Gastric bypass surgery for the severely obese associated with higher diabetes remission versus nonsurgical controls

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Key study points:

1.    Patients undergoing Roux-en-Y gastric bypass surgery for severe obesity had higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over a 6 year follow-up period

2.    Gastric bypass surgery remains the single most effective tool for achieving long term weight loss and improved cardiovascular and metabolic outcomes in severely obese individuals

Primer:  For the extremely obese, lifestyle and pharmacological therapy has been ineffective at producing sustained weight loss. Bariatric surgery remains the only medical intervention successful in providing substantial, long-term weight loss for severely obese patients. However, the promise that gastric bypass surgery holds for lowering cardiovascular and other disease risk in the ever expanding obese population has yet to be evaluated in a prospective, long term fashion. The study compared long term weight loss and cardiometabolic end-points in obese patients receiving Roux-en-Y gastric bypass (RYGB) surgery against non-operative control patients.   

This [prospective study] consisted of 1156 severely obese (BMI ≥ 35) patients aged 18-72 years who sought and received RYGB surgery (n = 418), desired but did not receive surgery (n = 41), or who were randomly selected from a population-based sample not seeking surgery (n = 321) between. At the 6 year follow-up time point, patient receiving RYGB surgery lost 27.7% of their initial body weight compared to .2% in the control group. 76% of the RYGB surgery group were able to maintain at least 20% weight loss 6 years after surgery. Glycemic control was also improved, with the percentage of patients with baseline glucose over 100mg/dl decreasing from 49% to 11% at 6 years after RYGB. Improvements in hypertension and dyslipidemia were also noted within the RYGB study group, whereas cardiovascular and metabolic status of the control groups generally worsened during the study period. Furthermore, this study boasts results are more robust than those done previously because of high rates of 6 year participation and follow-up to eliminate any potential bias.

In sum: This study was a large prospective look at the long term effects of RYGB surgery on cardiovascular and metabolic health status in severely obese individuals. The authors concluded that RYGB remains the most effective option for sustained weight loss, diabetes remission, and improvements in cardiovascular and metabolic in severely obese individuals who do not respond to lifestyle and pharmacological therapies.

Click to read the study in JAMA

By AH

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