Metabolic disease severity after gastric bypass differs by sex, race, and ethnicity: trends using the Assessment of Obesity-related Metabolic Comorbidities scoring.

BACKGROUND

The impact of race, insurance type, and sex on metabolic recovery after Roux-en-Y gastric bypass (RYGB) is incompletely understood.

OBJECTIVES

Delineate how demographic factors influence metabolic outcomes after RYGB.

SETTING

University Hospital, United States.

METHODS

Assessment of Obesity-related Metabolic Comorbidities scores for type 2 diabetes (T2D), hypertension (HTN), and dyslipidemia (DYS) were determined for patients preoperatively and up to 5 years post-RYGB at a single academic institution. Generalized linear mixed-effect models were used to evaluate score trends and remission over time.

RESULTS

Of 351 patients, 63% identified as non-Hispanic White (WNH), 13% as Black/African-American (B/AA), and 18% as Hispanic/Latinx (H/L). Most patients were female (76.6%) and privately insured (81.5%). H/L patients had more severe preoperative T2D than B/AA patients (P = .012), but differences resolved by 5 years, and only H/L patients showed sustained T2D improvement (P = .014). WNH patients had greater preoperative DYS severity than B/AA patients (P = .010) and were the only group with significant improvement at 5 years (P = .018). B/AA patients were the only group without significant HTN improvement by 5 years postoperatively. Private insurance was associated with long-term improvements in T2D and HLD. Although HTN was more severe in men than in women both preoperatively and postoperatively (P < .05), they experienced similar relative HTN improvement after surgery. Sustained improvement in total weight loss, T2D, and DYS severity was similar between sexes.

CONCLUSIONS

Racial and ethnic discrepancies in long-term durability of metabolic improvement exist and differ by disease. Men are disproportionately underutilizing bariatric surgery and presenting with more severe HTN, which resulted in worse weight and HTN response to RYGB.