In the Journals

Long-term bariatric surgery outcomes favorable in severe obesity

Among adults with severe obesity, those who receive Roux-en-Y gastric bypass are more likely to sustain their weight loss and remain in remission for type 2 diabetes and hypertension compared with those who do not undergo surgery, according to findings published in The New England Journal of Medicine.

Ted D. Adams, PhD, MPH, of the Intermountain Live Well Center Salt Lake, Intermountain Healthcare and the division of cardiovascular genetics, department of internal medicine at the University of Utah School of Medicine in Salt Lake City, and colleagues evaluated data from an observational, prospective study initiated in July 2001 on adults with severe obesity who sought and underwent Roux-en-Y gastric bypass (RYGB; n = 418), sought but did not undergo RYGB (n = 417) and did not seek RYGB (n = 321) to determine weight and metabolic outcomes after 12 years. Participants were followed until March 2016.

Clinical examinations were performed by researchers at baseline and 2, 6 and 12 years to determine the presence of type 2 diabetes, hypertension and dyslipidemia.

In the surgery group, the mean change in body weight from baseline was –45 kg at 2 years (-35%), –36.3 kg at 6 years (-28%) and –35 kg (-27%) at 12 years. From baseline to year 12, the mean change in body weight was –2.9 kg (-2%) in participants who sought but did not undergo surgery and 0 kg (-1%) in participants who did not seek surgery.

From baseline to year 12, 93% of the surgery group maintained a 10% weight loss, 70% maintained a 20% weight loss and 40% maintained a 30% weight loss. All postsurgical weight loss was regained in four participants in the surgery group.

Participants who underwent surgery had a lower 12-year incidence of type 2 diabetes (3%) compared with both nonsurgical groups (26% for both). The odds of type 2 diabetes incidence were lower in participants who underwent surgery than participants who sought but did not undergo surgery (OR = 0.08; 95% CI, 0.03-0.24) and participants who did not seek surgery (OR = 0.09; 95% CI, 0.03-0.29). Participants who underwent surgery also had lower incidence rates of hypertension and dyslipidemia compared with the other two groups. Remission of type 2 diabetes was observed in 75% of the surgery group at 2 years, 62% at 6 years and 51% at 12 years. The odds for type 2 diabetes remission were higher in participants who underwent surgery than participants who sought but did not undergo surgery (OR = 8.9; 95% CI, 2-40) and participants who did not seek surgery (OR = 14.8; 95% CI, 2.9-75.5).

Participants who underwent surgery also had a higher remission rate of hypertension compared with participants who sought but did not undergo surgery (adjusted OR = 5.1; 95% CI, 1.7-15.6), but not compared with participants who did not seek surgery at 12 years.

“The results from the current 12-year follow-up of a U.S.-based, long-term, prospective study of bariatric surgery indicate long-term durability of weight loss after Roux-en-Y gastric bypass,” the researchers wrote. “The weight increase between the 6-year and 12-year follow-up was minimal, near complete prevention of new-onset type 2 diabetes was observed, and the remission rate of type 2 diabetes 12 years after surgery was 51%. Substantial improvement was also seen in systolic hypertension and lipid levels.” – by Amber Cox

Disclosure s : Adams reports he receives grant support from NIH – National Institute of Diabetes and Digestive and Kidney Diseases and personal fees from Intermountain Healthcare Inc. Please see the study for all other authors’ relevant financial disclosures.

Among adults with severe obesity, those who receive Roux-en-Y gastric bypass are more likely to sustain their weight loss and remain in remission for type 2 diabetes and hypertension compared with those who do not undergo surgery, according to findings published in The New England Journal of Medicine.

Ted D. Adams, PhD, MPH, of the Intermountain Live Well Center Salt Lake, Intermountain Healthcare and the division of cardiovascular genetics, department of internal medicine at the University of Utah School of Medicine in Salt Lake City, and colleagues evaluated data from an observational, prospective study initiated in July 2001 on adults with severe obesity who sought and underwent Roux-en-Y gastric bypass (RYGB; n = 418), sought but did not undergo RYGB (n = 417) and did not seek RYGB (n = 321) to determine weight and metabolic outcomes after 12 years. Participants were followed until March 2016.

Clinical examinations were performed by researchers at baseline and 2, 6 and 12 years to determine the presence of type 2 diabetes, hypertension and dyslipidemia.

In the surgery group, the mean change in body weight from baseline was –45 kg at 2 years (-35%), –36.3 kg at 6 years (-28%) and –35 kg (-27%) at 12 years. From baseline to year 12, the mean change in body weight was –2.9 kg (-2%) in participants who sought but did not undergo surgery and 0 kg (-1%) in participants who did not seek surgery.

From baseline to year 12, 93% of the surgery group maintained a 10% weight loss, 70% maintained a 20% weight loss and 40% maintained a 30% weight loss. All postsurgical weight loss was regained in four participants in the surgery group.

Participants who underwent surgery had a lower 12-year incidence of type 2 diabetes (3%) compared with both nonsurgical groups (26% for both). The odds of type 2 diabetes incidence were lower in participants who underwent surgery than participants who sought but did not undergo surgery (OR = 0.08; 95% CI, 0.03-0.24) and participants who did not seek surgery (OR = 0.09; 95% CI, 0.03-0.29). Participants who underwent surgery also had lower incidence rates of hypertension and dyslipidemia compared with the other two groups. Remission of type 2 diabetes was observed in 75% of the surgery group at 2 years, 62% at 6 years and 51% at 12 years. The odds for type 2 diabetes remission were higher in participants who underwent surgery than participants who sought but did not undergo surgery (OR = 8.9; 95% CI, 2-40) and participants who did not seek surgery (OR = 14.8; 95% CI, 2.9-75.5).

Participants who underwent surgery also had a higher remission rate of hypertension compared with participants who sought but did not undergo surgery (adjusted OR = 5.1; 95% CI, 1.7-15.6), but not compared with participants who did not seek surgery at 12 years.

“The results from the current 12-year follow-up of a U.S.-based, long-term, prospective study of bariatric surgery indicate long-term durability of weight loss after Roux-en-Y gastric bypass,” the researchers wrote. “The weight increase between the 6-year and 12-year follow-up was minimal, near complete prevention of new-onset type 2 diabetes was observed, and the remission rate of type 2 diabetes 12 years after surgery was 51%. Substantial improvement was also seen in systolic hypertension and lipid levels.” – by Amber Cox

Disclosure s : Adams reports he receives grant support from NIH – National Institute of Diabetes and Digestive and Kidney Diseases and personal fees from Intermountain Healthcare Inc. Please see the study for all other authors’ relevant financial disclosures.