Background

Sex is increasingly recognized as a biologic variable in the pathophysiology of obesity and its associated metabolic disorders. However, the effect of sex on metabolic recovery following RYGB is incompletely understood. We used an objective scoring system, Assessment of Obesity-related Metabolic Comorbidities (AOMC), to assess sex-specific metabolic responses to RYGB.

Methods

AOMC combines medication and biochemical data to assess severity of diabetes (DM), hypertension (HTN), and dyslipidemia (DYS) on a 6-point scale. Weight loss data and AOMC scores were calculated pre- and post-RYGB over five years at our academic institution. AOMC trends were tested with Wilcoxon signed-rank test (pairwise) and the Jonckheere-Terpstra test (>2 groups).

Results

Of 350 patients, men were underrepresented (23.4% vs. 76.6%, p<0.05). Race/ethnicity and insurance type did not differ by sex (Table 1A). Preoperatively, men presented at higher weight (148.4kg vs. 130.3kg, p<0.05) and with more severe HTN compared to women (Table1B), but BMI, DM, and DYS severity were similar. Post-operatively, men continued to have higher weight and HTN severity compared to women (Figure, p<0.05). However, the relative decrease in HTN severity scores was equal between sexes. Consistent and sustained improvement in total weight loss, DM and DYS severity was the same between sexes.

Conclusions

Our study reinforces that men are disproportionately underutilizing bariatric surgery despite presenting with more severe HTN. We found this resulted in worse weight and HTN response to RYGB. There is a need for increased awareness of bariatric surgery for men and earlier referral to address HTN.