Key result
Bariatric surgery via RYGB or SG resulted in a greater decrease in excess BMI (82.5% and 70.3%, respectively) compared to medical treatment (27.5%; p<0.001) at 2-year follow-up.
Why the study?
The study was conducted to compare the long-term effects and complications of medical treatment of obesity, including a very low energy diet, with bariatric surgery.
Does bariatric surgery improve weight loss and metabolic outcomes compared to medical treatment with very low energy diet in individuals referred for obesity treatment?
Cohort (n=971)
Does bariatric surgery improve weight loss and metabolic outcomes compared to medical treatment with very low energy diet in individuals referred for obesity treatment?
Absolute Event Rate: 82.5% vs 27.5%
p-value: p=<0.001
Bariatric surgery (RYGB or SG) is significantly more effective for weight loss than medical treatment with very low energy diet at 2 years, though all treatments showed positive effects on cardiovascular risk factors and well-being.
May support bariatric surgery for greater weight loss in obesity referrals; leaves open long-term cardiovascular outcome confirmation.
OBJECTIVES: To compare long-term effects and complications of medical treatment (MT) of obesity including very low energy diet with bariatric surgery. DESIGN AND SETTING: referred for obesity treatment. Demographic and anthropometric data, laboratory samples, and questionnaire replies were collected at baseline and 2 years. PARTICIPANTS AND INTERVENTIONS: 971 individuals were recruited 2015-2017. 382 received MT, 388 Roux-en-Y gastric bypass (RYGB) and 201 sleeve gastrectomy (SG). MAIN OUTCOME MEASURES: Primary outcomes included changes in anthropometric measures, metabolic variables and safety. These were analysed using a linear regression model. A logistic regression model was used to analyse composite variables for treatment success (secondary outcomes). A random forest (RF) model was used to examine the importance of 15 clinical domains as predictors for successful treatment. RESULTS: Two-year data were available for 667 individuals (68.7%). Regarding primary outcomes, the decrease in excess BMI was 27.5%, 82.5% and 70.3% and proportion achieving a weight of >10% was 45.3%, 99.6% and 95.6% for MT, RYGB and SG, respectively (p<0.001). The groups were comparable regarding levels of vitamins, minerals and haemoglobin or safety measures. Likelihood for success (secondary outcome) was higher in the surgical groups (RYGB: OR 5.3 (95% CI 3.9 to 7.2) vs SG: OR 4.3 ((95% CI 3.0 to 6.2)) in reference to MT. Baseline anthropometry had the strongest predictive value for treatment success, according to the RF model. CONCLUSIONS: In clinical practice, bariatric surgery by RYGB or SG is most effective, but meaningful weight loss is achievable by MT with strict caloric restriction and stepwise introduction of a normal diet. All treatments showed positive effects on well-being, cardiovascular risk factors, and levels of vitamins and minerals at 2-year follow-up and groups were similar regarding safety measures. TRIAL REGISTRATION NUMBER: NCT03152617.
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Höskuldsdóttir et al. (2022) conducted a cohort in obesity (n=971). Bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) vs. Medical treatment including very low energy diet was evaluated on decrease in excess BMI (p=<0.001). Bariatric surgery via RYGB or SG resulted in a greater decrease in excess BMI (82.5% and 70.3%, respectively) compared to medical treatment (27.5%; p<0.001) at 2-year follow-up.
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