Comparing effects of obesity treatment with very low energy diet and bariatric surgery after 2 years: a prospective cohort study

Abstract

ObjectivesTo compare long-term effects and complications of medical treatment (MT) of obesity including very low energy diet with bariatric surgery.Design and settingThis prospective study conducted in a clinical setting recruited individuals with body mass index (BMI) ≥35 kg/m2 referred for obesity treatment. Demographic and anthropometric data, laboratory samples, and questionnaire replies were collected at baseline and 2 years.Participants and interventions971 individuals were recruited 2015–2017. 382 received MT, 388 Roux-en-Y gastric bypass (RYGB) and 201 sleeve gastrectomy (SG).Main outcome measuresPrimary 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.ResultsTwo-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.ConclusionsIn 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 numberNCT03152617.

Impact of Medical and Surgical Obesity Treatment on Dental Caries: A 2-Year Prospective Cohort Study

“…The BMI of the participants in the current study was reduced after 2 years only in the surgically treated group. In the main study BASUN, a decrease in BMI was seen both in the medically and the surgically treated patients, even if the weight reduction was greater in the surgically treated group [Höskuldsdottir et al, 2022]. Both medical and surgical obesity treatment have been shown to be effective regarding weight loss [Ma et al, 2017;Lean et al, 2018], although most studies do not compare those treatments but have "care as usual" as a control group.…”

“…Both medical and surgical obesity treatment have been shown to be effective regarding weight loss [Ma et al, 2017;Lean et al, 2018], although most studies do not compare those treatments but have "care as usual" as a control group. It might be hypothesized that the intestinal differences in anatomy after RYGB and SG could have an impact, for example, on nutritional and hormonal status with subsequent consequences [Sumithran et al, 2011;Höskuldsdottir et al, 2022]. At the start of BASUN, RYGB was the predominant obesity surgery method in Sweden while SG surgeries increased during the inclusion period.…”

“…At the start of BASUN, RYGB was the predominant obesity surgery method in Sweden while SG surgeries increased during the inclusion period. Today, the two methods are used equally often in Sweden [SOReg, 2022], and both methods reduce weight and comorbidities [Höskuldsdottir et al, 2022;Thaher et al, 2022]. The possible significance of the surgery method for oral health needs to be further investigated.…”

Factors associated with different patterns of weight change after bariatric surgery: A longitudinal study

“…It is associated with an increased risk of type 2 diabetes, dyslipidemia, sleep apnea, coronary heart disease, deterioration in quality of life and increased mortality 1–3 . Bariatric surgery achieves rapid, significant, and sustained weight loss (WL) as well as remission of obesity‐related comorbidities and overall mortality 4–6 . Observational studies have reported that the greatest WL occurs in the first 2 years after bariatric surgery 7 .…”

“… 1 , 2 , 3 Bariatric surgery achieves rapid, significant, and sustained weight loss (WL) as well as remission of obesity‐related comorbidities and overall mortality. 4 , 5 , 6 Observational studies have reported that the greatest WL occurs in the first 2 years after bariatric surgery. 7 However, 15%–35% of patients do not reach their WL goal in the first 2 years after the procedure.…”