Gastric Bypass Bests Gastric Band in Obese Adults

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Compared with gastric band procedures, gastric bypass led to better long-term weight loss, diabetes and other metabolic outcomes, new data published in JAMA suggest.

In a systematic review, researchers evaluated the efficacy of bariatric procedures after 2 years for weight loss, type 2 diabetes, hypertension and hyperlipidemia in severely obese adults. Studies qualified for inclusion if they assessed gastric bypass, gastric band or sleeve gastrectomy in patients with a BMI of at least 35 and had more than 2 years of information on outcomes.

Twenty-nine of 7,371 clinical studies (7,971 patients) were included in the review. Gastric bypass studies included six prospective cohorts and five retrospective cohorts, and sleeve gastrectomy studies included two retrospective cohorts.

Results revealed that all studies had 95% confidence intervals for mean, median or both exceeding 50% excess weight loss, which occurred in 31% of gastric band studies (nine prospective cohorts and five retrospective cohorts).

For gastric bypass, mean sample-sized–weighted percentage of excess weight loss was 65.7% compared with 45.0% for gastric band, according to the researchers.

In nine studies, comorbidity improvement was assessed. For type 2 diabetes, sample-size–weighted remission rates were 66.7% for gastric bypass vs. 28.6% for gastric band. For hypertension, remission rates were 38.2% for gastric bypass vs. 17.4% for gastric band. For hyperlipidemia, remission rates were 60.4% for gastric bypass vs. 22.7% for gastric band.

This study indicates that long-term outcomes were better for gastric bypass as compared with gastric band in severely obese patients, the researchers concluded.

Gastric Bypass Bests Gastric Band in Obese Adults
Gastric Bypass Bests Gastric Band in Obese Adults

Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. The goal of this study was to assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension and hyperlipidemia in severely obese adults.

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