Joseph Chebli MD Northwest Obesity Surgery Weight Loss Surgery Seattle Washington

Bariatric Surgery : A Systematic Review and Meta-analysis (Buchwald, H. JAMA 2004)

Diabetes completely resolved in 76.8% of patients and resolved or improved in 86%
Hyperlipidemia improved in 70%
Hypertension was resolved in 61.7% and resolved or improved in 78.5%
Obstructive sleep apnea was resolved in 85.7% and resolved and improved in 83.6%

Meta-Analysis: Surgical Treatment of Obesity (Maggard, M. Ann Intern Med 2005)

Evidence supporting a benefit of bariatric surgery was strongest in patients with a BMI>40
For BMIs of 35 to 39, data from case series strongly support superiority of surgery but cannot be considered conclusive
Gastric bypass procedures result in more weight loss than gastroplasty
Bariatric procedures currently in use have been performed with an overall mortality of less than 1%
Adverse events occur in about 20% of cases
A laparoscopic approach results in fewer wound complications than an open approach

Swedish Obese Subjects Study (Sjostrom, L. N Engl J Med 2004)

Prospective, nonrandomized, interventional trial involving 4047 subjects
Largest trial comparing surgical versus medical treatment of morbid obesity
2010 patients underwent surgery (gastric banding, gastroplasty, or gastric bypass)
2037 chose medical treatment
At 2 years, weight had increased by 0.1 percent in the control group and decreased by 23.4 percent in the surgery group
At 10 years, weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group
Energy intake was lower and the proportion of physically active subjects was higher in the surgery group
Two and ten-year rates of recovery were better for diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension and hyperuricemia were more favorable in the surgery group
Surgery group had lower two and ten year incidence rates of diabetes, hypertriglceridemia, and hyperuricemia
Surgically treated patients were significantly less likely to require medications for cardiovascular disease or diabetes at two and six years
Costs of medications were reduced significantly in the surgically treated group
Surgically treated patients had dramatic improvement in scores on validated measures of quality of life

Long-Term Mortality after Gastric Bypass Surgery (Adams NEJM 2007)

Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding (O’Brien Ann Intern Med 2006)

Implications of Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes (O'Brien JAMA 2008)

Economics

Obese adults have 36%-39% higher health care costs than normal-weight persons
Obesity is associated with increased costs to businesses, partly because of absenteeism and health-related lost production timeSampalis compared long-term direct health care costs in 1035 bariatric surgical patients with 5746 obese controls
At 3.5 years, the cost of surgery was compensated for by a reduction in total cost
Medication costs, specifically for antihypertensive and diabetic medications are reduced by as much as 77% after surgery
Snow found the savings in drug costs was equal to the cost of surgery at 32 months
Assessments of quality adjusted life years have been conducted and favor bariatric surgery over nonsurgical treatment
Conservative attempts at lasting weight loss in the morbidly obese have a nearly 100% failure rate in the long term
Life expectancy increases
Increase in employability and productivity
Activities of daily living improve markedly
Decrease in medical claims and absenteeism
Even in those over age 60, there is a significant decrease in number and dose of drugs with cost-savings
References (Hensrud Mayo Clin Proc 2006; Sampalis Obes Surg 2004; Craig Am J Med 2002; Snow Obes Surg 2004; Jensen SOARD 2005; Brethauer Clev Clinic J Med 2006; Mason Obes Surg 1992)