Obesity is one of the greatest public health problems in industrialized countries. In the US, UK, and Australia, for instance, the prevalence of obesity has more than doubled in the past 25 years. Currently in the U.S. , 67% of the population is overweight or obese and in European countries the obesity rates range between 40% and 50%. Obesity is linked to an increased risk of serious medical conditions including type 2 diabetes, hypertension and certain types of cancer.
Treatment options for obesity include non-surgical treatment and bariatric surgery. The non-surgical treatment is usually a multicomponent approach that includes behavioral therapy, dietary and pharmacotherapies. The most commonly used bariatric surgery techniques are Roux-en-Y gastric bypass, sleeve gastrostomy, and laparoscopic adjustable gastric banding.
In this new study researchers examined the effects of bariatric surgery compared to non-surgical treatments in randomized controlled trials on weight loss, cardiovascular risk factors, adverse events, and quality of life in individuals with a body mass index ≥30. Researchers also reported on body weight, cardiovascular risk factors, quality of life, or adverse events.
Dr. Viktoria Glory, MSc, PhD, junior researcher at the Basel Institute for Clinical Epidemiology and Biostatistics at University Hospital Basel in Switzerland and lead author of study along with colleagues examined data from 11 randomized studies with 796 individuals with a mean body mass at baseline of 30 to 52.
Individuals were assigned to either bariatric surgery techniques or non-surgical treatments that included behavioral therapy, dietary, increasing physical activity level and pharmacotherapies. Follow-up was over a two year period.
The results showed that the individuals who were assigned to bariatric surgery had lost more body weight, an average of 26 k , compared to those assigned to non-surgical treatments and had higher remission rates of type 2 diabetes and metabolic syndrome, a group of health problems that can lead to diabetes, heart attack and stroke.
After bariatric surgery, individuals had greater improvement in quality of life and reductions in medication use compared to those who had been assigned to non-surgical treatments.
Also revealed, the bariatric group had a higher decrease of plasma triglyceride concentrations, (triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates) and a greater increase in high density lipoprotein cholesterol concentrations.
There were no changes seen in blood pressure and total or low density lipoprotein cholesterol concentrations between the two groups.
There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%).
In their conclusion the researchers write “Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals.”
The researchers note there were limitations to this study including summary measures of effect sizes are based on only 11 studies or fewer depending on outcome and the team does not have information from randomized controlled trials on bodyweight in the long term.
The findings of this study are published in the BMJ.
More information on bariatric surgery can be viewed online at News Medical.