New analysis of bariatric surgery supports its use

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As we ve noted recently, there is widespread acceptance of the utility of bariatric surgery for severely obese individuals. However, according to a report in JAMA Surgery, there has not been a comprehensive review of and comparison between the various types of bariatric surgery since 2003. Thus, Dr. Su hsin Chang of the Washington University School of Medicine and colleagues performed a meta-analysis of research performed since 2003 to examine the risks, benefits and efficacy of several bariatric procedures.

After an extensive literature review, the researchers included a total of 164 studies; 37 randomized clinical trials, and 127 observational studies. There were nearly 162,000 individuals, aged 45 years on average, whose BMI was nearly 46, which put them in the extremely obese category.

There were five categories of treatment evaluated: Gastric bypass, adjustable gastric banding, vertical banded gastroplasty, sleeve gastrectomy, and non-surgical intervention.For each type of treatment, decrease in BMI, surgical complications, death within 30 days of surgery were assessed, as was the rate of reoperation. Remission of comorbidities such as diabetes were defined as the proportion of the surgery patients who reported a condition being either resolved or improved post-surgery.

In a relatively complicated statistical analysis, the researchers found that the surgical patients lost between 12 and 17 BMI units by 5 years post-surgery. The mortality rate was lower than had been previously reported: Only 0.08 percent. Participants undergoing gastric bypass surgery lost the most weight, but also had more complications. Adjustable gastric banding had lower complication rates, but higher reoperation rates as well as less weight loss.

"The take home message from this meta-analysis," commented ACSH's Dr. Ruth Kava, "is that bariatric surgery is effective, and it seems that as it is performed more frequently the rates of mortality drop. Even more important than the magnitudes of weight loss, is the amelioration of comorbid conditions such as diabetes. No other form of obesity treatment has yet shown such positive results."