Study Shows Sustained Weight Loss Advantage among Obese Veterans Receiving Specific Bariatric Surgery
Research indicates that bariatric surgery is the most effective intervention for inducing weight loss among obese patients. However, much less is known about sustained weight loss after surgery because few studies report outcomes with sufficient long-term patient follow-up. This study compared 10-year weight change between 1,787 Veterans who underwent Roux-en-Y gastric bypass (RYGB) and 5,305 Veterans who did not undergo surgery. It also compared 4-year weight change between RYGB patients and 379 Veterans who underwent sleeve gastrectomy (SG) and 246 Veterans who underwent adjustable gastric banding (AGB). Investigators identified Veterans who underwent any bariatric surgery in VA bariatric centers or community hospitals reimbursed by VA from January 2000 through September 2011. The main outcome was weight change up to 10 years after surgery (through December 2014). Weight measurements recorded during outpatient visits were obtained from VA's electronic medical record.
- Among obese Veterans who received VA care, patients who underwent RYGB lost much more weight than matched non-surgical patients – and were able to sustain most of this weight loss in the long term.
- RYGB patients had lost 21% more of their baseline weight at 10 years than matched non-surgical patients. More than 70% of RYGB patients had at least 20% weight loss and approximately 40% had at least 30% weight loss at 10 years compared with 11% and 4%, respectively, for non-surgical matches.
- Among surgical patients, RYGB patients experienced the greatest weight loss (28%) after four years; SG patients experienced significantly less weight loss than RYGB (18%), while AGB patients lost the least weight (11%).
- This study provides evidence that bariatric surgery induces significant long-term weight loss, including among older male patients. This finding is important because few studies have examined weight change 10 years following surgery and nearly all prior studies were predominantly comprised of women.
- Veterans were not randomized, risking unobserved confounding after matched comparisons.
- Non-surgical matches did not receive formal weight loss treatment, but it is possible that a small subset participated in VA's weight loss program MOVE!
- Weight data were not systematically and routinely collected as part of a prospective data collection effort, so weights at specific time points were model-estimated predictions.
This study was funded by HSR&D (IIR 10-159), and Dr. Maciejewski was supported by an HSR&D Research Career Scientist Award (RCS 10-391). Drs. Maciejewski, Olsen, Smith, Weidenbacher, and Yancy and Ms. Van Scoyoc are part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.
Maciejewski M, Arterburn D, et al. Bariatric Surgery and Long-Term Durability of Weight Loss. JAMA Surgery. August 31, 2016;e-pub ahead of print.