Results of the surgical treatment of obesity

MacLean, Lloyd D.; Rhode, Barbara; Sampalis, John S.; Ra, Forse

doi:10.1016/s0002-9610(05)80420-9

Cited by 289 publications

(118 citation statements)

References 6 publications

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“…The LAP-BAND system is the only laparoscopic adjustable gastric band that has been approved by the FDA for use in the United States. Table 3 demonstrates selected series of open RYGBP, published primarily over the past decade, with key outcome parameters [43][44][45][46][47][48][49][50][51][52][53]. These studies varied considerably regarding which outcome parameters were reported.…”

Section: Gastric Banding Resultsmentioning

confidence: 99%

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Medical and surgical options in the treatment of severe obesity

Fisher

Schauer

2002

The American Journal of Surgery

275

156

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Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). The problem of obesity has reached epidemic proportions in the United States. More than 50% of adults are obese or overweight, and 5% are severely obese (body mass index [BMI] of Ն35) [1]. Numerous studies have demonstrated a strong relation between BMI and the development of lifeimpairing comorbidities, such as hypertension, diabetes (type 2), atherosclerosis, sleep apnea, and osteoarthritis. Obesity is associated with a higher risk of cancer (breast, colon, uterine) and premature death. Patients with severe or morbid obesity (BMI Ͼ35), the focus of this review, are consequently most severely affected by the disease, have a poor quality of life, and thus have the greatest need for weight loss therapy. Numerous medical and surgical treatments for severe obesity have come and gone over the years, underscoring the challenge and complexity of obesity management. The intent of this review is to summarize the current status of medical and surgical options for the treatment of severe obesity. Management of obesity

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Section: Gastric Banding Resultsmentioning

confidence: 99%

“…RYGBP has been directly compared only with VBG. The majority of prospective comparative studies show significantly better weight loss with RYGBP compared with VGB [23,[47][48][49].…”

Section: Gastric Banding Resultsmentioning

confidence: 99%

Medical and surgical options in the treatment of severe obesity

Fisher

Schauer

2002

The American Journal of Surgery

275

156

View full text Add to dashboard Cite

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“…One of the RCTs that they did include used a horizontal, unbanded gastroplasty 85 and therefore should have been excluded. Four other RCTs comparing vertical banded gastroplasty with gastric bypass [86][87][88][89] as well as three retrospective series [90][91][92] and the SOS cohort trial 17 all found gastric bypass to cause greater weight loss than gastroplasty. One study not cited by either report found an equivalent weight loss between vertical banded gastroplasty and gastric bypass when patients were allowed to choose the operation, but the drop-out rate (15% seen at 5 y) was excessive.…”

Section: Resultsmentioning

confidence: 99%

“…8 In contrast to the SOS study, which was almost entirely purely gastric restriction, 127 both the Washington State and Canadian studies were predominantly gastric bypass, which is associated with greater weight loss. [86][87][88][89][90][91][92] In the Canadian study, there was a 45% decrease in total health-care expenditures in the surgically treated cohort. 8 Both studies noted a significantly lower mortality in the surgical patients.…”

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

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“…The superiority of gastric bypass over vertical banded gastroplasty in achieving weight loss has been demonstrated by several controlled studies. [24][25][26][27] Weight loss stabilizes between 18 and 24 months postsurgery; 14,28,29 a trend to regain small amounts of weight can be observed in the third year. 28 Although bariatric surgery is generally effective, there is great variability in outcome.…”

Section: Introductionmentioning

confidence: 98%

Does obesity surgery improve psychosocial functioning? A systematic review

Herpertz¹,

Kielmann²,

et al. 2003

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OBJECTIVE:The objective of this study is to present a review of the psychosocial outcome of bariatric surgery with special consideration of psychiatric comorbidity, psychopathology, psychosocial functioning, econometric data, and general quality of life (QoL). PURPOSE: A review of all (non-) controlled trials of the last two decades both with a retrospective and prospective design and a follow-up period of at least 1 y. RESEARCH METHODS AND PROCEDURES:The relevant literature was identified by a search of computerized databases. All articles published in English and German since 1980 were reviewed. Based on the requirements of the evidenced-based guidelines of the Agency for Health Care Policy and Research and the Scottish Intercollegiate Guidelines Network, each study was rated by a level of evidence. RESULTS: In all, 171 publications were reviewed. Using the above inclusion/exclusion criteria, 63 articles including two systematic reviews were identified. A total of 40 studies focused on psychosocial outcome after obesity surgery. CONCLUSION: Mental health and psychosocial status including social relations and employment opportunities improve for the majority of people after bariatric surgery thus leading to an improved QoL. Psychiatric comorbidity, predominantly affective disorders, and psychopathologic symptoms decrease postsurgically. A substantial percentage of bariatric surgery patients suffer from binge eating disorder or binge eating symptoms. The effect of bariatric surgery on the outcome of binge eating symptoms largely depends on the type of operation. With the exception of patients with a severe psychiatric comorbidity, the concern that obesity surgery will reinforce psychic symptoms and lead to a reduction in the QoL seems to be unfounded.

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Results of the surgical treatment of obesity

Cited by 289 publications

References 6 publications

Medical and surgical options in the treatment of severe obesity

Medical and surgical options in the treatment of severe obesity

Evidence-based medicine reports on obesity surgery: a critique

Does obesity surgery improve psychosocial functioning? A systematic review

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