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

Øvrebø, Bente
Master thesis
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URI
http://hdl.handle.net/11250/281450
Date
2014
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  • Institutt for samfunnsmedisin og sykepleie [2607]
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.
Publisher
NTNU

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