Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities

Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag; Lindberg, Morten; Hertel, Jens Kristoffer; Hjelmesæth, Jøran

doi:10.1001/jama.2017.21055

Cited by 271 publications

(210 citation statements)

References 37 publications

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“…At a rate of 54·4 per cent, abdominal pain was one of the most common complaints after RYGB in another study, whereas in a third abdominal pain accounted for 15 per cent of all long‐term complications after RYGB requiring hospital admission. A cohort and register‐based study with median follow‐up of 6·5 years reported abdominal pain in 26·1 per cent of patients (92 per cent RYGB), and in 13·5 per cent of patients receiving medical treatment for obesity. One study that did examine patient‐reported abdominal pain after RYGB reported an increase from 17 per cent at baseline to 32 per cent at 2 years.…”

Section: Discussionmentioning

confidence: 99%

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

et al. 2019

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Background Despite increased emphasis on patient‐reported outcomes, few studies have focused on abdominal pain symptoms before and after Roux‐en‐Y gastric bypass (RYGB). The aim of this study was to quantify chronic abdominal pain (CAP) in relation to RYGB. Methods Patients with morbid obesity planned for RYGB were invited to participate at a tertiary referral centre from February 2014 to June 2015. Participants completed a series of seven questionnaires before and 2 years after RYGB. CAP was defined as patient‐reported presence of long‐term or recurrent abdominal pain lasting for more than 3 months. Results A total of 236 patients were included, of whom 209 (88·6 per cent) attended follow‐up. CAP was reported by 28 patients (11·9 per cent) at baseline and 60 (28·7 per cent) at follow‐up ( P < 0·001). Gastrointestinal Symptom Rating Scale (GSRS) scores (except reflux scores) and symptoms of anxiety increased from baseline to follow‐up. Most quality of life (QoL) scores (except role emotional, mental health and mental component scores) also increased. At follow‐up, patients with CAP had higher GSRS scores than those without CAP, with large effect sizes for abdominal pain and indigestion syndrome scores. Patients with CAP had more symptoms of anxiety, higher levels of catastrophizing and lower QoL scores. Baseline CAP seemed to predict CAP at follow‐up. Conclusion The prevalence of CAP is higher 2 years after RYGB compared with baseline values.

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Section: Discussionmentioning

confidence: 99%

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

et al. 2019

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“…Bariatric surgery is associated with sustainable weight loss and reduced morbidity and mortality in patients with morbid obesity [3]. However, a recent cohort study of 1,888 patients with morbid obesity showed that patients treated with bariatric surgery had increased risk of complications such as abdominal pain, gastrointestinal ulcers, and iron deficiency compared with patients who were treated with lifestyle treatment after 6.5 years of follow-up [4]. This study furthermore showed a 50% increased risk of new-onset depression in patients who underwent bariatric surgery compared with patients who received intensive lifestyle treatment [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, a recent cohort study of 1,888 patients with morbid obesity showed that patients treated with bariatric surgery had increased risk of complications such as abdominal pain, gastrointestinal ulcers, and iron deficiency compared with patients who were treated with lifestyle treatment after 6.5 years of follow-up [4]. This study furthermore showed a 50% increased risk of new-onset depression in patients who underwent bariatric surgery compared with patients who received intensive lifestyle treatment [4]. Moreover, reduced alcohol tolerability is considered a complication from bariatric surgery, and empirical evidence indicates that gastric bypass increases the risk of developing both alcohol use disorders and substance use disorders [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

et al. 2019

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Background: Bariatric surgery is associated with greater and more sustainable weight loss compared with lifestyle intervention programs. On the other hand, bariatric surgery may also be associated with physical and psychosocial complications. The influence of psychological evaluation on treatment choice, however, is not known. We aimed to examine variables associated with treatment choice and, specifically, if self-reported lifetime adversity influenced obesity treatment, i.e. bariatric surgery, high-intensive lifestyle treatment or low-intensive lifestyle treatment in primary care. Methods: We consecutively included 924 patients from the registry study of patients with morbid obesity at Akershus University Hospital, Lørenskog, Norway. Treatment selection was made through a shared decision-making process. Self-reported lifetime adversity was registered by trained personnel. Logistic regression models were used to assess the associations between obesity treatment and possible predictors. Results: Patients who chose bariatric surgery were more likely to have type 2 diabetes (DM2) compared with patients who chose lifestyle treatment (bariatric surgery: 35%, high-intensive lifestyle treatment: 26%, and low-intensive lifestyle treatment: 26%; p = 0.035). Patients who chose bariatric surgery were less likely than patients who chose lifestyle intervention to report lifetime adversity (bariatric surgery: 39%, high-intensive lifestyle treatment: 47%, and low-intensive lifestyle treatment: 51%; p = 0.004). After multivariable adjustments, increasing BMI, having DM2, and joint pain were associated with choosing bariatric surgery over non-surgical obesity treatment (odds ratio [95% CI]: BMI 1.03 [1.01–1.06], DM2 1.47 [1.09–1.99], and joint pain 1.46 [1.08–1.96]). Self-reported lifetime adversity was furthermore associated with lower odds of choosing bariatric surgery in patients with morbid obesity (0.67 [0.51–0.89]). Conclusion: This study shows that increasing BMI, DM2, and joint pain were all associated with treatment choice for obesity. In addition, self-reported lifetime adversity was associated with the patients’ treatment choice for morbid obesity. Consequently, we suggest that decisions concerning obesity treatment should include dialogue-based assessments of the patients’ lifetime adversity.

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“…At the moment, bariatric surgery is undoubtedly associated with a higher percentage of weight loss in the short and long term . However, it is also a permanent procedure and is associated with side effects and vitamin deficiencies . The available data in regard to long‐term outcomes on those individuals with less severe obesity is not as clear and despite the fact that several studies have found that BMI is not a reliable marker of metabolic improvement, most have compared individuals above or below a dichotomous threshold, have not compared BMI extremes, and included participants with a very high mean BMI .…”

Section: Combining All Data: Why Should We Exert Caution In Recommendmentioning

confidence: 99%

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m²: Why caution is still needed

Halpern

Mancini

2019

Obesity Reviews

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Summary Bariatric surgery has shifted from being a risky procedure to an evidence‐based one, with proven benefits on all‐cause mortality, cardiovascular disease, cancer, and diabetes control. The procedure has an overall positive result on type 2 diabetes mellitus (T2DM), with a substantial number of patients achieving disease remission. This has resulted in several studies assessing possible weight‐independent effects of bariatric surgery on glycemic improvement, in addition to recommendation of the procedure to patients with class 1 obesity and T2DM, for whom the procedure was classically not indicated, and adoption of a new term, “metabolic surgery,” to highlight the overall metabolic benefit of the procedure beyond weight loss. Recently, the Diabetes Surgery Summit (DSS) has included metabolic surgery in its T2DM treatment algorithm. Although the discussion brought by this consensus is highly relevant, the recommendation of metabolic surgery for patients with uncontrolled T2DM and a body mass index of 30 to 35 kg/m2 still lacks enough evidence. This article provides an overall view of the metabolic benefits of bariatric/metabolic surgery in patients with class 1 obesity, compares the procedure against clinical treatment, and presents our rationale for defending caution on recommending the procedure to less obese individuals.

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Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities

Cited by 271 publications

References 37 publications

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m²: Why caution is still needed

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Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities

Cited by 271 publications

References 37 publications

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m2: Why caution is still needed

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Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m²: Why caution is still needed