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Cited by 819Bariatric Surgery and OutcomesBody Contouring and SurgeryMinimally Invasive Surgical Techniques

Long-term Follow-up After Bariatric Surgery: A Systematic Review

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Puzziferri, Nancy, Roshek, Thomas B., Mayo, Helen G., Gallagher, Ryan, Belle, Steven H., Livingston, Edward H.·2014·JAMA
DOI 10.1001/jama.2014.10706PMC PMC4409000
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Abstract

IMPORTANCE: Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE: 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. EVIDENCE REVIEW: MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS: Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size-weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size-weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass ( n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE: Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.

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Crossref · 10.1001/jama.2014.10706

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  • MBS produces superior weight loss outcomes compared with nonoperative treatments.

    “Studies with long-term follow up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that MBS produces superior weight loss outcomes compared with nonoperative treatments [9–14].”

    From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [13]

    The Results > Weight Loss section reports substantial long-term weight loss after bariatric surgery, but its comparison is gastric bypass versus gastric band. The paper does not establish that surgery produces superior weight loss to nonoperative treatments, so the claimed comparator is unsupported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Long-term results of metabolic and bariatric surgery consistently demonstrate safety and efficacy.

    “Long-term results of MBS consistently demonstrate safety and efficacy.”

    From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [13]

    The Conclusions report substantial, sustained weight loss after gastric bypass, and the Discussion reports relatively low long-term complication rates in the included bypass and band studies (page numbers unavailable). But the paper says few studies have adequate long-term follow-up and that evidence for sleeve gastrectomy is insufficient. It therefore does not establish consistent long-term safety and efficacy across bariatric procedures. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Various interventions and policies to address obesity have been developed and studied, but no programme to date has shown long-term, sustained, population-level reductions in obesity.

    “Various interventions and policies to address obesity have been developed and studied,53, 54, 55, 56 but no programme to date has shown long-term, sustained, population-level reductions in obesity.57”

    From Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021 (2023) · cites this paper as [54]

    Citation 57 is attached to the claim that no programme has achieved sustained, population-level reductions in obesity. The Discussion and Abstract Conclusions address long-term follow-up and possible overestimation of outcomes after bariatric surgery, not population-level obesity trends or the effectiveness of programmes generally. Searches for sustained population-level reductions and obesity programmes found no passage addressing that claim; page numbers were unavailable in our copy. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • A more marked hypolipidaemic effect occurs when weight reduction is greater, as observed in severely obese patients who undergo bariatric surgery.

    “An even more marked hypolipidaemic effect occurs when weight reduction is more relevant, as observed in severely obese patients who undergo bariatric surgery.”

    From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [181]

  • Bariatric surgery seems to induce beneficial effects not only on the overall risk factor profile but also on cardiovascular events.

    “This treatment seems to induce beneficial effects not only on the overall risk factor profile, but also on CV events. 181”

    From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [181]

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Authors
Puzziferri, N., Roshek, T. B., Mayo, H. G., Gallagher, R., Belle, S. H., & Livingston, E. H.
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • University of Pittsburgh (US)
  • The University of Texas at Arlington (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2014-09-03
Volume
312
Issue
9
Pages
934
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2014.10706
PMC
PMC4409000
OpenAlex
W2068618758
Cited by
819
References
51
Citations by year
2026: 24 · 2025: 40 · 2024: 53 · 2023: 65 · 2022: 69 · 2021: 72 · 2020: 79 · 2019: 65 · 2018: 95 · 2017: 91 · 2016: 86 · 2015: 66 · 2014: 8 · 2013: 2 · 2012: 1
FWCI
82.84
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001105, KL2TR001103)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
bariatric surgery, obesity, long-term follow-up, excess weight loss, gastric bypass, sleeve gastrectomy, gastric band, type 2 diabetes remission, hypertension remission, comorbidity improvement, quality of evidence, treatment effectiveness, HbA1c, body mass index, quality of life
MeSH terms
Diabetes Mellitus, Follow-Up Studies, Humans, Hyperlipidemias, Hypertension, Obesity, Time Factors, Weight Loss, Treatment Outcome, Endpoint Determination, Bariatric Surgery

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