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

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Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities

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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
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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.

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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
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 › Medicine › Public Health, Environmental and Occupational Health › 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

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