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Review
. 2014 Aug 27:349:g3961.
doi: 10.1136/bmj.g3961.

Bariatric surgery for obesity and metabolic conditions in adults

David E Arterburn  1 , Anita P Courcoulas  2
Affiliations
Review

Bariatric surgery for obesity and metabolic conditions in adults

David E Arterburn et al. BMJ. .

Abstract

This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.

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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare: no support from any organization for the submitted work. DEA reports grants from the National Institutes of Health, grants and non-financial support from Informed Medical Decisions Foundation, grants from Department of Veterans Affairs, and grants from the Agency for Healthcare Research and Quality outside the submitted work. APC reports other funding from J&J Ethicon Scientific, personal fees from J&J Ethicon Scientific, grants from NIH-NIDDK, grants from Covidien, grants from EndoGastric Solutions, and grants from Nutrisystem outside the submitted work.

Figures

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Fig 1 The evolution of bariatric surgery procedures. Use the interactive tool at:http://www.bmj.com/content/349/bmj.g3961/infographic
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Fig 2 (A) Horizontal gastroplasty; (B) vertical banded gastroplasty; (C) Roux-en-Y gastric bypass; (D) transected Roux-en-Y gastric bypass; (E) laparoscopic adjustable gastric band; (F) biliopancreatic diversion; (G) biliopancreatic diversion with duodenal switch; (H) vertical sleeve gastrectomy
See this image and copyright information in PMC

Comment in

References

    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012;307:491-7. - PubMed
    1. Public Health England. Morbid obesity. 2014. www.noo.org.uk/NOO_about_obesity/Morbid_obesity.
    1. Neovius M, Teixeira-Pinto A, Rasmussen F. Shift in the composition of obesity in young adult men in Sweden over a third of a century. Int J Obes (Lond) 2008;32:832-6. - PubMed
    1. Howard NJ, Taylor AW, Gill TK, Chittleborough CR. Severe obesity: investigating the socio-demographics within the extremes of body mass index. Obes Res Clin Pract 2008;2:I-II. - PubMed
    1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23:427-36. - PubMed

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