A study led by Dr. Ted Adams of the University of Utah School of Medicine has shown that six years after gastric bypass surgery patients had achieved significant weight loss, high diabetes remission rates and reduced cardiovascular health risks. The study adds further credence to the belief that Roux-en-Y gastric bypass surgery is a good solution for obese patients suffering from diabetes and cardiovascular disease.
The study analyzed 1156 obese individuals with a body mass index (BMI) of 35 or greater from July 2000 to June 2011. The data from 418 individuals who underwent a Roux-en-Y gastric bypass procedure was compared with two control groups. The first control group consisted of 417 people who had considered gastric bypass surgery but opted not to proceed, and the second control group contained 321 individuals not considering weight loss surgery and randomly selected from a large Utah database. Overall, the study participants were 82% female, had a mean BMI of 45.9 and ranged from 18 to 72 years of age.
The weight loss results were very impressive for the gastric bypass patients. Six years post-surgery, these individuals had lost 27.7% of their initial body weight (IBW). This dramatically outperformed the control groups, as group 1 gained 0.2% of IBW and group 2 lost 0% of IBW. Weight loss maintenance was also very good for those that had weight loss surgery, as 76% of patients still maintained at least a 20% reduction from their initial body weight.
The diabetes remission rates for the gastric bypass patients were excellent and greatly surpassed that seen with the control groups. At the six year mark, the surgery group had a 62% diabetes remission rate, while the rates were only 8% and 6%, respectively, for control group 1 and 2. Further, the incidence of diabetes during the study period was only 2% for the gastric bypass surgery participants, compared to 17% and 15%, respectively, for the control groups. The study considered individuals to have type 2 diabetes mellitus if they: (i) were being prescribed anti-diabetic medication for the disease; (ii) had a fasting blood glucose level of at least 126 mg/dl; or (iii) had an hemoglobin A1C level of at least 6.5%.
Cardiovascular health risks were also analyzed and the study showed very good results related to hypertension (high blood pressure), low HDL cholesterol, high LDL cholesterol and high triglycerides remission rates. Six years after the Roux-en-Y gastric bypass surgery, that group saw a hypertension remission rate of 42%, greatly surpassing the control group 1 and 2 which achieved an 18% and 9% rate, respectively. Hypertension was said to be present if the participant had a resting blood pressure of a least 140/90 mm HG or if he was being prescribed anti-hypertensive medication. The HDL cholesterol remission rate, using an HDL threshold of 40 mg/dL, for the weight loss surgery group was an impressive 67%, compared to 34% for control group 1 and 18% for control group 2. Further, for the gastric bypass group, the LDL cholesterol and high triglycerides remission rates were 53% and 71%, respectively, which again significantly outperformed the control groups.
While the study results are impressive, critics of it may point out that almost all of its participants are the same race – 96% non-Hispanic white. The lack of geographic diversification may also be brought into question as the study was clearly dominated by people from the Utah area. However, it remains to be discovered whether the above issues have any adverse impact on the overall efficacy of Roux-en-Y gastric bypass as a treatment for diabetes and cardiovascular disease.
Source: The Journal of the American Medical Association