title: Health benefits of gastric bypass surgery after 6 years.
abstract: BACKGROUND
  Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain.
  
  
  OBJECTIVE
  To examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery.
  
  
  METHODS
  A prospective Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese (body mass index [BMI] ≥ 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) who sought and received RYGB surgery (n = 418), sought but did not have surgery (n = 417; control group 1), or who were randomly selected from a population-based sample not seeking weight loss surgery (n = 321; control group 2).
  
  
  METHODS
  Weight loss, diabetes, hypertension, dyslipidemia, and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment.
  
  
  RESULTS
  Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P < .001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P < .001). The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively.
  
  
  CONCLUSIONS
  Among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years.
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, 420 Chipeta Way, Room 1160, Salt Lake City, UT 84108, USA. ted.adams@utah.edu
authors.forename: Ted D
authors.initials: TD
authors.lastname: Adams
authors.forename: Lance E
authors.initials: LE
authors.lastname: Davidson
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.forename: Ronette L
authors.initials: RL
authors.lastname: Kolotkin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pendleton
authors.forename: Michael B
authors.initials: MB
authors.lastname: Strong
authors.forename: Russell
authors.initials: R
authors.lastname: Vinik
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Wanner
authors.forename: Paul N
authors.initials: PN
authors.lastname: Hopkins
authors.forename: Richard E
authors.initials: RE
authors.lastname: Gress
authors.forename: James M
authors.initials: JM
authors.lastname: Walker
authors.forename: Tom V
authors.initials: TV
authors.lastname: Cloward
authors.forename: R Tom
authors.initials: RT
authors.lastname: Nuttall
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hammoud
authors.forename: Jessica L J
authors.initials: JL
authors.lastname: Greenwood
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.forename: Rodrick
authors.initials: R
authors.lastname: McKinlay
authors.forename: Steven C
authors.initials: SC
authors.lastname: Simper
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Smith
authors.forename: Steven C
authors.initials: SC
authors.lastname: Hunt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012306:Risk; D012307:Risk Factors; D015431:Weight Loss; D055815:Young Adult