Bariatric surgery has become one of the most effective interventions for inducing weight loss among obese patients. Several operations are available for patients considering bariatric surgery, including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). “Despite proven efficacy, research from clinical trials on these operations has been based mostly on short-term follow-up,” says Matthew L. Maciejewski, PhD. “In addition, SG has only recently been introduced as an option, meaning long-term safety and durability data are lacking for this procedure. This is a critical evidence gap considering that SG has become the most commonly performed operation in the United States.”
Little is known about the durability of weight loss after RYGB, AGB, or SG beyond 2 to 3 years. Head-to-head comparisons of these bariatric surgeries with long-term follow-up are also needed. Also, more representation from men undergoing these procedures is necessary in order to better inform patients and surgeons when they select a specific procedure to treat obesity because most trials have predominantly enrolled women.
An Important Comparison
To address questions about the long-term durability of bariatric surgery, Dr. Maciejewski and colleagues compared 10-year weight changes in a large, multisite, clinical cohort of veterans who had bariatric surgery in 2000-2011. Published in JAMA Surgery, the authors examined patients undergoing RYGB and compared their outcomes with non-surgical matches and compared 4-year weight changes in a head-to-head comparison of veterans who underwent RYGB, AGB, or SG.
“Obese patients who underwent gastric bypass surgery lost much more weight than non-surgical matches and were able to sustain most of this weight loss in the long term,” Dr. Maciejewski says. Patients undergoing RYGB lost 21% more of their baseline weight when assessed at 10 years than non-surgical matches. Only about 3% of patients undergoing RYGB regained weight back to within an estimated 5% of their baseline weight at 10 years. In the head-to-head comparison across the three procedures, RYGB induced significantly more weight loss at 4 years than SG or AGB.
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Data from the study showed that patients undergoing RYGB lost nearly 28% of their baseline weight, comparing favorably to the rates observed in those undergoing AGB (about 11%) and SG (about 18%). Patients undergoing RYGB lost approximately 17% more of their baseline weight than patients undergoing AGB and nearly 10% more than patients undergoing SG.
The study findings provide clinicians with more evidence on the long-term benefits regarding bariatric surgery. “However, additional research is needed on postoperative complications, disease resolution, and long-term mental health outcomes,” says Dr. Maciejewski. “This information can help bariatric surgery candidates choose a procedure that is best for them.”
Ultimately, Dr. Maciejewski says the mission of surgeons should be to engage patients in a high-quality shared decision-making conversation about their weight loss treatment options. This is especially important considering previous research suggests patients often have unrealistic expectations of the weight loss that bariatric surgery will help them achieve.
Matthew L. Maciejewski, PhD, has indicated to Physician’s Weekly that he has worked as a paid speaker for the University of Alabama-Birmingham and has received grants from the Department of Veterans of Affairs Health Services Research and Development Service, AHRQ, the National Institute on Drug Abuse, the National Cancer Institute, and the National Committee for Quality Assurance. He also acknowledges that he owns Amgen stock because of his spouse’s employment.
Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016 Aug 31 [Epub ahead of print]. Available at: http://archsurg.jamanetwork.com/article.aspx?articleid=2546331.
Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313:62-70.
Coleman KJ, Huang YC, Hendee F, Watson HL, Casillas RA, Brookey J. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10:396-403.
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961.