15 Jan Long-term Medical Complications with Bariatric Surgery vs Medical Obesity Treatment
MedicalResearch.com Interview with:
Jøran Hjelmesæth MD, PhD
Morbid Obesity Centre and Section of Endocrinology
Department of Medicine
Vestfold Hospital Trust
Department of Endocrinology, Morbid Obesity and Preventive Medicine
Institute of Clinical Medicine
University of Oslo, Norway
MedicalResearch.com: What is the background for this study? What is known? Some previous studies have shown beneficial long-term effects of bariatric surgery on the remission and incidence of diabetes, hypertension and dyslipidemia, whilst high quality data on the long-term incidence of adverse effects, mental health conditions and complications after bariatric surgery are sparse or lacking. In addition, the control groups in previous studies of the effect of bariatric surgery seldom or never received any specific specialist based non-surgical treatment alternative.
The present pragmatic real world study was performed at a publicly funded single tertiary care obesity center in Norway where patients could choose between bariatric surgery and specialized medical treatment (voluntarily and free of charge). Nearly complete short- and long-term (≤ 10 years) data on beneficial and detrimental outcomes were retrieved from national registries (Norwegian Prescription Database and Norwegian Patient Registry). The results confirm the beneficial long-term effects of bariatric surgery (gastric bypass) on the remission and incidence of diabetes, hypertension and dyslipidemia, as demonstrated in some previous studies.
MedicalResearch.com: What is new? This study shows that bariatric surgery, as compared with specialized medical obesity treatment, was associated with a two-fold higher risk of specialist treated abdominal pain (Relative Risk, 95% Confidence Interval: 1.9, 1.6-2.3) and any gastrointestinal surgery (RR 2.0, 1.7-2.4). The latter included operation for abdominal pain (RR 12.9, 4.7-35.7), bowel obstruction (RR 10.5, 5.1-21.5) and operations on gallbladder (RR 3.4, 2.1-5.3). In addition, patients undergoing bariatric surgery had 50%, 30% and 30% increased risk of drug treated new-onset depression, anxiety and sleep-disorders and opioid use, respectively.
MedicalResearch.com: What should readers take away from your report?
Response: The present study demonstrated that bariatric surgery compared with medical treatment was associated with a clinically important increased risk for long-term complications, depression and opioid-use, as well as lower risks of obesity-related metabolic comorbidities.
Accordingly, the detrimental effects of bariatric surgery should not be underestimated in the shared-decision making process, and the patients who do not want surgery should be offered evidence-based non-surgical treatment alternatives.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should focus on improving non-surgical treatment of severe obesity and related comorbidities.
Jakobsen GS, Småstuen MC, Sandbu R, Nordstrand N, Hofsø D, Lindberg M, Hertel JK, Hjelmesæth J. Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities. JAMA. 2018;319(3):291–301. doi:10.1001/jama.2017.21055
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