Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
Open accessAbstract
BACKGROUND: Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown. METHODS: The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years. RESULTS: After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable. CONCLUSIONS: As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.
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The Swedish Obese Subjects Study's non-surgical group averaged a 0.1% weight gain at 10 years.
“For example, in the non-surgical treatment group of the Swedish Obese Subjects Study21 of bariatric surgery, a 0·1% weight gain was reported, on average, after 10 years.”
From 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study (2009) · cites this paper as [21]
The Abstract reports a 0.1% weight gain in the control group after two years, not ten. At ten years, it reports a 1.6% weight gain in that group. (LLM, conf=0.95)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredBariatric surgery has a relevant beneficial effect on body weight loss, survival, and obesity-related comorbidities.
“These studies showed a relevant beneficial effect of surgery on body weight loss, survival, and obesity-related comorbidities (64, 65).”
From Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis (2013) · cites this paper as [65]
The Abstract reports substantial long-term weight loss and improvements in several obesity-related risk factors after surgery, though not all risk factors improved. The “death and other adverse events” section says mortality analyses were still ongoing, so this paper does not establish a survival benefit. (LLM, conf=0.91)
Experimental — accuracy not yet measuredLong-term effects of bariatric surgery are known only from observational, non-randomized studies, often of poor methodological quality.
“Our knowledge of the long-term effects of bariatric surgery is based only on observational, non-randomized studies, often of poor methodological quality.”
From Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis (2013) · cites this paper as [65]
The Study Design section (page not provided) describes the SOS study as a prospective, nonrandomized intervention trial, and the discussion (under “death and other adverse events”; page not provided) says its main limitation was the lack of randomization. These passages support the concern about nonrandomized long-term evidence, but the paper does not say that such studies were often of poor methodological quality or that the evidence consisted only of observational studies. (LLM, conf=0.83)
Experimental — accuracy not yet measuredLong-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 [11]
The Abstract reports sustained weight loss and improvements in several risk factors at 10 years, supporting long-term efficacy for severe obesity. The “death and other adverse events” section reports postoperative deaths and complications, but says analyses of mortality and other major outcomes were still ongoing. It therefore does not establish long-term safety or the broader claim that results consistently demonstrate both safety and efficacy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMBS 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].”
A total of 8 articles were used across more than 1 component.
“A total of 8 articles were used across more than 1 component.141,142,144,148,156,159,168,169”
From 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2014) · cites this paper as [168]
A total of 10 studies (12 articles) met the inclusion criteria, were rated as good or fair quality, and are included in the summary table.
“A total of 10 studies (12 articles) met the inclusion criteria, were rated as good or fair quality, and are included in the summary table.141,142,144,148,151,155,156,159,161,168,169,172”
From 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2014) · cites this paper as [168]
In morbidly obese individuals, bariatric surgery is linked to a large drop in type 2 diabetes incidence at 2 and 10 years.
“a substantial reduction in 2- and 10-year incidence of type 2 diabetes114”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [114]
In morbidly obese individuals, bariatric surgery is associated with sustained weight loss.
“In morbidly obese people, bariatric surgery was associated with a sustained weight loss”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [114]
In the Swedish Obese Subjects (SOS) study, 10% of RYGB patients did not maintain ≥5% weight loss at 10-year follow-up.
“In the Swedish Obese Subjects (SOS) study, the first long-term prospective trial to provide information on the effects of BS, 10% of RYGB patients did not maintain ≥ 5% weight loss at 10-year follow-up [1, 5, 6].”
Average weight reduction is approximately 28% after LAGB and 40% after RYGB, and type 2 diabetes remission occurs in 48% and 84% respectively.
“The average reduction in body weight is approximately 28% after laparoscopic adjustable gastric banding (LAGB) and 40% after Roux-en-Y gastric bypass (RYGB) and metabolic benefits such as remission of type 2 diabetes occurs in 48% and 84% in LAGB and RYGB patients, respectively (3, 4).”
From Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass (2009) · cites this paper as [3]
In follow-up of type 2 diabetic patients who have had bariatric surgery, with a mean sustained weight loss of >20 kg, diabetes is virtually eliminated.
“In this setting, with a mean sustained weight loss of >20 kg, diabetes is virtually eliminated (42–45).”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [43]
Recovery from hypertension was more common in the surgery group at both 2 years (21% control vs 34% surgery) and 10 years (11% control vs 19% surgery), but no change in hypertension incidence rate was noted between groups at the 2- and 10-year analysis.
“Although recovery from hypertension was more common in the surgery group at both 2 years (21% control vs 34% surgery) and 10 years (11% control vs 19% surgery), no change in hypertension incidence rate was noted between groups at the 2-and 10-year analysis.220”
In the Swedish Obese Subjects Study, after 2 years, weight increased by 0.1% in the control group and decreased by 23.4% in the bariatric surgery group; after 10 years, weight increased by 1.6% in the control group and decreased by 16.1% in the bariatric surgery group.
“After 2 years, patients' weight had increased by 0.1% in the control group and had decreased by 23.4% in the bariatric surgery group, whereas after 10 years, weight had increased by 1.6% in the control group and decreased by 16.1% in the bariatric surgery group.”
At 10 years, SBP in the surgery group had increased 0.5 mm Hg from baseline, compared with 4.4 mm Hg in the control group, while DBP remained 2.6 mm Hg below baseline, compared with 2.0 mm Hg below baseline in the control group.
“At 10 years, SBP in the surgery group had increased 0.5 mm Hg from initial baseline, as compared with 4.4 mm Hg in the control group, while DBP remained 2.6 mm Hg below baseline, as compared with 2.0 mm Hg below baseline in the control group.”
At 2 years, the surgery group demonstrated significant decreases in SBP (-4.4 mm Hg) and DBP (-5.2 mm Hg) compared with increases in SBP (+0.5 mm Hg) and DBP (+0.3 mm Hg) in the control group.
“At 2 years, the surgery group demonstrated significant decreases in SBP ()4.4 mm Hg) and DBP ()5.2 mm Hg) as compared with increases in SBP (+0.5 mm Hg) and DBP (+0.3 mm Hg) seen in the control group.”
Many studies have shown that weight loss improves blood pressure, diabetes, sleep apnea, hyperlipidemia, and sympathetic/parasympathetic tone.
“Many studies have shown that weight loss improves blood pressure, diabetes, sleep apnea, hyperlipidemia, and sympathetic/parasympathetic tone (196, 284, 324, 365).”
From Cardiac remodeling in obesity (2008) · cites this paper as [324]
Bariatric surgery in general produces much greater amounts of weight loss than life-style modification or pharmacotherapy, and these losses are usually sustained for much longer.
“Nonetheless, bariatric surgery in general produces much greater amounts of weight loss than life-style modification or pharmacotherapy, and these losses are usually sustained for much longer (324).”
From Cardiac remodeling in obesity (2008) · cites this paper as [324]
Ten years after laparoscopic adjustable gastric banding, patients regained 38% of the maximal weight they lost at 1 year.
“A large prospective multicenter Swedish study found that 10 years after laparoscopic adjustable gastric banding (LAGB), patients regained 38% of the maximal weight they lost at 1 year [32]”
In a Swedish study, mean daily caloric intakes increased from 1500 kcal/day at 6 months to 2000 kcal/day at 4-10 years post-bariatric surgery, contributing to long-term weight regain.
“In a Swedish study, the mean daily caloric intakes increased from1500 kcal/day at 6 months to 2000 kcal/day at 4–10 years post-BS, contributing to long-term WR [32].”
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References 40 · Cited by 4,457
Research works printed but not linked: 1
- [20]20. 1999 World Health Organization- International Society of Hypertension Guide- lines for the Management of Hypertension: Guidelines Subcommittee. J Hypertens 1999; 19:151-83.
- Authors
- Sjöström, L., Lindroos, A.-K., Peltonen, M., Torgerson, J., Bouchard, C., Carlsson, B., Dahlgren, S., Larsson, B., Narbro, K., Sjöström, C. D., Sullivan, M., & Wedel, H.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Norra Älvsborgs Länssjukhus (SE)
- Pennington Biomedical Research Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-12-23
- Volume
- 351
- Issue
- 26
- Pages
- 2683-2693
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2110791445
- Cited by
- 4,457
- References
- 40
- Citations by year
- 2026: 61 · 2025: 93 · 2024: 120 · 2023: 145 · 2022: 182 · 2021: 189 · 2020: 181 · 2019: 179 · 2018: 198 · 2017: 251 · 2016: 217 · 2015: 313 · 2014: 291 · 2013: 305 · 2012: 314
- FWCI
- 138.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- bariatric surgery, gastric surgery, morbid obesity, weight loss, diabetes remission, cardiovascular risk factors, hypertriglyceridemia, hyperuricemia, hypertension, hypercholesterolemia, HDL cholesterol, physical activity, energy intake, lifestyle, long-term outcomes
- MeSH terms
- Energy Intake, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Hyperlipidemias, Hypertension, Life Style, Male, Middle Aged, Obesity, Risk Factors, Gastric Bypass, Gastroplasty, Weight Loss, Exercise, Body Mass Index, Incidence, Treatment Outcome, Hyperuricemia
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