Sleeve gastrectomy was associated with a significantly lower BMI at 12 months compared to intensive lifestyle modification with medications (mean difference -3.2 kg/m2; 95% CI -4.9 to -1.5; P<0.001).
Cohort (n=190)
Does sleeve gastrectomy improve BMI trajectory and time to achieving ≥ 25% total weight loss compared to intensive lifestyle modifications with obesity management medications in adults with severe obesity?
Sleeve gastrectomy provides greater and more rapid weight loss than intensive lifestyle modifications with obesity medications over 1 year, though both yield clinically meaningful metabolic improvements.
Mean Difference: -3.2 (95% CI -4.9–-1.5)
Absolute Event Rate: 28.4% vs 31.6%
p-value: p=< 0.001
ABSTRACT Aims To compare sleeve gastrectomy (SG) with intensive lifestyle modification combined with obesity management medications (ILM/OMMs) in adults with severe obesity, focusing on BMI trajectory, time to achieving clinically meaningful weight loss, and metabolic outcomes in a real‐world clinical setting. Materials and Methods This prospective matched cohort study included 190 patients (BMI ≥ 35 kg/m 2 , obesity‐related comorbidities) assigned to SG or ILM/OMM in a 1:1 ratio, matched for age, sex, BMI, and diabetes duration. The primary outcomes were change in BMI at 12 months and time to achieving ≥ 25% total weight loss (TWL). Secondary outcomes included changes in weight and obesity‐related comorbidities (hypertension, dyslipidemia, type 2 diabetes) ( clinicalTrials.gov , NCT06820047). Results At 12 months, model‐based BMI was lower after SG than after ILM/OMM (28.4 kg/m 2 , 95% CI 27.2 to 29.6 vs. 31.6 kg/m 2 , 95% CI 30.5 to 32.8; between‐group difference −3.2 kg/m 2 , 95% CI −4.9 to −1.5; p < 0.001). Estimated %TWL was greater after SG than after ILM/OMM at 12 months (37.6%, 95% CI 36.5 to 38.7 vs. 18.0%, 95% CI 16.9 to 19.1; difference 19.6 percentage points, 95% CI 18.1 to 21.1; p < 0.001). Time to achieving ≥ 25% TWL was shorter after SG; the median time was 6 months in the SG group, whereas the median was not reached by 12 months in the ILM/OMM group (log‐rank p < 0.001; HR 13.85, 95% CI 7.81–24.58). Both groups showed metabolic improvement, although between‐group differences were limited. Conclusions SG was associated with greater and more rapid weight loss than ILM/OMM over 1 year, with earlier achievement of ≥ 25% TWL. Both approaches produced clinically meaningful metabolic improvements, supporting individualized treatment selection.
Russo et al. (Sun,) conducted a cohort in Severe obesity (n=190). Sleeve gastrectomy vs. Intensive lifestyle modification combined with obesity management medications (ILM/OMMs) was evaluated on Change in BMI at 12 months (MD -3.2, 95% CI -4.9 to -1.5, p=< 0.001). Sleeve gastrectomy was associated with a significantly lower BMI at 12 months compared to intensive lifestyle modification with medications (mean difference -3.2 kg/m2; 95% CI -4.9 to -1.5; P<0.001).