More Weight Loss in Bariatric Surgery Than Standard Care

BMI changes vary with surgery type, with highest weight loss with diversionary procedures

THURSDAY, July 28 (HealthDay News) -- Bariatric surgery appears to have substantially higher efficacy than standard care for reducing weight in severely obese adults, according to a review published in the August issue of Obesity Reviews.

Raj Padwal, M.D., from the University of Alberta in Edmonton, Canada, and colleagues reviewed available literature to February 2009 to assess the clinical efficacy and safety of bariatric surgery. A total of 31 long-term randomized controlled trials (RCTs) comparing bariatric surgeries and/or standard care, and involving 2,619 patients with a mean age of 30 to 48 years, and mean body mass index (BMI) of 42 to 58 kg/m² were included in the analysis. Change in BMI was the primary outcome measure, and evidence-based items with potential to indicate risk of bias were assessed.

The investigators found that, compared to standard care, BMI levels differed from baseline to one year in 15 trials involving 1,103 participants. Mean differences in BMI were highest for predominantly diversionary procedures, including jejunoileal bypass (−11.4 kg/m²), mini-gastric bypass (−11.3 kg/m²), biliopancreatic diversion (−11.2 kg/m²), and sleeve gastrectomy (−10.1 kg/m²). An intermediate BMI change of −9.0 kg/m² was seen for Roux-en-Y gastric bypass. Purely restrictive procedures, including horizontal gastroplasty, vertical banded gastroplasty, and adjustable gastric banding showed the least BMI differences. Adjustable gastric banding had fewer serious adverse events than Roux-en-Y gastric bypass.

"We found that, although data from large, adequately powered, long-term RCTs are lacking, bariatric surgery appears substantially more effective than standard care for the treatment of severe obesity in adults," the authors write.

Several authors disclosed financial ties to health care and medical device companies.

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