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Surgery vs. non-surgery

Bypass more beneficial than non-surgical treatment

Surgery results in weight loss and diabetes resolution
Reduction in weight lessens cardiovascular burden
Dr Sheldon Litwin (Credit: Georgia Health Sciences University)

A six-year study assessing the association of Roux-en-Y gastric bypass with weight loss, diabetes mellitus and other health risks, has concluded that it is more beneficial than non-surgical treatment.

“I am seeing 25-year-olds weighing 350lbs who present with chest pain or shortness of breath,” said Dr Sheldon Litwin, a preventive cardiologist and Chief of the Medical College of Georgia Section of Cardiology at Georgia Health Sciences University, and co-author of the study. “The problem is of enormous magnitude. Everything from the heart disease process to its diagnosis and treatment are affected by obesity. We see it every day. This really is the number-one issue facing us.”

Research

Bariatric surgery is known to accelerate weight loss much faster than lifestyle modifications, and thereby lessen heart disease risk. As a result, Litwin and colleagues decided to investigate whether gastric bypass was more beneficial that lifestyle intervention.

Between July 2000 and June 2011, 1,156 severely obese (BMI≥ 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) were recruited. The subjects were divided into three groups: patients who sought and received bypass surgery (n=418), those who sought but did not have surgery (n=417; control group 1), or those who were randomly selected from a population-based sample not seeking weight loss surgery (n=321; control group 2).

The main outcome measures were weight loss, diabetes, hypertension, dyslipidemia and health-related quality of life measures, using propensity score adjustment.

Outcomes

Six years after surgery, patients who received bypass surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight, compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2.

Weight loss maintenance was also superior in bypass patients with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving surgery maintaining at least 20% weight loss two and six years post- surgery, respectively.

Diabetes remission rates six years post-surgery were 62% (95% CI, 49%-75%) in the surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs. control group 1 and 21.5 (95% CI, 5.4-85.6; p<0.001) vs control group 2.

The incidence of diabetes throughout the course of the study was reduced after surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both p<0.001). The numbers of participants with bariatric surgery-related hospitalisations were 33 (7.9%), 13 (3.9%), and six (2.0%) for the surgery group and 2 control groups, respectively.

"I would much rather see everybody out there riding their bikes, walking, running, going to the gym. No question that is better than having surgery," said Litwin. “However, surgery may be the only thing that enables many obese individuals to make these healthy lifestyle changes.”

He explained that patients who are not candidates for surgery or other invasive treatments, are typically prescribed a drug regimen based on symptoms.

“This long-term study provides an objective assessment of what we see every day: bariatric surgery helps many patients make a healthy transformation, inside and out,” said Dr Michael A. Edwards, Director of the GHS Health System Weight Loss Center and Chief of the MCG Section of Minimally Invasive and Digestive Disease Surgery. “Critical to successful outcomes is proper screening to identify the best surgical candidates and the availability of a comprehensive weight loss team to complete a thorough health assessment, provide bariatric surgery options and provide support and information to make long-term healthy lifestyle changes.”

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