1. Health Benefits of Gastric Bypass Surgery After 6 Years
JAMA Theme Issue Media Briefing New York, NY

2. Background
In the U.S., severe obesity is rapidly increasing at a rate greater than moderate obesity
There are a projected 31 million Americans meeting criteria for bariatric surgery
Long-term studies relating the health benefits of gastric bypass surgery remain limited

3. Purpose
Prospectively compare clinical outcomes in severely obese patients receiving RYGB surgery with similarly severely obese controls
See bariatric surgery types on JAMA’s Patient Page (page 1173) - banding not approved in US and the sleeve not performed when Utah study initiated

4. Utah Obesity Study Design
Exam 1
319
410
400
Exam 2
315
387
388
Exam 3
Utah Health Family Tree Program
321
Surgical Center
417
No Surgery
418
RYGB
Baseline
2 Years
6 Years

5. What We Measured
Type 2 diabetes: Fasting blood glucose ≥ 126 mg/dL, HgA1c ≥ 6.5% or antidiabetic medication Dyslipidemia: Fasting LDL-C ≥ 160 mg/dL, fasting HDL-C < 40 mg/dL, or fasting triglycerides ≥ 200 mg/dL or using lipid lowering medication Hypertension: Resting clinic blood pressure ≥ 140/90 mmHg or antihypertensive medication Quality of Life (QOL): Obesity-specific QOL tool and SF-36 (physical and mental)
Changed Willitt to Willett. Added ‘day’ after weekend.

6. Statistical Analysis
Propensity scores – this analysis adjusts for differences in groups
Logistic regression – this analysis adjusts for any remaining differences
Remission of baseline prevalent disease defined as clinically normal levels of fasting glucose and lipids and of resting blood pressure – each without reported medication use at examination three
Changed Willitt to Willett. Added ‘day’ after weekend.

7. Unadjusted Baseline Results
Variables
RYGB Surgery (418)
Control
Group 1
(417)
Control Group 2
(321)
Female, %
84.4
76.0*
Age, y
42.5
43.0
49.4*
BMI
47.3
46.3
43.8*
SBP, mm Hg
126.3
125.6
128.8
DBP, mm Hg
71.9
72.0
72.3
Glucose, mg/dL
101
107*
Quality of life
31.4
34.9*
54.4*
* Statistical difference between groups

8. Weight as Percent of Baseline%
Surgery Group
Control Group 1
Control Group 2

9. Fasting Blood Glucose mg/dL Surgery Group Control Group 1

10. HDL-Cholesterol
mg/dL
Surgery Group
Control Group 1
Control Group 2

11. Blood Pressure
mg/dL
Surgery Group
Control Group 1
Control Group 2

12. Percent Weight Change
Only surgical patients

13. Percent Weight Change

14. Change in Body Weight (% of Initial)
At 6 years:
96% of the RYGB group had maintained more than 10% of weight loss from baseline
76% had maintained more than 20% weight loss from baseline

15. Change in Fasting Blood Glucose
At 6 years, RYGB had:
Decrease in fasting glucose of 23.7 mg/dL relative to control group 1
Decrease of 19.5 mg/dL relative to control group 2

16. Diabetes at 6 years Group Baseline Prevalence Incidence Remission
Surgery
22% 2%
62%
Control 1
25%
17% 8%
Control 2
29%
15% 6%
OR: 0.11
OR: 0.21
OR: 16.5
OR: 21.5

17. Hypertension at 6 years Group Baseline Prevalence Incidence Remission
Surgery
43%
16%
42%
Control 1
31%
18%
Control 2
52%
33% 9%
OR: 0.40
OR: 0.47
OR: 2.9
OR: 5.0

18. High LDL-C at 6 years Group Baseline Prevalence Incidence Remission
Surgery
20% 4%
53%
Control 1
18%
25%
22%
Control 2
21%
30%
10%
OR: 0.12
OR: 0.14
OR: 4.4
OR: 6.8

19. Low HDL-C at 6 years Group Baseline Prevalence Incidence Remission
Surgery
41% 5%
67%
Control 1
45%
32%
34%
Control 2
36%
38%
18%
OR: 0.10
OR: 3.8
OR: 6.2

20. High Triglycerides at 6 years
Group
Baseline Prevalence
Incidence
Remission
Surgery
43% 3%
71%
Control 1
41%
25%
33%
Control 2
28%
34%
OR: 0.10
OR: 0.13
OR: 5.1
OR: 3.4

21. Conclusion
RYGB surgery provided long-term diabetes, hypertension, and abnormal lipid remission and improvement in other risk factors when compared with severely obese patients not having surgery
There was a 5- to 9-fold reduction in the risk of new diabetes in surgical patients compared with severely obese controls who did not have surgery
The large improvement in fasting glucose seen at 2 years follow-up, continued to 6 years
Significant weight loss was sustained for an average of 6 years

22. TD Adams and coauthors
Health Benefits of Gastric Bypass Surgery After 6 Years

24. BMI - Examples Category BMI Female Male Normal weight 18.5 - 25 140 lb
Overweight
176 lb
203 lb
Obese Class I (moderately obese)
208 lb
240 lb
Obese Class II (severely obese)
239 lb
277 lb
Obese Class III (very severely obese)
> 40
300 lb
347 lb
(67 in)
(72 in)