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Cited by 1,688Bariatric Surgery and OutcomesBody Contouring and SurgeryMinimally Invasive Surgical Techniques

The Effectiveness and Risks of Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2003-2012

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Chang, Su-Hsin, Stoll, Carolyn R. T., Song, Jihyun, Varela, J. Esteban, Eagon, Christopher J., Colditz, Graham A.·2014·JAMA Surgery
DOI 10.1001/jamasurg.2013.3654PMC PMC3962512
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Abstract

IMPORTANCE: The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003. OBJECTIVE: To examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques. DATA SOURCES: Literature searches of Medline, Embase, Scopus, Current Contents, Cochrane Library, and Clinicaltrials.gov between 2003 and 2012 were performed. STUDY SELECTION: Exclusion criteria included publication of abstracts only, case reports, letters, comments, or reviews; animal studies; languages other than English; duplicate studies; no surgical intervention; and no population of interest. Inclusion criteria were a report of surgical procedure performed and at least 1 outcome of interest resulting from the studied surgery was reported: comorbidities, mortality, complications, reoperations, or weight loss. Of the 25,060 initially identified articles, 24,023 studies met the exclusion criteria, and 259 met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS: A review protocol was followed throughout. Three reviewers independently reviewed studies, abstracted data, and resolved disagreements by consensus. Studies were evaluated for quality. MAIN OUTCOMES AND MEASURES: Mortality, complications, reoperations, weight loss, and remission of obesity-related diseases. RESULTS: A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161,756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression. In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. The complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%). Gastric bypass was more effective in weight loss but associated with more complications. Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass. Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass. CONCLUSIONS AND RELEVANCE: Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.

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  • Bariatric surgery procedures are irreversible, require major lifelong lifestyle changes, and have complication rates of 11-23%.

    “They are irreversible, require major lifelong lifestyle changes, and have complication rates of 11–23% [78].”

    From Dual and Triple Incretin-Based Co-agonists: Novel Therapeutics for Obesity and Diabetes (2024) · cites this paper as [78]

    The Results (§3.3.1; page unavailable) report a 17% complication rate in randomized trials, with an 11–23% confidence interval—not complication rates ranging from 11% to 23%. The same section reports 10% in observational studies. The passages found do not establish that the procedures are irreversible or require major lifelong lifestyle changes. (LLM, conf=0.90)

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  • GLP-1R monoagonism falls short of the efficacy of bariatric surgery in treating obesity and diabetes, which resolves T2D for more than 80% of patients and produces an average 25-33% reduction in body weight depending on the type of surgery.

    “Though far exceeding the efficacy of prior anti-obesity medications, GLP-1R monoagonism still falls short of the efficacy of bariatric surgery in treating obesity and diabetes, which resolves type 2 diabetes (T2D) for more than 80% of patients and produces an average of 25–33% reduction in body weight depending on the type of surgery employed [77, 78].”

    From Dual and Triple Incretin-Based Co-agonists: Novel Therapeutics for Obesity and Diabetes (2024) · cites this paper as [78]

    The Results (§3.3.3; page unavailable) report diabetes remission rates of 92% in randomized trials and 86% in observational studies, supporting the claim’s more-than-80% figure. However, the Methods (§2.5.1; page unavailable) define remission as a condition being either resolved or improved, so these figures do not establish that diabetes resolved in more than 80% of patients. The paper reports BMI change and percent excess weight loss, not the claimed 25–33% reduction in total body weight, and it does not compare surgery with GLP-1R monoagonism. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. [24]Bradley D Conte C Mittendorfer B Effects of gastric bypass and adjustable gastric banding on glucose homeostasis Journal of Clinical Investigation 2012 112
  2. [26]http://www.ama-assn.org/amednews/2012/04/23/bisa0423.htm Accessed December, 12, 2012

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Authors
Chang, S.-H., Stoll, C. R. T., Song, J., Varela, J. E., Eagon, C. J., & Colditz, G. A.
Affiliations
  • Washington University in St. Louis (US)
  • Department of Statistics, Seoul National University, Seoul, South Korea4currently with ASAN Medical Center, Seoul, South Korea
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2014-03-01
Volume
149
Issue
3
Pages
275
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2013.3654
PMC
PMC3962512
OpenAlex
W1987593352
Cited by
1,688
References
74
Citations by year
2026: 58 · 2025: 91 · 2024: 137 · 2023: 123 · 2022: 138 · 2021: 167 · 2020: 161 · 2019: 156 · 2018: 152 · 2017: 146 · 2016: 156 · 2015: 145 · 2014: 54
FWCI
116.55
Type
journal article
Language
en
Open access
Locations
  • JAMA Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Foundation for Barnes-Jewish Hospital (KM1CA156708)
  • National Institutes of Health (KL2TR000450, UL1TR000448, TL1TR000449)
  • Agency for Healthcare Research and Quality (KM1CA156708, K01HS022330)
  • National Cancer Institute (U54CA155496, KM1CA156708)
  • 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, weight loss, postoperative mortality, surgical complications, reoperation, gastric bypass, gastric banding, sleeve gastrectomy, obesity-related comorbidities, long-term outcomes, body mass index, randomized controlled trials, observational studies, meta-regression, subgroup analysis, publication bias, risk of bias
MeSH terms
Adult, Humans, Obesity, Postoperative Complications, Reoperation, Weight Loss, Body Mass Index, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Risk Assessment, Bariatric Surgery, Observational Studies as Topic

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