Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study
Open accessAbstract
Background: There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. Objective: To compare weight loss and safety among bariatric procedures. Design: Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674). Setting: 41 health systems in the National Patient-Centered Clinical Research Network. Participants: 65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. Intervention: 32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. Measurements: Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. Results: Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. Limitation: Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. Conclusion: Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. Primary Funding Source: Patient-Centered Outcomes Research Institute.
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Bariatric surgery yields durable benefits including 25-35% weight loss, T2D remission, and lower cardiovascular and mortality risk.
“with durable benefits including 25–35% weight loss, T2D remission, and lower cardiovascular and mortality risk [177].”
From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [177]
The Results (page unavailable) report substantial weight loss through five years, but 25–35% does not describe all procedures: five-year mean loss was 25.5% for gastric bypass, 18.8% for sleeve gastrectomy, and 11.7% for gastric banding. The Methods > Outcomes and Discussion (pages unavailable) show that diabetes remission and longer-term cardiovascular and mortality risks were not evaluated. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOverall weight loss outcomes for MBS that are durable for years after surgery are consistently reported at greater than 60% excess weight loss, with some variation depending on the specific operation performed.
“Overall weight loss outcomes for MBS that are durable for years after surgery are consistently reported at greater than 60% percent excess weight loss (%EWL), with some variation depending on the specific operation performed [14, 114, 115].”
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 [115]
The Results (Comparative Effectiveness for Weight Loss; page not provided) report weight loss through five years and differences among procedures. But the Methods (Outcomes; page not provided) specify percent total weight loss, not percent excess weight loss; the paper does not establish the claimed greater-than-60% EWL figure. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRoux-en-Y gastric bypass and sleeve gastrectomy lead to a weight loss of 25-31% after one year and 19-25% after 5 years, with an average 5% higher weight reduction with Roux-en-Y gastric bypass vs. sleeve gastrectomy.
“The latter two are the most commonly used surgical methods and lead to a weight loss of 25-31 % after one year and 19-25 % after 5 years (with an average 5 % higher weight reduction with Roux-en-Y gastric bypass vs. sleeve gastrectomy) [84].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [84]
The Results (Comparative Effectiveness for Weight Loss) report one-year total weight loss of 25.2% for sleeve gastrectomy and 31.2% for Roux-en-Y gastric bypass, broadly matching the claimed range. At five years, the figures are 18.8% and 25.5%; the Discussion reports a bypass advantage of 5.9 percentage points at one year and 6.7 at five years, rather than an average of 5%. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLong-term studies of 4 to 10 years of follow-up suggest that insufficient weight reduction (proportion of people unable to reduce their initial weight by >5%) is observed in 2-15% of patients.
“Longterm studies of 4 to 10 years of follow-up suggest that insufficient weight reduction (proportion of people unable to reduce their initial weight by >5 %) is observed in 2-15 % of patients [84,85].”
From Obesity and MASLD: Is weight loss the (only) key to treat metabolic liver disease? (2024) · cites this paper as [84]
The Results (Comparative Effectiveness for Weight Loss; page unavailable) say that nearly all gastric-bypass and sleeve-gastrectomy patients achieved more than 5% total weight loss at five years, supporting the general point that insufficient loss was uncommon in those groups. The paper does not give the claimed 2–15% range in the available text, and its reported weight-loss outcomes are at 1, 3, and 5 years, not through 10 years. (LLM, conf=0.85)
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References 41 · Cited by 317
Research works printed but not linked: 1
- [14]Reames BN, Birkmeyer NJ, Dimick JB, Goodney PR, Dzebisashvili N, Goodman DC, Variation in the Care of Surgical Conditions: Obesity. A Dartmouth Atlas of Health Care Series. Lebanon, NH: The Dartmouth Institute for Health Policy and Clinical Practice; 2014. 36441863
- Authors
- Arterburn, D., Wellman, R., Emiliano, A., Smith, S. R., Odegaard, A. O., Murali, S., Williams, N., Coleman, K. J., Courcoulas, A., Coley, R. Y., Anau, J., Pardee, R., Toh, S., Janning, C., Cook, A., Sturtevant, J., Horgan, C., McTigue, K. M., & Collaborative*, F. T. P. B. S.
- Affiliations
- Kaiser Permanente Washington Health Research Institute (US)
- Rockefeller University (US)
- Translational Research Institute for Metabolism and Diabetes (US)
- University of California, Irvine (US)
- Kaiser Permanente (US)
- Community Partners' Network, Nashville, Tennessee (N.W.)
- University of Pittsburgh (US)
- Harvard University (US)
- Duke University (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2018-12-04
- Volume
- 169
- Issue
- 11
- Pages
- 741-750
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC6652193
- OpenAlex
- W2898794004
- Cited by
- 317
- References
- 41
- Citations by year
- 2026: 29 · 2025: 35 · 2024: 40 · 2023: 49 · 2022: 58 · 2021: 41 · 2020: 38 · 2019: 25 · 2018: 2
- FWCI
- 27.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (OBS-1505-30683)
- 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, weight loss, Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, major adverse events, postoperative complications, obesity, long-term weight loss outcomes, surgical safety, body mass index, comparative effectiveness, hospital readmission, quality of life, patient satisfaction, patient-reported outcomes
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Gastrectomy, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Postoperative Complications, Retrospective Studies, Gastric Bypass, Gastroplasty, Weight Loss, Bariatric Surgery, Young Adult, Comparative Effectiveness Research
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