Patients Continue to Experience Benefits 3 Years After Weight-Loss Surgery for Severe Obesity

Anita P. Courcoulas, MD, MPH, director of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center, and colleagues found that 3 years after undergoing bariatric surgery for severe obesity, patients had, on average, lost a substantial amount of weight and improved on several health measures. (Image: University of Pittsburgh Medical Center)

Anita P. Courcoulas, MD, MPH, director of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center, and colleagues found that 3 years after undergoing bariatric surgery for severe obesity, patients had, on average, lost a substantial amount of weight and improved on several health measures. (Image: University of Pittsburgh Medical Center)

More encouraging data are emerging on the benefits of bariatric surgery in reducing substantial amounts of weight and improving health in severely obese patients, according to a study published by JAMA.

Researchers with the Longitudinal Assessment of Bariatric Surgery Consortium, a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse regions of the country looked at health measures for severely obese patients 3 years after weight-loss surgery. Patients who had undergone Roux-en-Y gastric bypass surgery had lost about 90 pounds, or about 30% of their original weight; those who had undergone laparoscopic adjustable gastric banding lost about 44 pounds, or about 16% of their original weight. The median presurgical weight for both groups was about 284 pounds.

The researchers also found among study participants who had diabetes at the time of surgery, partial remission of the disease occurred in about two-thirds of those undergoing Roux-en-Y bypass and just over a quarter of those undergoing gastric banding. Abnormal blood lipid levels were eliminated in about 62% of patients after Roux-en-Y bypass and in about 27% after gastric banding. Hypertension resolved in almost 40% of patients with Roux-en-Y bypass and in almost 20% of patients with gastric banding.

Lead author Anita P. Courcoulas, MD, MPH, director of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center, discusses her team’s findings.

news@JAMA: Why did you do the study?

Dr Courcoulas: Our focus was to look at the durability of weight and health changes after bariatric surgery in a carefully studied, heterogeneous population with a high degree of follow-up.

news@JAMA: These patient populations had different results based on the procedure performed. Why is that?

Dr Courcoulas: Our study didn’t specifically address the potential mechanisms of weight change, nor was it designed to make head-to-head procedure comparisons. In our study, both bypass and banding did lead to substantial weight loss at 3 years that compares favorably to the modest weight loss resulting from lifestyle intervention alone. The weight loss after banding was less than reported in previous studies and not as large as the weight loss after bypass. This may be a function of patient, provider, and/or many other factors and deserves further attention.

news@JAMA: Given that Roux-en-Y bypass appears to outperform gastric banding, why not have everyone who needs bariatric surgery receive the bypass?

Dr Courcoulas: There are patients who come to see a bariatric surgeon who are not comfortable with bypass because of the anatomical changes they will undergo, so banding is appealing for those still wanting help to lose weight.

news@JAMA: So is bariatric surgery the best option for severely obese individuals looking to lose weight and improve health measures?

Dr Courcoulas: The extreme heterogeneity in outcomes we found highlights the need to better understand factors contributing to individual differences in weight loss results. It would make sense if one of the important variables in determining how much weight one will lose and how well that weight loss is maintained is lifestyle modification—how do you make the most of an operation to help enhance those results? Even so, longer-term follow-up is needed to determine the durability of the weight and health improvements we observed.



Categories: Bariatric Surgery, Diabetes Mellitus, Lipids and Lipid Disorders, Nutritional and Metabolic Disorders, Obesity