BACKGROUND Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (non-surgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)

HE PREVALENCE OF EXTREMEobesity in the United States is increasing at a rate greater than moderate obesity. 1 , 2 Unfortunately, lifestyle therapy is generally insufficient as a weight management intervention for patients who are extremely obese. To date, effective long-term weight loss through pharmacological therapy has been marginal, leaving bariatric For editorial comment see p 1160.

BACKGROUND Interaction between maternal obesity, intrauterine environment and adverse clinical outcomes of newborns has been described. METHODS Using statewide birth certificate data, this retrospective, matched-control cohort study compared paired birth weights and complications of infants born to women before and after Roux-en-Y gastric bypass surgery (RYGB) and to matched obese non-operated women in several different groups. Women who had given birth to a child before and after RYGB (group 1; n = 295 matches) and women with pregnancies after RYGB (group 2; n = 764 matches) were matched to non-operated women based on age, body mass index (BMI) prior to both pregnancy and RYGB, mother’s race, year of mother/s birth, date of infant births and birth order. In addition, birth weights of 13 143 live births before and/or after RYGB of their mothers (n = 5819) were compared (group 3). RESULTS Odds ratios (ORs) for having a large-for-gestational-age (LGA) neonate were significantly less after RYGB than for non-surgical mothers: ORs for groups 1 and 2 were 0.19 (0.08–0.38) and 0.33 (0.21–0.51), respectively. In contrast, ORs in all three groups for risk of having a small for gestational age (SGA) neonate were greater for RYGB mothers compared to non-surgical mothers (ORs were 2.16 (1.00–5.04); 2.16 (1.43–3.32); and 2.25 (1.89–2.69), respectively). Neonatal complications were not different for group 1 RYGB and non-surgical women for the first pregnancy following RYGB. Pregnancy-induced hypertension and gestational diabetes were significantly lower for the first pregnancy of mothers following RYGB compared to matched pregnancies of non-surgical mothers. CONCLUSION Women who had undergone RYGB not only had lower risk for having an LGA neonate compared to BMI-matched mothers, but also had significantly higher risk for delivering an SGA neonate following RYGB. RYGB women were less likely than non-operated women to have pregnancy-related hypertension and diabetes.

Importance Bariatric surgery has been shown to be effective in reducing total and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known. Objectives To examine if gastric bypass surgery was equally effective in reducing mortality across different age-at-surgery groups. Design Total and cause-specific mortality rates and hazard ratios were estimated from a retrospective cohort within four categories defined by age at surgery: <35, 35–44, 45–54, and 55–74 years. Mean follow-up was 7.2 years. Setting Gastric bypass surgical patients seen at a private surgical practice from 1984 to 2002. Participants A cohort of 7925 gastric bypass surgery patients and 7925 group-matched, non-operated severely obese subjects identified through driver license records. Matching criteria included year of surgery to year of driver license application, gender, 5-year age groups and three BMI categories. Intervention Roux-en-Y gastric bypass surgery. Main Outcome Total and cause-specific mortality compared between those with and without gastric bypass surgery using hazard ratios. Results The mean age at surgery was 39.5±10.5 years and the mean pre-surgical BMI was 45.3±7.4 kg. Compared with non-operated subjects, adjusted all-cause mortality after gastric bypass surgery was significantly lower for the 35–44, 45–54, and 55–74 year age groups (hazard ratios (HR) of 0.54 (95% confidence interval of 0.38–0.77), 0.43 (0.30–0.62), and 0.50 (0.31–0.70), respectively; all p<0.005) but was not lower for the <35 year age group (HR 1.22 (0.82–1.81)). The lack of mortality benefit in the <35 age group primarily derived from a significantly higher number of externally-caused deaths (HR 2.53 (1.27–5.07)). Gastric bypass patients had a significantly lower age-related increase in mortality than non-operated severely obese subjects (p=0.0014). Conclusions Gastric bypass surgery was associated with improved long-term survival for all ages-at-surgery >35 years, with externally-caused deaths only elevated in younger women. Gastric bypass surgery is protective against mortality even for older patients and also reduces the age-related increase in mortality observed in severely obese non-surgical subjects.

This study demonstrates no statistically significant difference in the rate of IAA among children following LA and OA. LA can be performed for perforated appendicitis without increasing the risk of IAA.