CoChat
Sign Up
Cited by 358Bariatric Surgery and OutcomesObesity, Physical Activity, DietObesity and Health Practices

Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities

Open access
Jakobsen, Gunn Signe, Småstuen, Milada Cvancarova, Sandbu, Rune, Nordstrand, Njord, Hofsø, Dag, Lindberg, Morten, Hertel, Jens Kristoffer, Hjelmesæth, Jøran·2018·JAMA
DOI 10.1001/jama.2017.21055PMC PMC5833560
Open this paper in CoChat — free accountOpen PDF

Abstract

Importance: The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. Objective: To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Design, Setting, and Participants: Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Exposures: Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Main Outcomes and Measures: Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Results: Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4]). Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]). The proportion of patients with low ferritin levels was significantly greater in the surgical group (26% vs 12%, P < .001). Conclusions and Relevance: Among patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatment was associated with a clinically important increased risk for complications, as well as lower risks of obesity-related comorbidities. The risk for complications should be considered in the decision-making process.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jama.2017.21055

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Bariatric surgery and endoscopic procedures are important therapeutic options in people with type 2 diabetes and ABCD.

    “Bariatric surgery and endoscopic procedures are important therapeutic options in persons with T2D and ABCD.777–781”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [778]

    The Abstract describes bariatric surgery as a treatment option for severe obesity and associates it with remission of type 2 diabetes; the Key Points report better diabetes outcomes than with medical treatment. The paper does not address endoscopic procedures, so it supports only the bariatric-surgery part of the claim. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In clinical trials comparing bariatric surgery with medical treatment in people with type 2 diabetes, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of type 2 diabetes in some people.

    “In clinical trials comparing bariatric surgery vs medical treatment in persons with T2D, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of T2D in some persons.777–783”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [778]

    The Discussion reports more diabetes remission after surgery than after medical treatment (risk difference, 42.7%) over a median 6.5 years. But the Key Points identify this study as a cohort study, not a clinical trial, and the passages found do not report comparative short- or long-term A1C reductions; the A1C values shown are baseline values. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Jakobsen, G. S., Småstuen, M. C., Sandbu, R., Nordstrand, N., Hofsø, D., Lindberg, M., Hertel, J. K., & Hjelmesæth, J.
Affiliations
  • Sykehuset i Vestfold (NO)
  • Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-01-16
Volume
319
Issue
3
Pages
291
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2017.21055
PMC
PMC5833560
OpenAlex
W2784324162
Cited by
358
References
43
Citations by year
2026: 19 · 2025: 21 · 2024: 43 · 2023: 50 · 2022: 44 · 2021: 53 · 2020: 50 · 2019: 44 · 2018: 32 · 2017: 1 · 2013: 1
FWCI
46.52
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
bariatric surgery, morbid obesity, lifestyle intervention, gastric bypass, diabetes remission, hypertension remission, obesity-related comorbidities, postoperative complications, long-term outcomes, weight loss, prescription drug dispensing, patient registry data, United States comparison, cost-effectiveness, quality of life, patient satisfaction
MeSH terms
Adult, Depression, Diabetes Mellitus, Type 2, Female, Ferritins, Humans, Hypertension, Male, Middle Aged, Obesity, Morbid, Remission Induction, Cohort Studies, Comorbidity, Body Mass Index, Treatment Outcome, Bariatric Surgery

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review