A 52-Year-Old Woman With Obesity: Review of Bariatric Surgery

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, CO-222, Boston, MA 02215, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2009; 302(10):1097-104. DOI: 10.1001/jama.2009.1197
Source: PubMed


Ms J is a 52-year-old woman with severe obesity and depression, anxiety, and osteoarthritis who has not been able to sustain weight loss through dieting and is now considering having weight loss surgery. She would like to know the long-term effects of surgery, including its psychological consequences. The article discusses the consequences of the 2 most commonly performed bariatric procedures, Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding, and their effects on weight loss, comorbidities, psychological function, and overall quality of life. Evidence suggests average weight loss at 10 years after surgery of 25% and 13%, respectively. The risk of perioperative mortality varies with patient factors and surgeon experience but is typically less than 1% with experienced surgeons. Roux-en-Y gastric bypass has a higher complication rate than laparoscopic adjustable gastric banding. Many obesity-related comorbidities such as diabetes and hypertension resolve or improve with weight loss, and quality of life generally improves in parallel with weight loss. However, depression and anxiety, as Ms J experiences, do not necessarily improve as a result of surgery.

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    • "While non-surgical management of obesity is favorable; several studies have failed to demonstrate maintenance of weight loss in the long term.[10–12] Research has shown that despite conservative modalities resulting in 4–8% weight loss, 90% of patients relapse within five years.[13–15] Indeed the maintenance of weight loss is crucial in attaining the beneficial effects of weight reduction which include: resolution or improvement of comorbidities, improvement in health-related quality of life (QOL) and increased survival.[6] "
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    ABSTRACT: A prospective longitudinal study was conducted to describe short-term outcome and quality of life (QOL) of endoscopically placed gastric balloon (EPGB) and laparoscopic adjustable gastric band (LAGB). Forty seven consecutive patients with body mass index (BMI) of 42 to 72 kg/m² were assigned to undergo EPGB (n=17) or LAGB (n=30) between May 2008 and May 2010. The main measured outcomes included weight loss, resolution or improvement of comorbidities, hospital stay, complications and QOL. Patients were followed up for a mean of 14 months. Hospital stay was shorter for EPGB patients (one versus two days, P<0.001). Early postoperative complications recorded in EPGB were minor including nausea and vomiting. No late complications were recorded in the EPGB group. One case of band slippage was reported in the LAGB group and fixed laparoscopically. Percent excess weight loss was less in EPGB compared to LAGB (26.2% versus 44.0%, P=0.004). Resolution or improvement of comorbidities was comparable in both groups. The globally impaired preoperative quality of life showed considerable improvement in both groups. EPGB is a safe and effective approach in short-term management of morbid obesity. Weight loss, resolution of comorbidities and improvement in QOL were comparable between both groups.
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    ABSTRACT: Bariatric operations are increasingly being used to induce weight loss and ameliorate or cure most of the morbidities that accompany obesity. These procedures not only produce substantial weight loss (>50% body weight), but they cure or ameliorate the comorbidities (diabetes type 2, hypertension, sleep apnea, hyperlipidemia) in the vast majority of patients. These procedures can usually be performed laparoscopically with a mortality of less than 0.5% and a hospital stay of 1 to 3 days. Presently they are the only effective treatment for weight loss in the extremely obese patient (body mass index >/= 35).
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