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RYGB sustains long-term weight loss in veterans
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Compared with adults with obesity who did not undergo bariatric surgery, those who had Roux-en-Y gastric bypass lost more weight and sustained most of that loss 10 years after surgery.
Further, Roux-en-Y gastric bypass (RYGB) yields greater weight loss than sleeve gastrectomy or adjustable gastric banding 4 years after surgery, according to researchers.
Matthew L. Maciejewski , PhD, of the Center for Health Services Research in Primary Care at Durham Veterans Medical Center in Durham, North Carolina, and colleagues evaluated data on 1,787 adults (mean age, 52 years; mean BMI, 47.7 kg/m2) who underwent RYGB between Jan. 1, 2000, and Sept. 30, 2011, and 5,305 nonsurgical matches (mean BMI, 47.1 kg/m2) from the Veterans Administration health care system. Follow-up on these patients was conducted for 10 years. The analysis was conducted from Sept. 9, 2014 to Feb. 12, 2016.
Compared with the nonsurgical group, the RYGB group lost a higher percentage of baseline weight at 1 year (1.1% vs. 31%) and at 10 years (7.3% vs. 28.6%). Of 564 participants in the RYGB group, just 3.4% were within 5% of their original baseline weight at 10 years compared with 55.5% of 1,247 participants in the nonsurgical group.
Patients who underwent RYGB were also compared with 379 who underwent sleeve gastrectomy and 246 who underwent adjustable gastric band to compare weight change up to 4 years.
At 4 years, the RYGB group lost the most weight (27.5% of their baseline weight) followed by the sleeve gastrectomy group (17.8% of their baseline weight) and the adjustable gastric band group (10.6% of their baseline weight).
“Among obese patients receiving care in the VA health care system, veterans who underwent RYGB lost much more weight than nonsurgical matches and were able to sustain most of this weight loss in the long term,” the researchers wrote. “We found that RYGB induced significantly more weight loss at 4 years than [sleeve gastrectomy] or [adjustable gastric band]. These results provide further evidence for the beneficial association between surgery and long-term weight loss than has been demonstrated in shorter-term studies of younger, predominantly female populations.”
In an accompanying editorial, Jon C. Gould, MD, of the division of general surgery, department of surgery at the Medical College of Wisconsin in Milwaukee, wrote that although the study findings are remarkable in regard to the low number of patients who regained weight back within 10 years, “[it] does not allow for meaningful conclusions with regard to durable gains in quality of life or health.”
“Although weight loss is an important outcome measure, success of bariatric surgery is best defined by taking a wider view of the goals of surgery,” he wrote. “The term metabolic surgery is appropriate because it emphasizes the nonweight-related impact of these procedures, perhaps even on patients who ultimately gain their weight back.” – by Amber Cox
Disclosure: Gould reports no relevant financial disclosures. Maciejewski reports receiving institutional grants from the Department of Veterans Affairs and the Agency for Healthcare Research and Quality, receiving an institutional contract from the Centers for Meidcare and Medicaid Services and owning stock in Amgen. Please see the full study for a list of all other authors’ relevant financial disclosures.
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