Gastric Surgery for Morbid Obesity

Hall, John C.; Watts, J. F.; O'Brien, Paul Edmond; Dunstan, Richard E.; Walsh, John F.; Slavotinek, A. H.; Elmslie, R. G.

doi:10.1097/00000658-199004000-00007

Cited by 288 publications

(120 citation statements)

References 30 publications

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“…One of the RCTs that they did include used a horizontal, unbanded gastroplasty 85 and therefore should have been excluded. Four other RCTs comparing vertical banded gastroplasty with gastric bypass [86][87][88][89] as well as three retrospective series [90][91][92] and the SOS cohort trial 17 all found gastric bypass to cause greater weight loss than gastroplasty. One study not cited by either report found an equivalent weight loss between vertical banded gastroplasty and gastric bypass when patients were allowed to choose the operation, but the drop-out rate (15% seen at 5 y) was excessive.…”

Section: Resultsmentioning

confidence: 99%

“…8 In contrast to the SOS study, which was almost entirely purely gastric restriction, 127 both the Washington State and Canadian studies were predominantly gastric bypass, which is associated with greater weight loss. [86][87][88][89][90][91][92] In the Canadian study, there was a 45% decrease in total health-care expenditures in the surgically treated cohort. 8 Both studies noted a significantly lower mortality in the surgical patients.…”

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

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Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

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Section: Resultsmentioning

confidence: 99%

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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“…Weight loss was 28-76 kg after 2 y, [79][80][81][82][83][84][85][86][87][88][89] 17-73 kg after 3 y, [79][80][81][86][87][88][89] and 20 kg after 8 y in one study [82][83][84] based on a completers method of analysis. No study reported the proportion of subjects with Z5% weight loss, although this was probably high given the absolute weight loss with surgical therapy.…”

Section: Surgical Therapymentioning

confidence: 99%

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

et al. 2005

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BACKGROUND: Obesity is a common health problem that requires a long-term care approach. We systematically reviewed long-term (Z2 y) studies investigating dietary/lifestyle, pharmacologic, and surgical weight loss methods to assess (1) weight loss efficacy, defined by absolute weight loss and the proportion of subjects with Z5% weight loss, (2) effects of weight loss on cardiovascular risk factors, and (3) applicability of findings from studies to everyday clinical practice. METHODS: The MEDLINE, HealthSTAR, and the Cochrane Controlled Trials databases were searched for studies investigating the long-term efficacy of weight loss methods in overweight and obese adults. Data were extracted for (i) weight loss after 1 y (pharmacologic studies only), 2 y, 3 y, and 4 y, (ii) proportion of subjects with Z5% weight loss at the end of follow-up, and (iii) changes (end-of follow-up minus baseline values) in blood lipids, fasting blood glucose, and systolic and diastolic blood pressure. RESULTS: Dietary/lifestyle therapy provides o5 kg weight loss after 2-4 y, pharmacologic therapy provides 5-10 kg weight loss after 1-2 y, and surgical therapy provides 25-75 kg weight loss after 2-4 y. Weight loss of Z5% baseline weight is not consistently associated with improvements in cardiovascular risk factors and these benefits appear to be intervention specific and occur mainly in people with concomitant cardiovascular risk factors. Weight loss studies have methodologic limitations that restrict the applicability of findings to unselected obese people assessed in everyday clinical practice. These limitations include an inadequate study duration, large proportions of subjects lost to follow-up, a lack of an appropriate usual care group, and a lack of reporting of outcomes in high-risk subgroups. CONCLUSIONS: Dietary/lifestyle and pharmacologic weight loss interventions provide modest weight loss, and may improve markers of cardiovascular risk factors although these benefits occur mainly in patients with cardiovascular risks. Studies investigating weight loss have methodologic limitations that restrict the applicability of findings to obese patients assessed in clinical practice.

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“…The superiority of gastric bypass over vertical banded gastroplasty in achieving weight loss has been demonstrated by several controlled studies. [24][25][26][27] Weight loss stabilizes between 18 and 24 months postsurgery; 14,28,29 a trend to regain small amounts of weight can be observed in the third year. 28 Although bariatric surgery is generally effective, there is great variability in outcome.…”

Section: Introductionmentioning

confidence: 99%

Does obesity surgery improve psychosocial functioning? A systematic review

Herpertz¹,

Kielmann²,

et al. 2003

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OBJECTIVE:The objective of this study is to present a review of the psychosocial outcome of bariatric surgery with special consideration of psychiatric comorbidity, psychopathology, psychosocial functioning, econometric data, and general quality of life (QoL). PURPOSE: A review of all (non-) controlled trials of the last two decades both with a retrospective and prospective design and a follow-up period of at least 1 y. RESEARCH METHODS AND PROCEDURES:The relevant literature was identified by a search of computerized databases. All articles published in English and German since 1980 were reviewed. Based on the requirements of the evidenced-based guidelines of the Agency for Health Care Policy and Research and the Scottish Intercollegiate Guidelines Network, each study was rated by a level of evidence. RESULTS: In all, 171 publications were reviewed. Using the above inclusion/exclusion criteria, 63 articles including two systematic reviews were identified. A total of 40 studies focused on psychosocial outcome after obesity surgery. CONCLUSION: Mental health and psychosocial status including social relations and employment opportunities improve for the majority of people after bariatric surgery thus leading to an improved QoL. Psychiatric comorbidity, predominantly affective disorders, and psychopathologic symptoms decrease postsurgically. A substantial percentage of bariatric surgery patients suffer from binge eating disorder or binge eating symptoms. The effect of bariatric surgery on the outcome of binge eating symptoms largely depends on the type of operation. With the exception of patients with a severe psychiatric comorbidity, the concern that obesity surgery will reinforce psychic symptoms and lead to a reduction in the QoL seems to be unfounded.

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Gastric Surgery for Morbid Obesity

Cited by 288 publications

References 30 publications

Evidence-based medicine reports on obesity surgery: a critique

Evidence-based medicine reports on obesity surgery: a critique

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

Does obesity surgery improve psychosocial functioning? A systematic review

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