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JAMA Theme Issue Media BriefingJAMA Theme Issue Media BriefingNew York, NY
In the U.S., severe obesity is rapidly increasing at a rate greater than moderate obesity
There are a projected 31 million Americans meeting criteria for bariatric surgery
Long-term studies relating the health benefits of gastric bypass surgery remain limited
Prospectively compare clinical outcomes in severely obese patients receiving RYGB surgery with similarly severely obese controls
See bariatric surgery types on JAMA’s Patient Page (page 1173) - banding not approved in US and the sleeve not performed when Utah study initiated
315
387
388
Exam 3
319
410
400
Exam 2
Utah Obesity Study DesignUtah Obesity Study Design
Exam 1
2 Years 6 Years
321
Utah Health Family Tree
Program
Baseline
417
No Surgery
418
RYGBSurgical Center
Type 2 diabetes: Fasting blood glucose ≥ 126 mg/dL, HgA1c ≥ 6.5% or antidiabetic medication
Dyslipidemia: Fasting LDL-C ≥ 160 mg/dL, fasting HDL-C < 40 mg/dL, or fasting triglycerides ≥ 200 mg/dL or using lipid lowering medication
Hypertension: Resting clinic blood pressure ≥ 140/90 mmHg or antihypertensive medication
Quality of Life (QOL): Obesity-specific QOL tool and SF-36 (physical and mental)
Propensity scores – this analysis adjusts for differences in groups
Logistic regression – this analysis adjusts for any remaining differences
Remission of baseline prevalent disease defined as clinically normal levels of fasting glucose and lipids and of resting blood pressure – each without reported medication use at examination three
VariablesRYGB
Surgery (418)
Control Group 1
(417)
Control Group 2
(321)
Female, % 84.4 84.4 76.0*
Age, y 42.5 43.0 49.4*
BMI 47.3 46.3 43.8*
SBP, mm Hg 126.3 125.6 128.8
DBP, mm Hg 71.9 72.0 72.3
Glucose, mg/dL 101 107* 107*
Quality of life 31.4 34.9* 54.4*
* Statistical difference between groups
%
Surgery Group Control Group 1 Control Group 2
mg
/dL
Surgery Group Control Group 1 Control Group 2
mg
/dL
Surgery Group Control Group 1 Control Group 2
mg
/dL
Surgery Group Control Group 1 Control Group 2
Only surgical patients
Percent Weight Change
Percent Weight Change
At 6 years:
96% of the RYGB group had maintained more than 10% of weight loss from baseline
76% had maintained more than 20% weight loss from baseline
At 6 years, RYGB had:
Decrease in fasting glucose of 23.7 mg/dL relative to control group 1
Decrease of 19.5 mg/dL relative to control group 2
GroupBaseline
PrevalenceIncidence Remission
Surgery 22% 2% 62%
Control 1 25% 17% 8%
Control 2 29% 15% 6%
OR: 0.11
OR: 0.21
OR: 16.5
OR: 21.5
GroupBaseline
PrevalenceIncidence Remission
Surgery 43% 16% 42%
Control 1 43% 31% 18%
Control 2 52% 33% 9%
OR: 0.40
OR: 0.47
OR: 2.9
OR: 5.0
GroupBaseline
PrevalenceIncidence Remission
Surgery 20% 4% 53%
Control 1 18% 25% 22%
Control 2 21% 30% 10%
OR: 0.12
OR: 0.14
OR: 4.4
OR: 6.8
GroupBaseline
PrevalenceIncidence Remission
Surgery 41% 5% 67%
Control 1 45% 32% 34%
Control 2 36% 38% 18%
OR: 0.10
OR: 0.10
OR: 3.8
OR: 6.2
Group Baseline Prevalence
Incidence Remission
Surgery 43% 3% 71%
Control 1 41% 25% 33%
Control 2 41% 28% 34%
OR: 0.10
OR: 0.13
OR: 5.1
OR: 3.4
RYGB surgery provided long-term diabetes, hypertension, and abnormal lipid remission and improvement in other risk factors when compared with severely obese patients not having surgery
There was a 5- to 9-fold reduction in the risk of new diabetes in surgical patients compared with severely obese controls who did not have surgery
The large improvement in fasting glucose seen at 2 years follow-up, continued to 6 years
Significant weight loss was sustained for an average of 6 years
Available at www.jama.com
TD Adams and coauthors
Health Benefits of Gastric Bypass Surgery After 6 Years
Category BMI Female Male
Normal weight 18.5 - 25 140 lb 166 lb
Overweight 25 - 30 176 lb 203 lb
Obese Class I (moderately obese)
30 - 35 208 lb 240 lb
Obese Class II (severely obese)
35 - 40 239 lb 277 lb
Obese Class III (very severely obese)
> 40 300 lb 347 lb
(67 in) (72 in)