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Edited by Edward H. Livingston, MD
Bariatric Surgery and Long-term Weight Loss
The 2 most commonly performed operations for obesity are laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. In a randomized trial of 240 patients with morbid obesity, Salminen and colleagues found that laparoscopic Roux-en-Y gastric bypass resulted in greater weight loss than laparoscopic sleeve gastrectomy at 5 years, but the difference was not clinically significant. In an Editorial for this theme issue on treatments for severe obesity, Arterburn and Gupta note that shared decisions about obesity management are challenging because they require patients and physicians to consider complications and comorbidities as well as weight loss goals.
Editorials 1 and 2, Related Articles 1, 2, and 3, and JAMA Patient Page
Long-term Efficacy of Sleeve Gastrectomy
The sleeve gastrectomy procedure is technically easier, faster to perform, and potentially safer than Roux-en-Y gastric bypass, but there is insufficient evidence for its long-term efficacy. In a randomized trial of 217 patients with severe obesity who were randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period, Peterli and colleagues found no significant difference in excess weight loss.
Editorials 1 and 2, Related Article, and JAMA Patient Page
Gastric Bypass Surgery for the Treatment of Type 2 Diabetes
Preventing the microvascular complications of type 2 diabetes requires management of blood pressure and lipids as well as glycemic control. In a 5-year follow-up study by Ikramuddin and colleagues of 120 patients with obesity and type 2 diabetes who received a lifestyle-intensive medical management intervention, participants who also had Roux-en-Y gastric bypass were more likely to achieve a composite end point of hemoglobin A1c level less than 7.0%, low-density lipoprotein cholesterol level less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg.
Editorial and Related Articles 1 and 2
Bariatric Surgery and All-Cause Mortality
Obesity is a chronic disease with life-threatening complications. In a retrospective cohort study by Reges and colleagues of 33 540 patients with obesity, bariatric surgery was associated with lower all-cause mortality than nonsurgical obesity management over a median follow-up of approximately 4.5 years.
Treatment Options for Severe Obesity
Shared decisions about treatments for severe obesity must balance the risks of bariatric surgery against the adverse effects of the underlying disease. In a cohort study by Jakobsen and colleagues of 1888 patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatment was associated with higher risks of complications and lower risks of obesity-related comorbidities.
Clinical Review & Education
Long-term Outcomes of Bariatric Surgery
A recent article in JAMA Surgery assessed the long-term efficacy and safety of bariatric surgical procedures. In this From the JAMA Network article, Shubeck and colleagues discuss societal and cultural barriers to the surgical treatment of obesity.
Highlights. JAMA. 2018;319(3):205–207. doi:10.1001/jama.2017.12196
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