Bariatric Surgery: A Systematic Review and Meta-analysis

Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2004; 292(14):1724-37. DOI: 10.1001/jama.292.14.1724
Source: PubMed


About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.
To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).
Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.
A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).
A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.
Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

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    • "Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and biliopancreatic diversion with or without duodenal switch (BPD/BPD-DS) are the recommended and most commonly performed today[21]. Laparoscopic procedures are in general preferred over the open approach[11]. Newer techniques such as plication and mini-gastric or single loop gastric bypass are also emerging. Besides the variable effectiveness across procedures, each has risks and benefits. "
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    ABSTRACT: Background: Obesity is a major health concern in the Middle East and worldwide. It is among the leading causes of morbidity, mortality, health care utilization, and costs. With bariatric surgery proving to be a more effective treatment option for overweight and obesity, the need for systematic assessment of different procedures and their outcomes becomes necessary. These procedures have not yet been described in detail in our region. Objective: We aim to undertake a prospective study evaluating and comparing several surgical bariatric procedures in an Iranian population of morbid obese patients presenting to a specialized bariatric center. Methods: In order to facilitate and accelerate understanding of obesity and its complications, the Tehran Obesity Treatment Study (TOTS) was planned and developed. This study is a longitudinal prospective cohort study in consecutive patients undergoing bariatric surgery. TOTS investigators use standardized definitions, high-fidelity data collection system, and validated instruments to gather data preoperatively, at the time of surgery, postoperatively, and in longer-term follow-up. Results: This study has recruited 1050 participants as of September 2015 and is ongoing. Conclusions: This study will ensure creation of high-level evidence to enable clinicians to make meaningful evidence-based decisions for patient evaluation, selection for surgery, and follow-up care.
    Full-text · Article · Jan 2016
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    • "Several recent reports have demonstrated the efficacy of bariatric surgery in this population[4] [5]. Moreover, the preponderance of data now suggests the superiority of bariatric surgery to medical therapies for sustained weight loss and relief from obesity related metabolic conditions in adults and children [6] [7] [8] [9] [10] [11]. "
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    ABSTRACT: Homozygous or compound heterozygous melanocortin-4 receptor (MC4R) mutations are rare with fewer than 10 patients described in current literature. Here we report the short and long-term outcomes for four children ages 4.5-14 who are homozygous for loss-of-function mutations in the MC4R and underwent laparoscopic sleeve gastrectomy. All 4 patients experienced significant weight loss and improvement in, or resolution of, their comorbidities in the short term. One patient, however, has had significant weight regain in the long term. We conclude that MC4R signaling is not required for short term weight loss after laparoscopic sleeve gastrectomy in children. Behavior modification may be more important for long term weight maintenance, but patients with homozygous MC4R deficiency should not be excluded from consideration for sleeve gastrectomy. However, as at least one copy of functional MC4R is necessary and sufficient to induce long-term postoperative weight loss benefits, patients with complete loss of MC4R functionality might be less likely to exhibit the same benefits resulting from bariatric surgery.International Journal of Obesity accepted article preview online, 05 November 2015. doi:10.1038/ijo.2015.230.
    Full-text · Article · Nov 2015 · International journal of obesity (2005)
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    • "Bariatric surgery is considered the most effective means for substantial and sustained weight loss and resolution of medical comorbidities (Buchwald et al., 2004) for morbidly obese individuals (BMI ≥ 40; Maggard et al., 2005). Adherence to a calorie-restricted and healthy post-surgical diet is required to maintain weight loss, and disordered eating (e.g., binge eating) can interfere with maintaining dietary recommendations long-term (Saunders, Johnson, & Teschner, 1998). "
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    ABSTRACT: Objectives: It has been suggested that obesity stigmatization contributes to negative mental health outcomes, particularly among overweight individuals. This study examined the effects of exposure to media-portrayed anti-obesity messages on women's state self-esteem, body esteem, and food intake. It was hypothesized that exposure to anti-obesity messages would result in decreased state self-esteem and body esteem and in increased food intake, and that these effects would be more pronounced in individuals with either higher BMI or stronger perceived pressure to be thin. Method: Participants were randomly assigned to one of three experimental conditions in which they either: read a fictitious media article containing either anti-obesity messages or non-obesity-related health messages, or completed a neutral control task (word search). State self-esteem and body esteem were measured before and after the manipulation. Participants also completed a candy taste rating task and ad lib consumption was surreptitiously measured. Results: There was no main effect of condition on either psychological outcome variable or on grams consumed. Higher perceived sociocultural pressure to be thin was associated with a decrease in body esteem after reading the anti-obesity article only. Having a higher BMI was associated with greater candy intake in the word search condition. This trend was also apparent in the sun exposure condition, but not in the anti-obesity condition. Discussion: Exposure to anti-obesity messages appears to decrease weight-related body esteem in women who already feel strong pressure to be thin, and may lead heavier women to suppress their food intake.
    Full-text · Article · Nov 2015 · Eating behaviors
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