Bariatric Surgery Better Than Medical Therapy for Weight Loss, Metabolic Gain

Compared with medical therapy, bariatric surgery is associated with greater weight loss and  greater improvement of several metabolic parameters associated with obesity. Researchers reported their findings in Nutrition, Metabolism & Cardiovascular Diseases.

“Bariatric surgery is recommended for subjects with a body mass index (BMI) over of 40 kg/m² or with a BMI between 35 and 40 kg/m² with obesity-related comorbidities,” explained a research team from Florence, Italy. “[The] aim of the study was to compare different types of bariatric surgery with medical therapy for the treatment of obesity.”

The network meta-analysis of randomized controlled trials included 43 studies lasting 24 weeks or longer.

Bariatric surgery was associated with a significant reduction in BMI compared with medical therapy, according to the study. Moreover, bariatric surgery induced larger improvements than medical therapy in systolic blood pressure, triglyceride and fasting glucose, and HDL cholesterol.

Efficacy and safety results varied across specific surgical procedures. Network meta-analysis suggested the most effective were duodenal switch and bilio-pancreatic diversion, researchers reported.

“In direct comparisons, Roux-en-Y gastric bypass was more effective than laparoscopic adjustable gastric banding, laparoscopic vertical banded gastroplasty, and greater curvature plication, but less effective than duodenal switch,” they wrote, “whereas laparoscopic adjustable gastric banding was less effective than laparoscopic vertical banded gastroplasty and sleeve gastrectomy.”

Researchers had insufficient data to gauge how bariatric surgery affected mortality.

Reference:
Cosentino C, Marchetti C, Monami M, Mannucci E, Cresci B. Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2021;31(10):2815-2824. doi:10.1016/j.numecd.2021.06.018