Study details

For the study, researchers analyzed outcomes of 133 patients for Roux-en-Y gastric bypass between September 2018 and December 2020 using data from the Bariatric Surgery Rijnstate and Radboundumc Neuroimaging and Cognition in Obesity study.

The patients in the study were between the ages of 35 and 55 with a body mass index (BMI) over 40 or a BMI over 35 with comorbidities. Over 80% of the patients in the cohort were women.

The researchers assessed patients before their surgery, six months after their surgery, and two years following their surgery. They found that at both six months and two years following surgery, patients' body weight, BMI, waist circumference, and blood pressure were all significantly lower than before surgery. In addition, the percentage of total body weight loss increased from an average of 27% at six months to 34% at two years.

Researchers also noted cognitive benefits in patients following their surgery. Two years post-surgery, neuropsychological tests showed improvements of 20% or greater in global cognition (among 43% of patients), ability to shift attention (40%), episodic memory (32%), verbal fluency (24%), and working memory (11%).

The researchers also found that two years post-surgery, the proportion of patients with Beck Depression Inventory scores showing mild depressive symptoms declined from 42.3% before their surgery to 9.4%, and from 3.1% to 1.6% for moderate depressive symptoms.

The researchers noted that a high mean baseline score of 27 on the Montreal Cognitive Assessment and other neuropsychological assessments suggested "obesity did not impair cognitive performance in clinical sense."

Discussion

Previous studies have suggested bariatric surgery-induced weight loss could be associated with improved brain function, the researchers noted.

"However, results are contradictory, underlying mechanisms remain largely unknown, and it is uncertain whether outcomes are long-lasting," they wrote.

The researchers hypothesized that "[l]ower inflammation and adipokine secretion, remission of comorbidities, higher physical activity, and better mood" could have played a role in sustained improvement of global cognition.

They also noted that the stabilization of cerebral structure and functions was the most significant finding of their study.

"Despite the lower [cerebral blood flow (CBF)] in several regions, volumes of hippocampus, nucleus accumbens, frontal cortex, white matter, and white matter hyperintensities remained stable after surgery," they wrote. "Notably, the temporal cortex exhibited not only higher cortical thickness but also higher vascular efficiency after surgery, as indicated by a lower sCOV [spatial coefficient of variation]. These results highlight beneficial vascular responses occurring in conjunction with bariatric surgery. Accordingly, nucleus accumbens and parietal cortex demonstrated stable CBF and cerebrovascular efficiency."

Advisory Board's bariatric surgery-related resources

In 2022, the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders  updated guidelines  for weight-loss surgery, expanding eligibility for more people.

Under the new guidelines, anyone with a BMI over 35, regardless of whether they have any health problems, is eligible for weight loss surgery. People with a BMI over 30, which is the official definition of obesity, are also eligible if they have not been able to achieve substantial or long-term weight loss.

This expert insight outlines three barriers to bariatric surgery and how to overcome them. For patients considering bariatric surgery, this resource offers  three factors they should keep in mind  while they decide.

Meanwhile, this decision guide offers resources to help you build a successful weight management program that effectively attracts new patients struggling with obesity, guides patients through their care journey, and keeps patients engaged in the long term. (Kneisel, MedPage Today, 12/12)

Hospital and health system leaders worry that Wegovy and similar weight management medications will erode their bariatric surgery volumes and revenue. However, when health systems and providers provide comprehensive obesity care, they can drive growth for surgical services by improving outcomes, increasing volume, and decreasing costs.