Background

The impact of race and socioeconomic characteristics on metabolic recovery following RYGB is incompletely understood. We assessed how race/ethnicity and insurance type influenced metabolic response to RYGB.

Methods

We developed an objective scoring system, the Assessment of Obesity-related Metabolic Comorbidities (AOMC), to accurately assess the severity of metabolic diseases by combining treatment and biochemical data to assign a severity score on a 6-point scale. AOMC scores were calculated for diabetes (DM), hypertension (HTN), and dyslipidemia (DYS) pre- and post-operatively (1-, 2-, and 5-years) in patients who underwent RYGB from 2012-2016 at our academic institution. AOMC trends were tested with Wilcoxon signed-rank test (pairwise) and the Jonckheere-Terpstra test (>2 groups).

Results

Of 351 patients, 57% identified as non-Hispanic White, 13% Black, and 16% Hispanic. Race/ethnicity was significantly associated with private versus public insurance type or uninsured status (Table, p<0.05). Preoperative DM (p=0.25), HTN (p=0.38), or DYS (p=0.38) AOMC scores did not differ among racial/ethnic groups. Despite an equal degree of improvement of all scores at 1- and 2-years postoperatively in all groups, at 5 years, some scores returned to baseline in Black patients (HTN and DYS) and Hispanic patients (DYS) (Figure).

Conclusions

Racial/ethnic discrepancies in long-term durability of metabolic improvement exist and differ by disease. Variability in insurance type between groups may relate to treatment access and consequent metabolic disease control. Such data can enhance patient education regarding the expectations for metabolic recovery following RYGB and signal the importance of adjuvant treatments to surgery in high-risk racial/ethnic groups.