According to a study published in the journal JAMA Surgery and led by researchers at Duke Health and the Durham VA Medical Center, gastric bypass surgery is more effective than other procedures and non-surgical treatments.
The basics of gastric bypass surgery (and its variations thereof) consist of a separation of the stomach into two parts, and then reorganizing the small intestine so that both parts of the stomach are able to drain properly. This procedure reduces the volume of the stomach well over 90%, and the patient responds physiologically to a feeling of fullness from a much decreased intake of food. Thus, weight loss occurs.
The study’s two- part findings are based on 10 years of analysis of medical records for veterans who underwent three different kinds of weight-loss surgeries at VA medical centers or hospitals reimbursed by the VA.
“Very few studies have shown how weight-loss surgery patients change over the long term, which we consider a period of five years or more,” said lead author Matthew Maciejewski, Ph.D, a professor of medicine at Duke and director of the Health Economics and Policy Unit at the Durham VA Medical Center. “We also wanted to contribute to filling the evidence gap about the comparative outcomes of the different forms of weight-loss surgery.”
In the study’s first part, Maciejewski and other researchers compared the records of 1,787 veterans who underwent the Roux-en-Y gastric bypass to the records of 5,305 veterans who didn’t have any form of weight loss surgery. The non-surgical patients were chosen in relation to criteria—like age, sex, weight, body mass index (BMI), and chronic conditions—that had to be met in order to be properly compared to the gastric bypass group.
At one year, the bypass group lost 31 percent of their baseline weight, while the non-surgical group lost 1.1 percent, resulting in a 30 percent greater weight loss for the bypass group. At 10 years, the bypass group continued to maintain greater weight loss by nearly 21 percent compared to the non-surgical group.
In the study’s second part, the researchers compared weight change with 1,785 patients who had surgery with gastric bypass; 246 patients who had surgery with adjustable gastric binding (AGB—an inflatable silicone device placed around the top portion of the stomach to slow consumption of food); and 379 patients who underwent sleeve gastrectomy (SG—the removal of a large portion of the stomach along the greater curvature).
At four years, gastric bypass patients had lost 27.5 percent of their baseline weight, while AGB patients lost 10.6 percent and SG patients lost 17.8 percent. All other years showed the same—the bypass patients saw the most weight loss (although percentages in each group varied by year).
Maciejewski concluded that “The results indicate that bariatric surgery, especially gastric bypass, provides significant long-term health benefits in terms of dramatic and sustained weight loss up to ten years after surgery,” and that “Patients, clinicians and policymakers should feel confident that gastric bypass can induce sustainable weight loss.”
The authors note that the patients in the study were predominantly male and about five years older than the typical bariatric surgery patient seen outside of VA hospitals. Additionally, in the absence of standardized weight measurements for patients, researchers used model-estimated predictions for certain time points.