{\%}, p = 0.021) and VAT (MWL + 10.9{\%}, AGB − 28.0{\%}, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9{\%}, RYGB − 20.2{\%}, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB − 12.38{\%}, RYGB − 7.29{\%}, p = 0.15). Conclusions: At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. Clinical Trial Registration: NCTDK089557 – ClinicalTrials.gov.",
keywords = "Bariatric surgery, Body composition, Clinical trial, Weight loss",
author = "Sanskriti Varma and Clare Lee and Brown, {Todd T} and Nisa Maruthur and Schweitzer, {Michael A} and Thomas Magnuson and Kamel, {Ihab R} and Jeanne Clark",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11695-019-03879-4",
language = "English (US)",
journal = "Obesity Surgery",
issn = "0960-8923",
publisher = "Springer New York",

}

TY - JOUR

T1 - Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition

T2 - a Pilot Randomized Trial

AU - Varma, Sanskriti

AU - Lee, Clare

AU - Brown, Todd T

AU - Maruthur, Nisa

AU - Schweitzer, Michael A

AU - Magnuson, Thomas

AU - Kamel, Ihab R

AU - Clark, Jeanne

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. Methods: In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30–39.9 kg/m 2 , we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. Results: Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL − 5.2%, AGB − 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB − 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB − 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB − 12.38%, RYGB − 7.29%, p = 0.15). Conclusions: At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. Clinical Trial Registration: NCTDK089557 – ClinicalTrials.gov.

AB - Objective: Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. Methods: In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30–39.9 kg/m 2 , we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. Results: Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL − 5.2%, AGB − 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB − 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB − 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB − 12.38%, RYGB − 7.29%, p = 0.15). Conclusions: At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. Clinical Trial Registration: NCTDK089557 – ClinicalTrials.gov.

KW - Bariatric surgery

KW - Body composition

KW - Clinical trial

KW - Weight loss

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DO - 10.1007/s11695-019-03879-4

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SN - 0960-8923

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