METABOLISM

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Gastric Bypass Surgery Can Work

 

Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain. As a result, a study published in the Journal of the American Medical Association (2012;308:1122-1131), was performed to examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery.

 

The investigation was a prospective study conducted in Utah between July 2000 and June 2011. The study included 1,156 severely obese (BMI > 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9) who:

 

  1. sought and received RYGB surgery (n=418)
  2. sought but did not have surgery (n = 417; control group 1)
  3. 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 were compared between participants having RYGB surgery and control participants.

 

Results showed that 6 years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% of their initial body weight compared with 0.2% gain in control group 1 and 0% in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% and 76% of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively.

 

Diabetes remission rates 6 years after surgery were 62% in the RYGB surgery group, 8% in control group 1, and 6% in control group 2, with remission odds ratios (ORs) of 16.5; P < .001) vs. control group 1 and 21.5; P < .001) vs. control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery. The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively.

 

According to the authors, among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years.

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