Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

Abstract

BackgroundBariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.Methods and FindingsThis was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI 2.65–11.99). No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66–1.43). The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes.ConclusionsBariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese.

Obesity and bone metabolism

“…Gastric bypass and sleeve gastrectomy are associated with greater initial weight reduction rate than gastric banding [96]. Trends in body weight post-surgically show that patients undergoing RYGB exhibit the greatest weight loss, patients undergoing SG experience less weight loss and patients undergoing AGB have the least weight loss [97].…”

Identifying High-Risk Women for Endometrial Cancer Prevention Strategies: Proposal of an Endometrial Cancer Risk Prediction Model

“…Even those persistently obese women, benefit from a 50% lowering of endometrial cancer risk following surgery, suggesting that metabolic changes, such as improvements in insulin sensitivity, are also important in this context (12). Additional health benefits associated with bariatric surgery include a reduction in the incidence of other obesity-related cancers, including postmenopausal breast and colorectal cancer, as well as resolution of diabetes, hypertension, angina, and obstructive sleep apnea (13). These benefits need to be incorporated into cost-effectiveness studies when determining the value of weight loss surgery in cancer prevention.…”

Bariatric surgery for obese live kidney donors: an analysis of risks and benefits

“…Sustained weight loss, reduced mortality, and improved hyperglycemia and hypertension are all advantages of BS [8][9][10][20][21][22]. As with any procedure there are risks associated with BS.…”

“…BS results in sustained weight loss and improves hyperinsulinemia, hyperglycemia, dyslipidemia, and hypertension even after 6 months [8][9][10]21]. Douglas et al suggested that BS is associated with protective hazard ratios for type-2 diabetes mellitus, hypertension, angina, and myocardial infarction [22]. Furthermore, a 40,000 patient observational study suggested that BS was associated with a 46% reduction in heart failure compared to lifestyle interventions [23].…”