IntroductIonSeveral studies have shown bariatric surgery as a successful long-term treatment for weight-reduction for people with extreme (class III) obesity, especially when measured 2 years postoperatively (1-4). More recently, three prospective randomized controlled trials have compared health outcomes between bariatric surgery and nonsurgical treatment intervention (5-8). Importantly, none of these trials included gastric bypass procedures, only one study included exclusively severely obese subjects (6), one study limited participants to the overweight BMI range (a range that does not now qualify a patient for bariatric surgery) (5,8), and one study limited BMI to <40 kg/m 2 (7). Further, none of these studies included control groups not enrolled in weight-loss intervention treatment.Mingrone et al. (6) randomly assigned 79 severely obese patients to biliopancreatic diversion, a malabsorptive surgery, or a low-calorie diet (~1,200 kcal/day) and followed all subjects for 1 year. O'Brien and Dixon and colleagues Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m 2 ) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years.
