JAMA Study Confirms Significant, Long-Term
Weight Loss After Gastric Bypass
By Ranjan Sudan, MD
Long-term durability of bariatric surgery has often been questioned by the medical community and the lay public. Most studies that have attempted to address long-term results (greater than 10 years) in the United States have been in small cohorts from single centers and hence the question remains inadequately answered. The Swedish Obesity Study did report long-term data but was from a different era when vertical banded gastroplasty was commonly performed.
The study by Maciejewski, Arterburn, Scoyoc, et al published in JAMA Surgery addresses this gap in knowledge. They showed that in the Veteran population from multiple centers, Roux-en-Y gastric bypass produced durable weight loss compared to matched veteran populations undergoing usual care. There are several strengths of this study and includes a large multi-institutional cohort of patients, and a follow-up rate of nearly 82%. Patients were primarily male and were older and had a higher comorbidity burden than the usual bariatric patient in the U.S.
Researcher Matthew Maciejewski at the Duke University School of Medicine collaborated with Dr. David Arterburn, a senior investigator at Group Health Research Institute in Seattle, in analyzing the data.
In this selected group of patients, the 72% of the RYGB group lost 21% more weight at 10 years compared to nonsurgical controls. It was noteworthy that a significant subset of these patients lost more than 30% of their baseline weight. In addition, weight regain at 10 years to within 5% of their baseline weight was seen in only 3.4% of patients.
The study shows that excellent long-term results can be achieved after a RYGB with minimal numbers of patients regaining all of their weight. The study also compared intermediate-term results (4 years) of RYGB versus the lap band and the sleeve gastrectomy. Not surprisingly, this part of the study confirms that RYGB has the highest weight loss followed by sleeve gastrectomy. Future work is needed to address resolution of comorbid conditions and also complications to establish the efficacy of gastric bypass long-term for weight loss and comorbidity resolution.
It is well known that elderly males who are heavier are at greater risk for complications. It would be great to know that an efficacious operation can also be performed safely in a high-risk population. Notwithstanding, this is a very important contribution to the literature on long-term results following RYGB and should go a long way towards helping reinforce to primary care providers and the lay public that this is a durable intervention.
Dr. Arterburn added, “When patients and their providers are considering bariatric surgery and choosing among the procedures, expected weight change is one of several criteria. Complications and costs are other factors. A comprehensive consideration of numerous factors will help a given patient choose whether gastric bypass or some other procedure is best for him or her.”
Bariatric Surgery and Long-term Durability of Weight Loss, August 31, 2016