First, it suggests that the findings of a new study showing superior results for gastric bypass on certain outcomes are novel and perhaps surprising. They are not. Second, it leaves readers with the impression that the studies covered represent the final, definitive word on which procedure offers the best risk-benefit profile. They do not. More context on the other studies that have been performed in this area — some much larger and more representative of the experience of a broad cross-section of patients — would have helped correct these deficiencies. For comparison, see how the competing HealthDay coverage did a slightly better job with some of these issues.
This story makes sweeping claims about gastric bypass being “better” than other procedures for the treatment of obesity. In medicine, however, the “better” treatment is almost always the one that the patient is more comfortable with after a careful consideration of risks and benefits.
While it is true, as this story states, that gastric bypass produces more weight loss faster than the lap band and has a bigger impact on diabetes, these advantages come with an increased risk of serious complications, including death. In addition, gastric bypass isn’t reversible whereas the band can be removed if the patient changes his or her mind. Meanwhile, band placement may be safer initially but the device sometimes fails or causes other problems that require a second operation. Moreover, patients need to follow-up more frequently with their doctor for adjustments or they won’t continue to lose weight. Patients need to consider these and many other factors before deciding which procedure is the better choice for them.
A comparison of the costs for each procedure should have been provided along with the head-to-head clinical findings. Some insurance policies will not cover these procedures, and even with coverage, costs for copays and other expenses (psychologists, dietitians, etc) may amount to significant additional expenditure.
There wasn’t enough detail or accuracy to earn a satisfactory on this point. Although the weight loss outcomes in one of the studies is clearly explained, for other measures, such as quality of life and diabetes, we are told merely that gastric bypass was “far better” than the band. This is a subjective characterization that would have have benefited from more precision. For the second study, the story states that diabetes “improved with gastric bypass but not with gastric sleeving.” This is not correct. The abstract states that remission of type 2 diabetes was seen in 93 percent of bypass patients and 47 percent of sleeve patients. That’s a big difference in favor of bypass, but the sleeve patients did also benefit some.
The study says the overall complication rate was “similar for both procedures,” but it never quantifies these risks the way HealthDay did, nor did it compare the seriousness of the complications. The failure to discuss mortality differences between these procedures is an especially important shortcoming of the piece. A key reason why people choose gastric banding is that they have a lower risk of dying from the procedure compared with gastric bypass. Although we can presume that nobody died as a result of the surgery in these studies (or else the story would likely have mentioned this), real world experience suggests that death is not uncommon with gastric bypass, especially with surgeons who are inexperienced and patients who are considered high risk. Somewhere along the line, this issue should have been raised.
The story makes aggressive claims about how gastric bypass is “no riskier” than other procedures and “better” for those with severe obesity and weight related medical conditions. In our view, however, it didn’t balance this language with enough caveats about the limitations of these analyses. We appreciate that the story pointed out the problems with comparing weight loss with gastric bypass and banding after only one year of follow-up surveillance. But we think the story should have placed more emphasis on the fact that these results came from a relatively small group of patients at a single institution with experienced surgeons. Patients getting a procedure done elsewhere may not get the same level of care that the investigators were able to provide in this study. And research from much larger studies than this one suggest that less experienced surgeons have worse outcomes with gastric bypass, which is a more complicated procedure than the band. Finally, a note about the uncertainty of truly long-term outcomes (10 years or more) would have been welcome, as some reports are suggesting that many bypass patients gain back a significant portion of their lost weight during this timeframe. There is also growing concern about the risk of serious neurological problems resulting from severe nutritional deficiencies in bypass patients.
The story did not engage in disease-mongering.
The story clears the minimum bar for this criterion, but not by much. The expert quoted at the end of the story provides a very salient point about the relatively short follow-up for the study. Perspectives from other experts presented earlier in the piece would have provided additional valuable context.
Though it doesn’t work for most people, a program of better diet and increased exercise can help some people lose weight and reduce chronic disease risk factors. The weight loss doesn’t have to be very substantial to yield important health benefits. The story could at least have mentioned nonsurgical options that might be helpful for some people.
The story reports that the Lap Band procedure is approved for people with a BMI as low as 30 if they have one or more related medical conditions. However, the story wasn’t precise enough about who might be a candidate for the other procedures discussed. According to National Institutes of Health criteria, weight loss surgery candidates should have a BMI of 40 or above or 35 with related medical conditions.
The story states that the bypass-band study is the first U.S. study to compare the two procedures head-to-head. What about this much larger head-to-head study from Texas that was published in 2008 and reported similar findings? Generally, the story presents the findings of these studies as if they are surprisingly novel, when in fact they mostly confirm findings that have been reported many times in previous research.
The story didn’t appear to lift anything directly from a news release put out by the journal publisher about the studies. Then again, there weren’t enough independent sources for us to tell how much the story may have relied on this press release. We’ll call it not applicable.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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