Most recent update: Friday, June 22, 2018 - 09:50

Bariatric News - Cookies & privacy policy

You are here

Obesity treatment

Bariatric surgery betters non-surgical treatment of obesity

Diabetes remission was 22 times higher compared with non-surgical treatment
Glucose levels decreased more after Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion than after adjustable gastric banding
There were no perioperative deaths, cardiovascular events, or deaths during follow-up

Bariatric surgery results in greater body weight loss and higher remission rates of type 2 diabetes compared with non-surgical treatment of obesity, according to a systematic review and meta-analysis of randomised controlled trials published in the BMJ.

"Individuals allocated to bariatric surgery lost more body weight, on average 26kg (57.3lbs), compared with nonsurgical treatment, and had higher remission rates of type 2 diabetes and metabolic syndrome," said study author Dr Viktoria Gloy from the Basel Institute for Clinical Epidemiology and Biostatistics at University Hospital Basel in Switzerland. "After surgery, patients also reported greater improvements in quality-of-life measures, and had greater reduction in medication use than nonsurgical patients.”

The international study claims that the paper “provides comprehensive evidence” of the superior results that can be gained from surgery, however the study authors from Switzerland, Canada, the US and Italy, note that the evidence beyond two years of follow-up “remains unclear” and they call for additional research.

The paper aims to summarise and quantify the effects of bariatric surgery, compared with non-surgical treatment in randomised controlled trials on weight loss, cardiovascular risk factors, adverse events, and quality of life in individuals with a BMI≥30.

The researchers included randomised controlled trials with ≥6 months of follow-up (BMI≥30), and from a total of 1988 records, 11 studies (n=796) were eligible and included in the meta-analysis.

Outcomes

The meta-analysis included 11 studies with 796 individuals. Bariatric patients were reported to have lost more body weight (mean 26kg) than individuals after non-surgical treatment (p<0.001). Body weight loss was not significantly different between surgically treated individuals who additionally received the same treatment as the non-surgical treatment group (p=0.24) and individuals after bariatric surgery who received a different accompanying treatment.

Diabetes remission was 22 times higher (p=0.002) compared with non-surgical treatment and the relative risk to achieve metabolic syndrome remission was 2.4 times higher (p<0.001) compared with non-surgical treatment.

The mean changes systolic (p=0.32) and diastolic (p=0.77) blood pressure were not significantly different between bariatric surgery and non-surgical treatment. Although the mean changes in triglyceride decreased more after bariatric surgery (p<0.001) than after non-surgical treatment.

The mean changes in total cholesterol concentration was not significantly different between bariatric surgery and non-surgical treatment (p=0.05), but changes in high density lipoprotein cholesterol concentration increased more after bariatric surgery than after non-surgical treatment (p<0.001). Whilst the mean changes in low density lipoprotein cholesterol concentration not significantly different between the two groups (p=0.06).

Bariatric surgery patients also saw a decrease in glucose levels compared with non-surgical patients (p<0.001). Glucose levels decreased more after Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion than after adjustable gastric banding (p<0.001) for all patients, as well as for studies which included patients with diabetes only.

Mean changes in glycated haemoglobin HbA1c also decreased more after bariatric surgery than after non-surgical treatment (p<0.001).

Adverse events

There were no perioperative deaths, cardiovascular events, or deaths during follow-up. After bariatric surgery, 21/261 (8%) individuals required reoperations (15/124 after adjustable gastric banding, 4/69 after Roux-en-Y gastric bypass, 1/49 after sleeve gastrectomy, 1/19 after biliopancreatic diversion). Other adverse events occurred after bariatric surgery as well as after non-surgical treatment: 29/194 (15%) developed iron deficiency anaemia after bariatric surgery other than adjustable gastric banding (21/126 Roux-en-Y gastric bypass, 6/49 sleeve gastrectomy, 2/19 biliopancreatic diversion) and 3/169 (2%) after non-surgical treatment.

Depression developed in 1/261 of surgically treated and in 1/55 of non-surgically treated individuals.

Conclusion

“This meta-analysis provides comprehensive evidence that, compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome,” the authors conclude. “Results are limited to two years’ follow-up and based on a small number of studies and individuals. The evidence beyond two years of follow-up, in particular on adverse events, cardiovascular diseases, and mortality remains unclear and calls for further research on the topic.”

To access this article, please click here

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.