Gastric bypass most effective for weight loss among common bariatric procedures

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Roux-en-Y gastric bypass was found to be the most effective bariatric procedure reviewed in this study in terms of patient weight loss.

2. The highest 30-day rate of adverse effects was observed in participants undergoing Roux-en-Y gastric bypass.

Evidence Rating Level: 2 (Good)

Study Rundown: There are a variety of different types of surgical procedures for management of obesity. These procedures include adjustable gastric banding (AGB) procedures, sleeve gastrectomy, and Roux-en-Y gastric bypass (RYGB). Currently, there is limited evidence regarding the long-term outcomes of these treatments. The authors of this study assessed weight loss and safety among bariatric procedures through a retrospective observational cohort study. Generally, they found that gastric bypass was most effective for weight loss when comparing common bariatric procedures. One limitation of this study was that the electronic health record databases had some missing data related to participant BMI at baseline or during follow-up. Furthermore, the study was nonrandomized in design and therefore there was at risk for unobserved confounding despite measures to eliminate bias. 

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Click to read the study in Annals of Internal Medicine 

Relevant Reading: Effectiveness of bariatric surgical procedures

In-Depth [retrospective cohort]: The authors conducted a retrospective observational cohort study utilizing data from 41 health systems in the National Patient-Centered Clinical Research Network, with data spanning from 2005 to 2015. A total of 32 208 RYGB, 29 693 sleeve gastrectomy, and 3192 AGB procedures were included in the study. The authors noted that the total numbers of patients with weight loss at 1 year was 31.2% (95% CI, 31.1% to 31.3%) for RYGB, compared to 25.2% (CI, 25.1% to 25.4%) for sleeve gastrectomy, and 13.7% (CI, 13.3% to 14.0%) for AGB. Further, the 30-day rate of adverse effects for RYGB was 5.0%, compared to 2.6% for sleeve gastrectomy and 2.9% for AGB.

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