Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity: 5-Year Changes in Body Weight, Risk Factors and Comorbidities

Abstract

Background: Not all morbidly obese patients want, or are eligible for bariatric surgery, and therefore depend on effective lifestyle interventions. Purpose: This study aimed to compare changes in body weight (BW), risk factors and comorbidities 5 years after Roux-en-Y gastric bypass (RYGB) or three lifestyle interventions in morbidly obese patients. Methods: 209 (75.1% women) morbidly obese adult (mean (standard deviation (SD)): age 40.9 years (9.5), BW 133.4 kg (19.6), body mass index (BMI) of 45.4 kg/m 2 (5.6)) patients were non-randomly allocated to: A) laparoscopic RYGB (n = 58), B) weight loss (WL) camp (n = 30), C) residential intermittent program (n = 64), or D) hospital outpatient program (n = 57). BW, risk factors and comorbidities were assessed at baseline, 1 and 5 years. Results: 89.0% and 54.1% completed the 1- and 5-year follow-up, respectively. Analysis of 5-year completers yielded a general reduction in BW at year 1 (-25.9 kg, 95% CI [-30.3, -21.6], p<0.001), followed by a regain of 11.3 kg (95% CI [6.9, 15.6], p<0.001) from 1 to 5 years. An overall reduction in BW from baseline was observed at the 5-year follow-up (-14.7 kg, 95% CI [-19.1, -10.3], p<0.001). After 5 years the RYGB group had lost significantly more BW (-30.9kg, 95% CI [-35.9, -25.9]), compared to the lifestyle groups: B (-13.3kg, 95% CI [-24.5, -2.1]), C (-5.5kg, 95% CI [-10.8, -0.2]) and D (-4.1 kg, 95% CI [-10.0, 1.8]) (all p<0.001), with no significant differences observed between the three latter groups. RYGB, group B, and group C had significant within-group WL after 5 years (all p<0.05). Plasma glucose and high-density lipoprotein cholesterol (HDL) were significantly better in the RYGB group at 5 years compared with all lifestyle groups (all p<0.05). Furthermore, a higher proportion of patients in the RYGB group experienced remission of hypertension compared with the lifestyle groups merged into one group (p<0.05). Conclusion: At the 5-year follow-up the RYGB was associated with a greater WL, overall healthier glucose and blood lipids, and a larger remission of hypertension, compared with lifestyle interventions. However, a significant 5-year WL was observed with lifestyle interventions as well.