Weight-Loss Surgery: Durable in the Long-Term

Benefits of gastric bypass surgery

In a recent report about the long term benefits of gastric bypass surgery good results were still being seen 12 years post-operative, an observational study found. People with severe obesity who underwent Roux-en-Y gastric bypass reported a sustained body weight reduction 12 years following surgery (-77.2 lbs from baseline, 95% CI -84.7 to -70.0, mean % change -26.9%), according to Ted D. Adams, PhD, MPH, of Intermountain Healthcare, and colleagues in the New England Journal of Medicine. Previously reported 2-year and 6-year observational data from this cohort were published by the research group to assess the clinical outcomes of patients who underwent gastric bypass, and was later ” broadened to include the durability and long-term outcomes of gastric bypass compared to severely obese patients who did not undergo surgical intervention,” Adams told MedPage Today. “We hoped to see similar favorable outcomes at 12 years.” With over a 90% follow-up rate at 12-years, the analysis included 1,156 severely obese patients — 418 of whom underwent Roux-en-Y gastric bypass. Comprising of two nonsurgical comparative groups, there were 417 patients who sought out surgery, but did not undergo surgery mainly due to insurance coverage (non-surgery group 1). ‘Nonsurgery group 2’ comprised of a total of 321 severely obese people, who did not seek out surgery. All nonsurgery participants were not provided with any study-based weight loss therapy, however, they were free to independently pursue such intervention. After 12 years, neither nonsurgery group achieved a significant mean change in weight loss:
  • Group 1: -6.4 lbs (-15.2 to -2.2, mean change -2.0%)
  • Group 2: -0.0 lbs (-7.7 to 7.7, mean change -0.9%)
Two years after gastric bypass, the surgery group reported a significant adjusted mean body weight change of -99.2 lbs from baseline (95 % CI -104.1 to 94.6 lb; mean percent change -35.0%). Similar benefits were also seen at 6 years out of surgery, with a sustained loss of -80.0 lbs mean body weight change from baseline (95% CI, -86.0 to -73.9 lb, mean percent change -28.0). “The fact that the mean 12-year percent weight loss from baseline was very similar to that measured at 6 years follow-up was somewhat of a surprise,” Adams noted. Weight loss wasn’t the only benefit sustained 12 years after surgery. Two years post-op, 75% of surgery patients with type 2 diabetes achieved remission (66 of 88), and 62% sustained 6-years post-op (54 of 87). At the 12-year follow-up, over half of patients who had type 2 diabetes at time of surgery remained in remission (43 of 84, 51%), with Adams calling this finding “encouraging.” The odds ratio for incidence diabetes versus nonsurgery 1 was 0.08 (95% CI 0.03-0.24), while the OR for incidence diabetes versus nonsurgery 2 was 0.09 (95% CI 0.03-0.29)(P<0.001 for both). Rates of diabetes remission were largely predicted by therapies used at baseline. Surgery patients who were not receiving antidiabetic medications as baseline were more likely to achieve remission after surgery (73%, 95% CI 46-99, 16 of 22), while 56% of those who were receiving oral medications at baseline achieved post-op remission (95% CI 35-77, 24 of 43). Only 16% of patients receiving insulin with or without other oral agents at baseline achieved remission (95% CI -8 to 39, three of 19). However, even in surgery patients who did not achieve remission, a significant improvement was still reported after 12 years, with a decreased mean in the amount of antidiabetic medications compared to both nonsurgery group 1 (-0.3± versus 0.8, P=0.002) and nonsurgery group 2 (-0.3 versus 1.1, P<0.001). Several cardiovascular-related benefits were also reported after 12 years among the surgery group, with significant remission rates reported for HDL cholesterol, LDL cholesterol, and triglyceride levels compared to both nonsurgical groups. Long term hypertension benefit was also reported following surgical intervention, although rate of remission was only significant when compared to the first nonsurgical group (adjusted OR 5.1, 95% CI 1.7-15.6, P<0.001). In a statement to MedPage Today, Paul Thodiyil, MD, director of the Bariatric Surgery Program at Mount Sinai Beth Israel, called this study “important,” and praised the long-term follow-up to assess the benefits of bariatric surgery, and specifically, the gastric bypass procedure. “While, sadly, it confirms an increased incidence of suicides in those undergoing weight loss surgery [five in the surgery group; two in nonsurgery group 1], the overall gains are substantial,” said Thodiyil, referring to the significant weight loss and diabetes benefits sustained long term. He was not involved with the study,
 Adams said that his group hopes to continue to follow both the surgical and nonsurgical participant cohorts into the future

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