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Long-term Follow-up After Bariatric Surgery: A Systematic Review
Open accessAbstract
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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“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]
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“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]
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“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]
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“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]
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“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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“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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Metadata
- 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)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-09-03
- Volume
- 312
- Issue
- 9
- Pages
- 934
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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
- FWCI
- 82.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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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