December 22, 2013
John DiTraglia MD
The Dec. 11 issue of The Journal of the American Medical Association has a report from the Longitudinal Assessment of Bariatric Surgery (LABS) funded by the National Institutes of Health (the government) about the outcome of severely obese patients followed for three years after having obesity surgery. (1)
There is also a flurry of reports in other journals and commentary too numerous for me to relate in detail in my small fat science column. But let me use one choice excerpt from the discussion in this LABS report. At the end of the first paragraph they say, “Variability in weight change also indicates a potential opportunity to improve patient selection and education prior to surgery as well as enhance support for continued adherence to lifestyle adjustments in the postoperative years.” But didn’t you just say in the second sentence of that paragraph, “Compared with the very modest weight loss resulting from lifestyle intervention at three years, weight loss from bariatric surgery was substantial…” You did.
The case stressed by these authors and the authors of a commentary in this issue of JAMA (2) is that there was variability in the response of patients to obesity surgery. While the average weight lost three years after Roux-en-Y gastric bypass was 31.5 percent, some patients lost somewhat less weight and some lost more. Yeah, I think we already knew that obesity was multi-factorial. The results after this kind of surgery send a much bigger message - it cuts through all that messiness and causes a remarkable weight loss in almost everybody and that weight loss has nothing to do with diet and exercise.
Speaking of lifestyle interventions, the Dec. 12 issue of the New England Journal of Medicine (NEJM) has several letters to the editor about the Look AHEAD study report on intensive lifestyle intervention in Type 2 diabetes that appeared in the July 11 issue of NEJM (3) and about which we wrote in this column. But my report on those juicy comments will have to wait for next week’s column.
1.Courcoulas AP. et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013;310(22):2416-25.
2.Ikramuddin S, Livingston EH. New insights on bariatric surgery outcomes JAMA 2013;310(22):2401-2.
3. Wing RR et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145-54.