Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up.
BACKGROUND
No long-term, high participation study of the outcome of bariatric surgery has examined how a multi-intervention approach to the treatment of severe obesity can achieve and sustain weight loss after an initial bariatric procedure.


METHODS
We employed a multi-intervention treatment that combines adjustable gastric banding with intensive follow-up to support patient life-style change and use of an algorithm allowing reoperation-to bypass, if necessary-in the event of complications. Four hundred four severely obese patients with an average BMI = 42.6 at the outset had initial AGB surgery and were followed with a high rate of face-to-face consultations for 7 years. Seventy-five percent of the patients retained a gastric band throughout the study. Weight loss, complications, and comorbidities were studied, and quality of life was assessed using Bariatric Analysis and Reporting Outcome System (BAROS).


RESULTS
Three hundred eighty-eight (96%) patients completed the 7-year follow-up. Average BMI reduction at 5 years was 28% and remained stable through year 7, at which the mean excess weight loss was 61%. The preoperative prevalence of metabolic syndrome, 59.7%, decreased to 13.3% at 7 years and was abolished for patients with more than 40% loss of initial BMI. Similar changes were seen for all components of metabolic syndrome. More than 60% of patients had a "good" or higher BAROS score; 10.1% were considered failures. Patients converted to gastric bypass, and those retaining gastric bands throughout the study had very similar outcomes.


CONCLUSIONS
Long-term, multi-intervention treatment of severe obesity can achieve and preserve weight loss and thus improved quality of life and sustained reduction or disappearance of all components of metabolic syndrome, for a high proportion of severely obese patients with preoperative BMI between 35 and 55.
Steffen
Rudolf
R
Private Praxis Dr. Steffen, Bern, Switzerland.
Potoczna
Natascha
N
Bieri
Norman
N
Horber
Fritz F
FF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000628:therapy*; D010353:Patient Education as Topic; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
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