Sleeve gastrectomy beneficial, but with greater risk for self-harm, substance use disorder
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Sleeve gastrectomy for class 1 obesity led to more weight loss and diabetes prevention compared with intensive lifestyle modification but was linked to higher risks for substance use disorder and self-harm, according to new data.
“By being perceived as a technically less challenging operation than the gastric bypass procedure, with a shorter operation time and a general view that short-term complications may be lower, sleeve gastrectomy is often considered for patients with class 1 obesity despite the lack of strong scientific support,” Erik Stenberg, MD, PhD, from the department of surgery from Örebro University Hospital in Sweden, and colleagues wrote in JAMA Network Open.
They added: “While good weight-loss results have been reported from case series, there is a lack of large, controlled studies addressing objective effectiveness and safety outcomes beyond 1 or 2 years compared with actively treated control individuals with class 1 obesity.”
Using data from several databases, including the Scandinavian Obesity Surgery Registry and Prescribed Drug Register, investigators compared 1,216 adults with class 1 obesity (BMI = 30 to < 35 kg/m2) who underwent sleeve gastrectomy with a BMI-matched group of 2,432 adults who participated in an intensive lifestyle modification program that included 3 months of a low-calorie diet, followed by 9 months of exercise and dietary advice. Cohorts also were matched for other demographics, including treatment year and antidepressant and anxiolytic use.
The mean age and BMI of participants in the surgery group was 42.4 years and 32.8, respectively, compared with 42.6 years and 32.9 in the lifestyle group, and about 90% of participants in both cohorts were women. Median follow-up was 5.1 years.
At 1 year, the surgery group had greater weight loss than the lifestyle group (22.9 kg vs. 11.9 kg), with similar findings reported at 2 years (21 kg. vs. 8.8 kg).
During follow-up, investigators reported lower diabetes drug use among the surgery group compared with the lifestyle group (59.7 vs. 100.4 events per 10,000 person-years).
“In participants without diabetes drug prescriptions before intervention, the risk of incident use was lower in the sleeve group than in the lifestyle group,” the researchers wrote.
However, among patients who treated diabetes at baseline, the 2-year remission rate was higher in the surgery group (48.4% vs. 22%).
In addition, the surgery group had higher rates of substance use disorder (94 vs. 50 events per 10,000 person-years) and self-harm (45 vs. 25 events per 10,000 person-years) compared with the lifestyle group.
Risks for major cardiovascular events and all-cause mortality were similar between the groups, according to the study.
“Substance use disorder, treatment for depression and anxiety, and health care encounters for self-harm were all increased in the surgery group compared with the intensive lifestyle treatment group,” the researchers wrote.
“Careful evaluation of patients before surgery, optimization of risk factors and close support during the perioperative and postoperative periods remain important measures, in particular for patients at increased risk of these complications.”
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