Bariatric surgery

doi:10.1136/bmj.a755

Published 31 July 2008, doi:10.1136/bmj.a755
Cite this as: BMJ 2008;337:a755

Editorials

Bariatric surgery

Can reduce weight and improve long term survival, but the risksmust also be considered

The first 150 words of the full text of this article appear below.

Severe obesity (body mass index $≥$ 40) has been linked to shortersurvival, poorer mental and physical health, and substantialhealthcare costs. Bariatric procedures, such as gastric bypassand gastric banding, dramatically reduce weight through gastricrestriction, malabsorption, changes in neuroendocrine signalling,or a combination of these mechanisms.

One criticism of bariatric surgery has been the paucity of studiescomparing its outcomes against non-surgical treatment. However,two recent controlled non-randomised studies found that bariatricsurgery improved long term survival.¹ ² The first was a prospectivestudy that matched 2010 patients who had undergone bariatricsurgery with 2037 non-surgical controls.¹ After a mean of 10.9years (with 99.9% follow-up), 6.3% of controls had died comparedwith 5.0% of surgical patients (hazard ratio 0.76, 95% confidenceinterval 0.59 to 0.99, number needed to treat 77). The secondwas a retrospective study of 9949 patients who had gastric bypasssurgery and 9628 matched non-surgical controls.² . . . [Full text of this article]