JAMA Theme Issue Media BriefingJAMA Theme Issue Media BriefingNew York, NY

ted.adams@utah.edu

In the U.S., severe obesity is rapidly increasing at a rate greater than moderate obesity

There are a projected 31 million Americans meeting criteria for bariatric surgery

Long-term studies relating the health benefits of gastric bypass surgery remain limited

Prospectively compare clinical outcomes in severely obese patients receiving RYGB surgery with similarly severely obese controls

See bariatric surgery types on JAMA’s Patient Page (page 1173) - banding not approved in US and the sleeve not performed when Utah study initiated

315

387

388

Exam 3

319

410

400

Exam 2

Utah Obesity Study DesignUtah Obesity Study Design

Exam 1

2 Years 6 Years

321

Utah Health Family Tree

Program

Baseline

417

No Surgery

418

RYGBSurgical Center

Type 2 diabetes: Fasting blood glucose ≥ 126 mg/dL, HgA1c ≥ 6.5% or antidiabetic medication

Dyslipidemia: Fasting LDL-C ≥ 160 mg/dL, fasting HDL-C < 40 mg/dL, or fasting triglycerides ≥ 200 mg/dL or using lipid lowering medication

Hypertension: Resting clinic blood pressure ≥ 140/90 mmHg or antihypertensive medication

Quality of Life (QOL): Obesity-specific QOL tool and SF-36 (physical and mental)

Propensity scores – this analysis adjusts for differences in groups

Logistic regression – this analysis adjusts for any remaining differences

Remission of baseline prevalent disease defined as clinically normal levels of fasting glucose and lipids and of resting blood pressure – each without reported medication use at examination three

VariablesRYGB

Surgery (418)

Control Group 1

(417)

Control Group 2

(321)

Female, % 84.4 84.4 76.0*

Age, y 42.5 43.0 49.4*

BMI 47.3 46.3 43.8*

SBP, mm Hg 126.3 125.6 128.8

DBP, mm Hg 71.9 72.0 72.3

Glucose, mg/dL 101 107* 107*

Quality of life 31.4 34.9* 54.4*

* Statistical difference between groups

%

Surgery Group Control Group 1 Control Group 2

mg

/dL

Surgery Group Control Group 1 Control Group 2

mg

/dL

Surgery Group Control Group 1 Control Group 2

mg

/dL

Surgery Group Control Group 1 Control Group 2

Only surgical patients

Percent Weight Change

Percent Weight Change

At 6 years:

96% of the RYGB group had maintained more than 10% of weight loss from baseline

76% had maintained more than 20% weight loss from baseline

At 6 years, RYGB had:

Decrease in fasting glucose of 23.7 mg/dL relative to control group 1

Decrease of 19.5 mg/dL relative to control group 2

GroupBaseline

PrevalenceIncidence Remission

Surgery 22% 2% 62%

Control 1 25% 17% 8%

Control 2 29% 15% 6%

OR: 0.11

OR: 0.21

OR: 16.5

OR: 21.5

GroupBaseline

PrevalenceIncidence Remission

Surgery 43% 16% 42%

Control 1 43% 31% 18%

Control 2 52% 33% 9%

OR: 0.40

OR: 0.47

OR: 2.9

OR: 5.0

GroupBaseline

PrevalenceIncidence Remission

Surgery 20% 4% 53%

Control 1 18% 25% 22%

Control 2 21% 30% 10%

OR: 0.12

OR: 0.14

OR: 4.4

OR: 6.8

GroupBaseline

PrevalenceIncidence Remission

Surgery 41% 5% 67%

Control 1 45% 32% 34%

Control 2 36% 38% 18%

OR: 0.10

OR: 0.10

OR: 3.8

OR: 6.2

Group Baseline Prevalence

Incidence Remission

Surgery 43% 3% 71%

Control 1 41% 25% 33%

Control 2 41% 28% 34%

OR: 0.10

OR: 0.13

OR: 5.1

OR: 3.4

RYGB surgery provided long-term diabetes, hypertension, and abnormal lipid remission and improvement in other risk factors when compared with severely obese patients not having surgery

There was a 5- to 9-fold reduction in the risk of new diabetes in surgical patients compared with severely obese controls who did not have surgery

The large improvement in fasting glucose seen at 2 years follow-up, continued to 6 years

Significant weight loss was sustained for an average of 6 years

Available at www.jama.com

TD Adams and coauthors

Health Benefits of Gastric Bypass Surgery After 6 Years

Category BMI Female Male

Normal weight 18.5 - 25 140 lb 166 lb

Overweight 25 - 30 176 lb 203 lb

Obese Class I (moderately obese)

30 - 35 208 lb 240 lb

Obese Class II (severely obese)

35 - 40 239 lb 277 lb

Obese Class III (very severely obese)

> 40 300 lb 347 lb

(67 in) (72 in)