Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.

Selective CB1-receptor blockade with rimonabant significantly reduces body weight and waist circumference and improves the profile of several metabolic risk factors in high-risk patients who are overweight or obese and have an atherogenic dyslipidemia.

Abstract. L. Sj€ ostr€ om (The Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden). Review of the key results from the Swedish Obese Subjects (SOS) trial -a prospective controlled intervention study of bariatric surgery (Review). J Intern Med 2013; 273: 219-234.Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects (SOS) study is the first long-term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints. The SOS study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The age of participants was 37-60 years and body mass index (BMI) was ! 34 kg m À2 in men and ! 38 kg m À2 in women. Here, we review the key SOS study results published between 2004 and 2012. Follow-up periods varied from 10 to 20 years in different reports. The mean changes in body weight after 2, 10, 15 and 20 years were À23%, À17%, À16% and À18% in the surgery group and 0%, 1%, À1% and À1% in the control group respectively. Compared with usual care, bariatric surgery was associated with a long-term reduction in overall mortality (primary endpoint) [adjusted hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.54-0.92; P = 0.01] and decreased incidences of diabetes (adjusted HR=0.17; P < 0.001), myocardial infarction (adjusted HR = 0.71; P = 0.02), stroke (adjusted HR=0.66; P = 0.008) and cancer (women: adjusted HR = 0.58; P = 0.0008; men: n.s.]. The diabetes remission rate was increased severalfold at 2 years [adjusted odds ratio (OR) = 8.42; P < 0.001] and 10 years (adjusted OR = 3.45; P < 0.001). Whereas high insulin and/or high glucose at baseline predicted favourable treatment effects, high baseline BMI did not, indicating that current selection criteria for bariatric surgery need to be revised.

OBJECTIVE -It is well established that the risk of developing type 2 diabetes is closely linked to the presence and duration of overweight and obesity. A reduction in the incidence of type 2 diabetes with lifestyle changes has previously been demonstrated. We hypothesized that adding a weight-reducing agent to lifestyle changes may lead to an even greater decrease in body weight, and thus the incidence of type 2 diabetes, in obese patients.RESEARCH DESIGN AND METHODS -In a 4-year, double-blind, prospective study, we randomized 3,305 patients to lifestyle changes plus either orlistat 120 mg or placebo, three times daily. Participants had a BMI Ն30 kg/m 2 and normal (79%) or impaired (21%) glucose tolerance (IGT). Primary endpoints were time to onset of type 2 diabetes and change in body weight. Analyses were by intention to treat.RESULTS -Of orlistat-treated patients, 52% completed treatment compared with 34% of placebo recipients (P Ͻ 0.0001). After 4 years' treatment, the cumulative incidence of diabetes was 9.0% with placebo and 6.2% with orlistat, corresponding to a risk reduction of 37.3% (P ϭ 0.0032). Exploratory analyses indicated that the preventive effect was explained by the difference in subjects with IGT. Mean weight loss after 4 years was significantly greater with orlistat (5.8 vs. 3.0 kg with placebo; P Ͻ 0.001) and similar between orlistat recipients with impaired (5.7 kg) or normal glucose tolerance (NGT) (5.8 kg) at baseline. A second analysis in which the baseline weights of subjects who dropped out of the study was carried forward also demonstrated greater weight loss in the orlistat group (3.6 vs. 1.4 kg; P Ͻ 0.001).CONCLUSIONS -Compared with lifestyle changes alone, orlistat plus lifestyle changes resulted in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinically representative obese population. Difference in diabetes incidence was detectable only in the IGT subgroup; weight loss was similar in subjects with IGT and or NGT. Diabetes Care 27:155-161, 2004O besity is a serious health concern affecting Ͼ300 million people worldwide, representing a 50% increase in only 7 years (1). A number of studies (2-4) show that the risk of developing type 2 diabetes is closely linked to the presence and duration of overweight and obesity. Indeed, ϳ90% of individuals with type 2 diabetes are either overweight or obese (5). The World Health Organization has estimated that the number of adults with diabetes will more than double from an estimated 143 million in 1997 to 300 million by 2025 (5).The Swedish Obese Subjects (SOS) study has demonstrated that large weight losses in obese patients are associated with an 80% reduction in the 8-year incidence of diabetes (6). The Finnish Diabetes Prevention Study (DPS) and the Diabetes Prevention Program (DPP) have also demonstrated that modest weight loss achieved by lifestyle changes (diet and exercise) can significantly reduce the risk of developing type 2 diabetes in obese patients with impaired glucose...

Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

OBJECTIVE: To evaluate the construct validity of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. SUBJECTS: A total of 4377 middle-aged, obese subjects in the Swedish Obese Subjects (SOS) study. METHODS: The total sample was randomly split into two data subsets and psychometric testing was performed separately in each sample. Multitraitamulti-item analysis was conducted to test scaling assumptions and factor analysis was used to test the factor structure. Measures of mental well-being (MACL, HAD) were used for testing criterion-based validity. RESULTS: The Cognitive Restraint factor was consistently reproduced and scaling analysis demonstrated strong itemscale discriminant validity, while the item-scale convergent validity was unsatisfactory. The internal structure of the Disinhibition scale was weak. Most Disinhibition and Hunger items grouped in one global factor labeled Uncontrolled Eating. A third cluster containing items on Emotional Eating was also identi®ed. The obtained three-factor structure was cross-validated and replicated across subgroups by gender, age and BMI. CONCLUSION: The original TFEQ factor structure was not replicated. A short, revised 18-item instrument was constructed, representing the derived factors of Cognitive Restraint, Uncontrolled Eating and Emotional Eating. The most ef®cient items were used to boost both the convergent and discriminant validity of the scales.

A longitudinal population study of 1462 women aged 38-60 was carried out in Gothenburg, Sweden, in 1968-9. In univariate analysis the ratio of waist to hip circumference showed a significant positive association with the 12 year incidence of myocardial infarction, angina pectoris, stroke, and death. The association with incidence of myocardial infarction remained in multivariate analysis and was independent of age, body mass index, smoking habit, serum cholesterol concentration, serum triglyceride concentration, and systolic blood pressure.The relation between the ratio of waist to hip circumference and the end points of myocardial infarction, angina pectoris, stroke, and death was stronger than for any other anthropometric variable studied. IntroductionThe possible relation between obesity and cardiovascular disease has been the subject of great controversy. Interest has been focused mainly on quantity of adipose tissue and less on its distribution. Krotkiewski et al showed in a cross sectional study