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HealthDay does a good job reporting on study of long-term weight loss after bariatric surgery

obesity

10-year follow-up study finds many who had gastric bypass kept weight off

Weight-loss surgery helps people drop a significant amount of weight, and now a new study confirms that much of the weight appears to stay off for at least 10 years.

“This study suggests that patients interested in bariatric surgery, especially gastric bypass surgery, should be able to lose a significant amount of weight and keep that weight off for a very long time,” said study researcher Matt Maciejewski. He’s a professor of medicine at Duke University School of Medicine, in Durham, N.C.

While other research has found that weight-loss surgery is the most effective treatment for obese patients, there is less data on long-lasting effects. The new study is notable because of the decade-long follow-up, said Maciejewski, who is also a research career scientist at Durham Veterans Affairs Medical Center.

In the two-part study, Maciejewski’s team first looked at the results of about 1,800 men and women who had gastric bypass surgery. The investigators compared weight changes in gastric bypass surgery patients to weight changes in more than 5,300 obese veterans who had no weight-loss surgery or formal weight-loss treatment.

Gastric bypass surgery involves making the stomach smaller, and attaching the lower part of the small intestine directly to the stomach, so much of the small intestine is bypassed. After surgery, people feel much fuller, faster. The surgery also appears to alter gut hormones, gut bacteria and metabolism, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

At the study’s one-year mark, those who had the bypass had lost 31 percent of their starting weight, but the non-surgical patients had lost just 1 percent.

At 10 years, the researchers had weight information on 564 of the nearly 1,800 patients who had the gastric bypass. Only 19 of them had regained so much weight that they were nearly back to their starting weight; the rest kept off the weight.

Compared to the non-surgical group, the bypass group weighed 21 percent less than at the start of the study.

Next, the researchers compared three types of weight-loss surgeries: gastric bypass; sleeve gastrectomy; and adjustable gastric banding. In gastric banding, a band is placed at the top of the stomach to create a small pouch that reduces the size of the stomach. In sleeve gastrectomy, most of the stomach is removed, leaving a banana-shaped sleeve. As with gastric bypass surgery, both of these procedures leave people feeling full faster, according to NIDDK.

After four years, those who had gastric bypass lost nearly 28 percent of their starting weight. People who had sleeve gastrectomy lost about 18 percent and those with gastric banding lost about 11 percent, the researchers found.

The average age of the men and women studied was about 52, and three-quarters were men. Most were white.

The study was published online Aug. 31 in JAMA Surgery.

The study helps address a knowledge gap about long-term outcomes of bariatric surgery, said Dr. Jon Gould, chief of general surgery at the Medical College of Wisconsin in Milwaukee.

The study “shows that the gastric bypass procedure compared to sleeve gastrectomy or adjustable gastric banding produces more weight loss and it was sustained over the long term,” Gould said. He wrote a commentary to accompany the study in the same issue of the journal.

Based on the new study findings, Gould said, “I think a patient who is young and who has a long way to go may want to think about these results, and all other things being equal, might pick a gastric bypass for the long-term weight loss.”

The new finding, he added, validates his belief that the gastric bypass could be a “durable procedure.”

Maciejewski acknowledged that the study has limitations. For example, the study included mostly men, so the findings may not apply to women. In addition, women who undergo bariatric surgery are typically in their 30s through their 50s, he said. In this study, the average age of the men and women was 52.

“These results may not generalize to everyone,” he said.

Another possible limitation was the loss of patients during the follow-up, which could have affected the results, the researchers noted.

More information

To learn more about bariatric surgery procedures, visit the American Society for Metabolic and Bariatric Surgery.

SOURCES: Matt Maciejewski, Ph.D., research career scientist, Durham Veterans Affairs Medical Center and professor of medicine, Duke University School of Medicine, Durham, N.C.; Jon Gould, M.D., professor and chief of general surgery, Medical College of Wisconsin, Milwaukee; Aug. 31, 2016, JAMA Surgery, online

Last Updated: Aug 31, 2016

Rating

4 Star

Categories

Weight-Loss Surgery Sheds Pounds Long Term

Our Review Summary

Gastric bypass surgeryBariatric surgeries have been identified as perhaps the most successful means for people who are morbidly obese to lose weight, and use of these procedures is increasing, according to the American Society for Metabolic and Bariatric Surgery. Information about whether the weight-loss results last, and for how long, is a useful addition to the growing medical literature on these surgeries.

The study described here by HealthDay speaks directly to the issue in a couple of well-designed analyses, and the story does a good job of explaining both the methods and the results. Missing from an otherwise good narrative is information about the risks of these procedures, as well as their costs and overall availability to the general public.

 

Why This Matters

Obesity is a major health issue in the United States, and the use of bariatric surgical procedures is being used increasingly for those who are morbidly obese. Knowing how long people keep the weight off–and by how much—is useful for those deciding whether to opt into the procedure. Also of interest is if the health benefits, such as remission of type 2 diabetes, were sustained, though this study didn’t appear to investigate that.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost is not a component of this story.  That is an issue, as the story compares three weight-loss surgical options for morbidly obese individuals, and readers might well be interested in the economics. Also, it would be useful to discuss the costs of not having surgery in the matched population.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story does a nice job of making the weight loss comparisons—both over time for gastric bypass surgery and across surgical options—clear.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story makes no mention of harms. Bariatric procedures can lead to an array of complications that are worth considering. And on the flip side, it’s worth noting that research also has indicated that bariatric surgery can both extend quantity and quality of life when compared to not having surgery.

Does the story seem to grasp the quality of the evidence?

Satisfactory

Details of the two-part study conducted here are included and clearly described. And we were also pleased to see several study limitations discussed: “For example, the study included mostly men, so the findings may not apply to women.”

That said, we do wish more had been said about the study participants, such as average body mass index levels before and after the surgeries.

Does the story commit disease-mongering?

Satisfactory

Morbid obesity is a major and growing health issue with frustratingly few treatment options.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Sources are clearly identified, along with information about their links to the study itself (one scientist was the study’s lead researcher, and the other quoted in the story was independent).

Does the story compare the new approach with existing alternatives?

Satisfactory

This is another strong point of the story. The study compared the longer term weight-loss outcomes of the three primary bariatric surgical procedures.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story doesn’t make it readily clear how accessible these surgeries are, and who is a good candidate for one. Typically, these procedures are for people over a certain body-mass index, for example. And insurance coverage may or may not pay for it.

Does the story establish the true novelty of the approach?

Satisfactory

The story is clear that this study contributes to a growing set of data about long-term weight-loss effects of these surgeries.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Duke Medicine issued a news release, and the HealthDay story does not rely solely on it.

Total Score: 7 of 10 Satisfactory

Comments (2)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Linda Bacon

September 16, 2016 at 8:39 pm

I was so disappointed with this analysis. You missed a major point: they only reported results for 1/3 of the participants! Since research consistently suggests that people don’t report for follow up if they feel like they failed, this suggests that the majority regained the weight, which is consistent with what is seen in most weight loss studies. That suggests to me that this study actually proved that purported long term weight loss from bariatric surgery is a lie.

Reply

    Joy Victory

    September 17, 2016 at 6:03 am

    The story — wisely — pointed the drop-out rate out as a limitation; therefore, there wasn’t a need for us to point it out.

    Drop-out rates are a common limitation across many types of research, not just bariatric surgeries. Here is what they said:

    “At 10 years, the researchers had weight information on 564 of the nearly 1,800 patients who had the gastric bypass.”

    and

    “Another possible limitation was the loss of patients during the follow-up, which could have affected the results, the researchers noted.”

    Reply