Obesity Subtypes and Short Term Weight Loss After Vertical Sleeve Gastrectomy: A Retrospective Cohort Study

Raj Shah, Anand Nath, Timothy R Shope, Ivanesa L Pardo Lameda, John S Brebbia, Timothy R Koch


AIM: Vertical sleeve gastrectomy has become the most common surgical intervention for medically-complicated obesity.  This study examines the hypothesis that a clinical subtype of obesity (psychosocial factors, genetic risk, or early life endocrine disruptors termed obesogens) can identify the best candidates for vertical sleeve gastrectomy.

MATERIALS AND METHODS: This is a retrospective cohort study of 225 consecutive new individuals with medically-complicated obesity seen preoperatively in outpatient bariatric clinic in an urban community teaching hospital.  Eighty-four individuals underwent sleeve gastrectomy with a minimum of 6 months of follow up.

RESULTS: Among 3 subtypes, early life obesogen exposure has been identified in 14.5% of individuals, genetic risk in 24.5% of individuals, and psychosocial factors in 61% of individuals. Percent excess weight loss (mean+/-SD) at 6 months is different among the three groups (pANOVA=.024).  Individuals with genetic risk (38%+/-14) have significantly less weight loss (p=.029) than individuals with psychosocial factors (47%+/-15), while there is no difference compared to the obesogen subtype (41%+/-8.9).

CONCLUSION: The most common clinical subtype of obesity is psychosocial factors, and there is significantly higher short term weight loss after sleeve gastrectomy in individuals with psychosocial factors.  Weight loss may be limited by an individual’s genetic risk and early life obesogen exposure.  A prospective study is required to confirm these findings.


Obesity; Bariatric Surgery; Bariatrics; Psychosocial Factors; Weight Loss


Reilly JJ, El-Hamdouchi A, Diouf A, Monyeki A, Somda SA. Determining the worldwide prevalence of obesity. Lancet 2018; 391(10132): 1773-1774 [DOI: 10.1016/S0140-6736(18)30794-3]

Jensen MD, Ryan D, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129(25 Suppl 2): S102-138 [DOI: 10.1161/01.cir.0000437739.71477.ee]

Hebebrand J, Hinney A. Environmental and genetic risk factors in obesity. Child Adolesc Psychiatr Clin N Am 2009; 18(1): 83-94 [DOI: 10.1016/j.chc.2008.07.006]

Heindel JJ, Blumberg B. Environmental obesogens: mechanisms and controversies. Annu Rev Pharmacol Toxicol 2019; 59: 89-106 [DOI: 10.1146/annurev-pharmtox-010818-021304]

Shahnazaryan U, Wójcik M, Bednarczuk T, Kuryłowicz A. Role of obesogens in the pathogenesis of obesity. Medicina (Kaunas) 2019; 55(9): 515 [DOI: 10.3390/medicina55090515]

Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clinic Proc 2017; 92(2): 251-265 [DOI: 10.1016/j.mayocp.2016.09.017]

Koch TR, Shope TR, Camilleri M. Current and future impact of clinical gastrointestinal research on patient care in diabetes mellitus. World J Diabetes 2018; 9(11): 180-189 [DOI: 10.4239/wjd.v9.i11.180]

Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc 2020; 34(6): 2332-2358 [DOI: 10.1007/s00464-020-07555-y]

Sharbaugh ME, Shope TR, Koch TR. Will gastroenterologists be successful as metabolic physicians? J Gastroent Hep Res 2020; 9(2): 3101-3106 [DOI: 10.17554/j.issn.2224-3992.2020.09.908] Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/2833

Andalib I, Hsueh W, Shope TR, Brebbia JS, Koch TR. Prevalence of irritable bowel syndrome in morbidly obese individuals seeking bariatric surgery. J Gastroenterol Hepatol Res 2018; 7(1): 2516-2520 [DOI: 10.17554/j.issn.2224-3992.2018.07.747] Available from: URL: http://www. ghrnet.org/index.php/joghr/article/view/2208

El Ansari W, Elhag W. Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review. Obes Surg 2021; 31(4): 1755-1766 [DOI: 10.1007/s11695-020-05160-5]

Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: A meta-analysis. JAMA 2016; 315(2): 150-163 [DOI: 10.1001/jama.2015.18118]

Cottam S, Cottam D, Cottam A. Sleeve gastrectomy weight loss and the preoperative and postoperative predictors: a systematic review. Obes Surg 2019; 29: 1388–1396 [DOI: 10.1007/s11695-018-03666-7]

Karpińska IA, Kulawik J, Pisarska-Adamczyk M, et al. Is it possible to predict weight loss after bariatric surgery?—External validation of predictive models. Obes Surg 2021; 31: 2994–3004 [DOI: 10.1007/s11695-021-05341-w]

Egusquiza RJ, Blumberg B. Environmental obesogens and their impact on susceptibility to obesity: New mechanisms and chemicals. Endocrinology 2020; 161(3): 2020, 161(3):1–14 [DOI: 10.1210/endocr/bqaa024]

Grun F, Watanabe H, Zamanian Z, et al. Endocrine-disrupting organotin compounds are potent inducers of adipogenesis in vertebrates. Mol Endocrinol 2006; 20(9): 2141-2155 [DOI: 10.1210/me.2005-0367]

Le Maire A, Grimaldi M, Roecklin D, et al. Activation of RXR–PPAR heterodimers by organotin environmental endocrine disruptors. EMBO Reports 2009; 10(4): 367-373 [DOI: 10.1038/embor.2009.8]

Liu B, Sun Y, Lehmler H-J, Bao W. Association between urinary tin concentration and diabetes in nationally representative sample of US adults. J Diabetes 2018; 10(12): 977-983 [DOI: 10.1111/1753-0407.12798]

Völker J, Ashcroft F, Vedøy Å, Zimmermann L, Wagner M. Adipogenic activity of chemicals used in plastic consumer products. Environ Sci Technol 2022; 56(4): 2487-2496 [DOI: 10.1021/acs.est.1c06316]

Janesick AS, Shioda T, Blumberg B. Transgenerational inheritance of prenatal obesogen exposure. Mol Cell Endocrinol 2014; 398(1-2): 31-35 [DOI: 10.1016/j.mce.2014.09.002]

Hatoum IJ, Greenawalt DM, Cotsapas C, Reitman ML, Daly MJ, Kaplan LM. Heritability of the weight loss response to gastric bypass surgery. J Clin Endocrinol Met 2011; 96(10): E1630-E1633 [DOI: 10.1210/jc.2011-1130]

Yengo L, Sidorenko J, Kemper KE, Zheng Z, Wood AR, Weedon MN, & GIANT Consortium. Meta-analysis of genome-wide association studies for height and body mass index in∼ 700000 individuals of European ancestry. Human Mol Genetics 2018; 27(20): 3641-3649 [DOI: 10.1093/hmg/ddy271]

Neff KJ, Olbers T, Le Roux CW. Bariatric surgery: The challenges with candidate selection, individualizing treatment and clinical outcomes. BMC Medicine 2013; 11(1): 1-17 [DOI: 10.1186/1741-7015-11-8]

Mul JD, Begg DP, Alsters SI, et al. Effect of vertical sleeve gastrectomy in melanocortin receptor 4-deficient rats. Am J Phys Endocrinol Met 2012; 303(1): E103-E110 [DOI: 10.1152/ajpendo.00159.2012]

Sarwer DB, Allison KC, Wadden TA, et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Rel Dis 2019; 15(4): 650-655 [DOI: 10.1016/j.soard.2019.01.029]

Zakeri R, Batterham RL. Potential mechanisms underlying the effect of bariatric surgery on eating behaviour. Curr Opin Endocrinol Diabetes Obes 2018; 25(1): 3-11 [DOI: 10.1097/MED.0000000000000379]

King WC, Chen JY, Courcoulas AP, et al. Alcohol and other substance use after bariatric surgery: Prospective evidence from a US multicenter cohort study. Surg Obes Rel Dis 2017; 13(8): 1392-1402 [DOI: 10.1016/j.soard.2017.03.021]

Heinberg LJ, Lavery ME. Psychosocial issues after bariatric surgery. In Still CD, Sarwer DB, Blankenship J (eds). The ASMBS Textbook of Bariatric Surgery Volume 2: Integrative Health. New York: Springer, 2014: 43–54

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