Anita P Courcoulas1, Susan Z Yanovski2, Denise Bonds3, Thomas L Eggerman4, Mary Horlick2, Myrlene A Staten4, David E Arterburn5. 1. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 3. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. 4. Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 5. Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
Abstract
IMPORTANCE: The clinical evidence base demonstrating bariatric surgery's health benefits is much larger than it was when the National Institutes of Health last held a consensus panel in 1991. Still, it remains unclear whether ongoing studies will address critical questions about long-term complication rates and the sustainability of weight loss and comorbidity control. OBJECTIVE: To summarize findings from a multidisciplinary workshop convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The workshop aimed to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research directions. EVIDENCE REVIEW: The evidence presented at the workshop was selected by the planning committee for both its quality and duration of follow-up. The data review emphasized randomized clinical trials and large observational studies with long-term follow-up, with or without a control group. FINDINGS: Several small randomized clinical trials showed greater weight loss and type 2 diabetes mellitus remission compared with nonsurgical treatments within the first 2 years of follow-up after bariatric surgery. Large, long-term observational studies have shown durable (>5 years) weight loss, diabetes, and lipid improvements with bariatric surgery. Still unclear are predictors of outcomes, long-term complications, long-term survival, microvascular and macrovascular events, mental health outcomes, and costs. The studies needed to address these knowledge gaps would be expensive and logistically difficult to perform. CONCLUSIONS AND RELEVANCE: High-quality evidence shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments and are more effective at inducing initial type 2 diabetes mellitus remission in obese patients. More information is needed about the long-term durability of comorbidity control and complications after bariatric procedures and this evidence will most likely come from carefully designed observational studies.
IMPORTANCE: The clinical evidence base demonstrating bariatric surgery's health benefits is much larger than it was when the National Institutes of Health last held a consensus panel in 1991. Still, it remains unclear whether ongoing studies will address critical questions about long-term complication rates and the sustainability of weight loss and comorbidity control. OBJECTIVE: To summarize findings from a multidisciplinary workshop convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The workshop aimed to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research directions. EVIDENCE REVIEW: The evidence presented at the workshop was selected by the planning committee for both its quality and duration of follow-up. The data review emphasized randomized clinical trials and large observational studies with long-term follow-up, with or without a control group. FINDINGS: Several small randomized clinical trials showed greater weight loss and type 2 diabetes mellitus remission compared with nonsurgical treatments within the first 2 years of follow-up after bariatric surgery. Large, long-term observational studies have shown durable (>5 years) weight loss, diabetes, and lipid improvements with bariatric surgery. Still unclear are predictors of outcomes, long-term complications, long-term survival, microvascular and macrovascular events, mental health outcomes, and costs. The studies needed to address these knowledge gaps would be expensive and logistically difficult to perform. CONCLUSIONS AND RELEVANCE: High-quality evidence shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments and are more effective at inducing initial type 2 diabetes mellitus remission in obesepatients. More information is needed about the long-term durability of comorbidity control and complications after bariatric procedures and this evidence will most likely come from carefully designed observational studies.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Matthew L Maciejewski; Edward H Livingston; Valerie A Smith; Leila C Kahwati; William G Henderson; David E Arterburn Journal: Arch Surg Date: 2012-07
Authors: Matthew L Maciejewski; Edward H Livingston; Valerie A Smith; Andrew L Kavee; Leila C Kahwati; William G Henderson; David E Arterburn Journal: JAMA Date: 2011-06-12 Impact factor: 56.272
Authors: David E Arterburn; Andy Bogart; Nancy E Sherwood; Stephen Sidney; Karen J Coleman; Sebastien Haneuse; Patrick J O'Connor; Mary Kay Theis; Guilherme M Campos; David McCulloch; Joe Selby Journal: Obes Surg Date: 2013-01 Impact factor: 4.129
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Ronette L Kolotkin; Michael J LaMonte; Robert C Pendleton; Michael B Strong; Russell Vinik; Nathan A Wanner; Paul N Hopkins; Richard E Gress; James M Walker; Tom V Cloward; R Tom Nuttall; Ahmad Hammoud; Jessica L J Greenwood; Ross D Crosby; Rodrick McKinlay; Steven C Simper; Sherman C Smith; Steven C Hunt Journal: JAMA Date: 2012-09-19 Impact factor: 56.272
Authors: Steven H Belle; Paul D Berk; Anita P Courcoulas; David R Flum; Carolyn W Miles; James E Mitchell; Walter J Pories; Bruce M Wolfe; Susan Z Yanovski Journal: Surg Obes Relat Dis Date: 2007 Mar-Apr Impact factor: 4.734
Authors: Viktoria L Gloy; Matthias Briel; Deepak L Bhatt; Sangeeta R Kashyap; Philip R Schauer; Geltrude Mingrone; Heiner C Bucher; Alain J Nordmann Journal: BMJ Date: 2013-10-22
Authors: Tarissa Beatrice Zanata Petry; Pedro Paulo Caravatto; Fernando Quirino Pechy; Jose Luis Lopes Correia; Catia Cristina Lorenzi Guerbali; Regina Marcelina da Silva; João Eduardo Salles; Ricardo Cohen Journal: Curr Atheroscler Rep Date: 2015-09 Impact factor: 5.113
Authors: Ricard Corcelles; Mena Boules; Dvir Froylich; Amani Hag; Christopher R Daigle; Ali Aminian; Stacy A Brethauer; Barto Burguera; Philip R Schauer Journal: Obes Surg Date: 2016-08 Impact factor: 4.129
Authors: Catherine Keating; Martin Neovius; Kajsa Sjöholm; Markku Peltonen; Kristina Narbro; Jonas K Eriksson; Lars Sjöström; Lena M S Carlsson Journal: Lancet Diabetes Endocrinol Date: 2015-09-17 Impact factor: 32.069
Authors: Margaret E Smith; Jay S Lee; Aaron Bonham; Oliver A Varban; Jonathan F Finks; Arthur M Carlin; Amir A Ghaferi Journal: Surg Endosc Date: 2018-10-23 Impact factor: 4.584