Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution. Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Dietary Intervention Study of Hypertension. The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Melanocortin-4 Receptor Mutations and Polymorphisms Do Not Affect Weight Loss after Bariatric Surgery Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Endothelial Function in Hypertensive Obese Patients: 1 year After Surgically Induced Weight Loss Gender effect on vascular inflammation following bariatric surgery. Impact of Bariatric Surgery on the Pharmacokinetics Parameters of Amoxicillin How useful is weight reduction in the management of hypertension? Effect of Weight Loss on Aerobic Capacity in Patients with Severe Obesity Before and After Bariatric Surgery What are the long-term results 8 years after sleeve gastrectomy?
Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a body mass index of 30 kg/m2 to 35 kg/m2 ; had identifiable problems , including an obesity-related comorbid condition ( such as hypertension , dyslipidemia , diabetes , obstructive sleep apnea , or gastroesophageal reflux disease ) , severe physical limitations , or clinical ly significant psychosocial problems associated with their obesity ; had attempted to reduce weight over at least the previous 5 years ; could underst and the options offered and the r and omization process ; and were willing to comply with the requirements of each program . Exclusion Criteria We excluded c and i date s with a history of bariatric surgery or medical problems that contraindicated treatment in either study group , such as impaired mental status , drug or alcohol addiction , or portal hypertension . In addition , we excluded participants if they had undergone an intensive , physician-supervised program that used very-low-calorie diets or pharmacotherapy or if they did not attend the 2 initial patient information visits . Assessment We provided detailed information about the problems of obesity and about the 2 study groups through at least 2 discussion periods and a patient information booklet . Initial assessment included anthropometric measures ; identification of medical , physical , or psychosocial problems ( both weight-related and other ) ; and a discussion of previous weight loss efforts . The assessment included a detailed dietary history by the trial dietitian and a review by a specialist physician to determine the presence and severity of associated medical conditions . Initial investigations included measurements of fasting blood glucose level ; serum insulin level ; and a lipid profile , including HDL cholesterol and LDL cholesterol levels . After initial assessment , we instituted a program of advice on appropriate eating patterns and exercise and followed each patient on a monthly basis for 3 months . During this time , we assessed the patients ' fulfillment of tasks , such as completion of a food diary , and overall adherence to appointments . R and omization Process We r and omly allocated eligible patients to receive a conventional , intensive , nonsurgical program or laparoscopic adjustable gastric b and ing .  A computer-derived r and om allocation sequence , without blocking or stratification , performed the r and omization . This was prepared at the trial office . The trial coordinator enrolled participants and informed them of the trial allocation . After assessment had confirmed a participant 's suitability for r and omization , the coordinator contacted the trial office by telephone for allocation . The study was not blinded . Description of Nonsurgical and Surgical Interventions Common Program We instructed and encouraged all patients to follow appropriate lifestyle behavior of good eating practice s and increased exercise and activity . We also encouraged them to exercise for at least 200 minutes per week . Nonsurgical Program This program centered on the use of behavioral modification , very-low-calorie diet , and pharmacotherapy with education and professional support on appropriate eating and exercise behavior . During the 2-year period , 3 trained physicians developed a program using all the available modalities for each individual on the basis of guidelines prepared and continually review ed by a panel of experienced bariatric physicians . The program began with an intensive 6-month period of very-low-calorie diet ( 500 to 550 kcal/d ) using 1 to 3 packets of Optifast ( Novartis , Fremont , Michigan ) daily for 12 weeks , followed by a transition phase over 4 weeks combining some very-low-calorie meals with 120 mg of orlistat before nonvery-low-calorie diet meals , and then 120 mg of orlistat before all meals until the completion of the intensive phase . This intensive 6-month program was followed by further courses of very-low-calorie diets or orlistat as tolerated , as well as continual behavioral , dietary , and exercise advice to assist the participant in maintaining weight loss over a prolonged period . Sibutramine was not approved for use in Australia during the first 12 months of the study and , therefore , was not incorporated into the medical program . The management program for each individual was design ed to reflect good clinical practice . A physician saw each patient every 2 weeks during the very-low-calorie diet program and every 4 to 6 weeks during the rest of the study . All patients were seen at least every 6 weeks . Surgical Program Two experienced surgeons performed the laparoscopic adjustable gastric b and ( LAP-B AND System ) procedure , by a st and ardized method ( 14 ) , within 1 month of r and omization . The b and was placed along the perigastric pathway in all cases ( 16 ) . The treating surgeon review ed patient progress every 4 to 6 weeks during the study period and made adjustments to the volume of saline within the b and in the office by using st and ard clinical criteria ( 17 ) . Adverse Events All patients in the study were question ed about the occurrence of adverse events at each consultation , and physicians recorded the INTRODUCTION The South Pacific has a high prevalence of obesity and super-obesity . We review ed our experience with laparoscopic sleeve gastrectomy ( LSG ) to evaluate its efficacy and safety . METHODS A retrospective review of a prospect ively collected data base of LSGs carried out by one surgeon in one center . The percentage of excess weight loss and the rate of resolution or improvement of comorbidities reflected efficacy , and major complications or mortalities reflected safety . RESULTS From January 2008 to February 2013 , we performed 510 surgeries and included 494 consecutive patients ( 367 females ) ( 45.5 ± 11.2 years ) in our study .  LSG was the primary procedure in 384 patients , 6 patients had redo bariatric surgery after failure of initial LSG , 57 patients had a history of gastric b and ing with insufficient weight loss or b and -related complications , and 46 super-obese patients had an intragastric balloon placed before LSG . Average starting body mass index was 47.8 kg m(-2 ) . Mean percent excess weight loss was 64.3 % at 1 year ; 67.3 % at 2 years and 66.4 % at 3 years . The percentages of resolved comorbidities were as follows : hypertension : 48.3 % , type 2 diabetes mellitus : 72.5 % , dyslipidemia : 61.0 % , and obstructive sleep apnea : 77.8 % . The mortality rate was 1/494 . The postoperative morbidity included gastric fistula in 3.0 % , hemorrhaging in 2.4 % , and postoperative gastroesophageal reflux in 9.4 % . CONCLUSIONS In the South Pacific , LSG is a safe and effective means of treating morbid obesity with sustained weight loss and resolution of comorbid medical conditions OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery The possibility exists that dietary modification may increase the number of patients who remain normotensive after drug withdrawal . In an effort to resolve this question , former Hypertension Detection and Follow-up Program Stepped Care participants ( n = 496 ) were r and omized into four major groups at the end of the programme ( greater than 5 years antihypertensive therapy )  : controls ( continue medication ) ; discontinue medication , no dietary intervention ; discontinue medication and weight loss ; discontinue medication and reduce sodium . Groups 1 , 2 and 4 were further divided into obese ( greater than or equal to 120 % ideal weight , and non-obese groups ) . The weight reduction group ( greater than or equal to 120 % ideal weight ) lost 10.1 + /- 11 lbs without changing dietary sodium ( n = 87 ) . The sodium restriction group reduced urine sodium excretion from 145 to 97 mEq per day ( n = 169 ) . Sixty per cent of the weight loss group were normotensive at 56 weeks compared to 35 % withdrawn from medication without dietary intervention . The highest 56 weeks success rates were in the mild non-overweight hypertensives on sodium restriction ( 78 % ) , and the mild overweight hypertensives on weight reduction ( 72 % ) . R and omization to either weight loss group or sodium restriction group increased the likelihood of remaining off drugs ( adjusted odds ratio of 3.43 for the weight group and 2.17 for the sodium group ( P less than 0.05 ) . Age , severe hypertension greater than 5 years previous to entry into Dietary Intervention Study of Hypertension ( DISH ) or need for several drugs increased the chance of failure BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery Background The veteran population is routinely screened for post-traumatic stress disorder ( PTSD ) . The prevalence of obesity in this population continues to increase . We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD , after gastric bypass .  We also examined the effect of bariatric surgery on PTSD symptoms . Methods This retrospective review of prospect i ve data compares veterans with and without PTSD who underwent laparoscopic gastric bypass .  Differences between the means of age , initial BMI , and percent excess weight loss were compared between the groups using a Student ’s t test . Pearson ’s χ2 was used to evaluate the relationship between a diagnosis of PTSD , major depressive disorder ( MDD ) , and other Axis I psychiatric disorders . A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities , including diabetes mellitus ( DM ) , hypertension ( HTN ) , hyperlipidemia , and GERD . Results We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD . Both groups had a similar mean age and initial BMI . There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group ( 66 % ) and the non-PTSD group ( 72 % ) ( p = 0.102 ) . In assessing comorbid conditions , we found a significant association between the diagnosis of PTSD and MDD ( p = 0.002 ) , PTSD and other Axis I disorders ( p = 0.004 ) , and PTSD and GERD ( p = 0.002 ) . However , we saw no significant association between PTSD and DM ( p = 0.977 ) , HTN ( p = 0.332 ) , and obstructive sleep apnea ( OSA ) ( p = 0.676 ) . The severity of PTSD symptoms fluctuated in the postoperative period . Conclusions Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass . In addition , surgery does not seem to have an adverse effect on PTSD symptoms , although PTSD symptomatology tends to fluctuate over time . Further study in this patient population is warranted STUDY OBJECTIVES To evaluate the effect of bariatric surgery on  sleep apnea symptoms and obesity-associated morbidity  in patients with severe obesity . DESIGN Prospect i ve study . SETTING University hospitals and community centers in Sweden . INTERVENTION We investigated the influence of  weight loss surgery ( n=1729 ) on  sleep apnea symptoms and obesity-related morbidity using a  conservatively treated group ( n=1748 ) as a control . MEASUREMENTS AND RESULTS Baseline BMI in surgical group ( 42.2+/-4.4 kg/m(2 ) ) and control group ( 40.1+/-4.6 kg/m(2 ) ) changed -9.7+/-5 kg/m(2 ) and 0+/-3 kg/m(2 ) , respectively , at 2-year follow-up . In the surgery group , there was a marked improvement in all obstructive sleep apnea ( OSA ) symptoms compared with the control group ( P < 0.001 ) . Persistence of snoring ( 21.6 vs 65.5 % , adjusted OR 0.14 , 95 % CI 0.10 - 0.19 ) and apnea ( 27.9 vs 71.3 % , adjusted OR 0.16 , 95 % I 0.10 - 0.23 ) were much less in the surgery group compared with controls . Compared with subjects with no observed apnea at follow-up ( n=2453 ) , subjects who continued to have or developed observed apnea ( n=404 ) had a higher incidence of diabetes ( adjusted OR 2.03 , 95 % CI 1.19 - 3.47 ) and hypertriglyceridemia ( adjusted OR 1.86 , 95 % CI 1.07 - 3.25 ) but not hypertension ( adjusted OR 1.09 , 95 % CI 0.65 - 1.83 ) or hypercholesterolemia ( adjusted OR 0.91 , 95 % CI 0.53 - 1.58 ) . CONCLUSION Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years . Despite adjustment for weight change and baseline central obesity , subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia . Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone OBJECTIVE To examine the effect of a large , long st and ing and intentional weight reduction on the incidence of diabetes , hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls . RESEARCH METHODS AND PROCEDURES The ongoing prospect i ve SOS ( Swedish Obese Subjects ) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment . This report is based on 845 surgically treated patients and 845 controls ( BMI 41.0+/-4.6 kg/m2 ( mean+/-st and ard deviation [ S ] ) ) followed for 2 years . RESULTS Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg ( p<0.0001 ) . Two-year incidence of hypertension , diabetes , hyperinsulinemia , and lipid disturbances was compared in the two treatment groups . Adjusted odds ratios ( 95 % CI ) for the surgically treated group versus controls were 0.38 ( 0.22 , 0.65 ) for hypertension , 0.02 ( 0.00 , 0.16 ) for diabetes , 0.10 ( 0.03 , 0.28 ) for hyperinsulinemia , 0 . 10 ( 0.04 , 0.25 ) for hypertriglyceridemia , 0.28 ( 0.16 , 0.49 ) for low HDL-cholesterol and 1.24 ( 0.84 , 1.8 ) for hypercholesterolemia . Compared to controls , the 2-year recovery rates from hypertension , diabetes , hypo-HDL , and hypertriglyceridemia were significantly higher in the surgically treated group . DISCUSSION Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension , diabetes and some lipid disturbances . The results suggest that severe obesity can and should be treated CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity The aim of this study was to describe the effect of surgically induced weight loss on vascular function measured by flow-mediated dilatation ( FMD ) in hypertensive obese patients . This prospect i ve study included 33 patients ( 78 % females , mean age 53 ( 9 ) years ) undergoing bariatric surgery ( BS ) .  Before and 12 months postoperatively , the BMI , 24-h ambulatory BP , high-sensitivity C-reactive protein ( hs-CRP ) , leptin , homeostasis model assessment ( HOMA IR ) , and abdominal fat  were measured . Endothelial function was assessed by FMD . After BS , the excess body weight loss was 71 % ; the 24-h [ systolic 18(11)//diastolic 7(7 ) mmHg ] BP values , hs-CRP , leptin , HOMA , and abdominal fat significantly decreased , with no changes in endothelial function . Weight loss achieved by BS was associated with a significant improvement in BP and metabolic and inflammation parameters , but FMD did not improve Studies have shown that mortality was reduced by 31.6 % in patients that underwent bariatric surgery  compared with the non-operative control group . However , in most surgical series the majority of patients were women , and men had higher post-operative mortality rates and a higher postoperative morbidity , regardless of weight . Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss . Methods . A prospect i ve study evaluated vascular inflammation in obese patients before and three months after bariatric surgery .  Markers of vascular inflammation were measured - before surgery and three months afterwards . Results . One hundred and two patients ( 73 women and 29 men , 40.5 ± 12.3 years old ) underwent bariatric surgery .  Correlation was found between BMI change and waist circumference change ( r = 0.658 , P<0.001 ) . Three months post-surgery , BMI was significantly decreased ( p<0.001 ) ( a decrease of 8.82 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 17.33 cm ) . ICAM-1 levels and hs-CRP levels were decreased ( both P = 0.0001 ) . Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus ( men > women ; P = 0.05 ) and hypertension ( men > women ; P = 0.06 ) . In women , following bariatric surgery  , BMI was decreased ( p<0.001 ) ( a decrease of 9.25 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 18.8 cm ) . ICAM-1 levels were decreased ( p = 0.002 ) and hs-CRP levels were also decreased ( P = 0.0001 ) . In men , following bariatric surgery  , BMI was decreased ( p = 0.001 ) ( a decrease of 8.1 ) , waist circumference was reduced ( p<0.005 ) ( a decrease of 14.6 cm ) ; however , although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant ( both P = 0.09 ) . Discussion . Our study examined gender effects of bariatric surgery  on vascular inflammation  . Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients , while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation . These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing  bariatric operation for  weight loss .  This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome , and cardiovascular morbidity and mortality Background Bariatric surgery leads to several anatomo-physiological modifications that may affect pharmacokinetic parameters and consequently alter the therapeutic effect of drugs , such as antibiotics . The pharmacokinetics of oral amoxicillin after Roux-en-Y gastric bypass ( RYGB ) surgery is unknown . Objectives The objective of this study was to evaluate the impact of bariatric surgery on the pharmacokinetics of  amoxicillin . Methods This study was performed as a r and omized , open-label , single-dose clinical trial , with two periods of treatment , in which obese subjects ( n = 8) received an amoxicillin 500 mg capsule orally before and 2 months after the RYGB surgery . The  amoxicillin plasma concentration was determined by liquid chromatography coupled to mass spectrometry ( LC-MS/MS ) . Results After the surgery , the mean weight loss was 17.03 ± 5.51 kg , and mean body mass index ( BMI ) decreased from 46.21 ± 2.82 to 38.82 ± 3.32 kg/m2 . The mean amoxicillin area under the plasma concentration versus time curve from time zero to the time of the last quantifiable concentration ( AUC0–tlast ) increased significantly ( 3.5-fold ) ; the maximum plasma concentration ( Cmax ) increased 2.8-fold after the bariatric surgery . No correlation was found between amoxicillin absorption , BMI , and weight loss percentage . Conclusion The alterations observed in the amoxicillin pharmacokinetics suggest that obese subjects included in this trial had a substantially increase in amoxicillin systemic exposure after RYGB surgery . However , despite this increase , its exposure was lower than the values reported for non-obese volunteers . Trial Registration Identifiers : A group of previously untreated obese hypertensive patients were started on a weight reduction programme supervised by two dietitians working in a general practice surgery . It was stressed from the beginning of the programme that reducing blood pressure was the purpose of the diet . The results of follow-up after six months are presented together with results for a control group of obese hypertensive patients not receiving dietary advice or drug therapy , but being followed by the general practitioner . The weight , systolic blood pressure and diastolic blood pressure of the dieting hypertensive group were significantly lower than those of the non-dieting group after six months . However , the drop-out rate was significantly higher for the dieting group than for the non-dieting group . The results of a separate comparison between a control group of obese normotensive patients following the same dietary programme and the group of dieting obese hypertensive patients are also presented . Attendance rates and weight loss achieved were significantly better for the hypertensive group than for the normotensive group after 12 months . Weight reduction appears to be an effective first-line therapy for approximately 50 % of obese patients with mild to moderate hypertension , and raised blood pressure appears to provide motivation for such patients to attend a dietitian 's clinic and to lose weight Severe obesity has been associated with adverse effects on physical capacity . In a prospect i ve study , the aerobic capacity of severely obese patients was measured in order to observe the physiological response to weight loss from bariatric surgery .  Sixty-five consecutive patients ( 40.4 ± 8.4 years old ; 93.8 % female ; body mass index = 49.4 ± 5.4 kg/m2 ) were evaluated before bariatric surgery and then 6 and 12 months after surgery . Aerobic capacity was assessed with a scientific treadmill to measure maximal oxygen consumption ( VO2max ) , heart rate , blood pressure , time on the treadmill , and distance walked ( modified Bruce test )  . For the three observational periods , VO2max was 25.4 ± 9.3 , 29.8 ± 8.1 , and 36.7 ± 8.3 ml/kg/min ; time on the treadmill was 5.4 ± 1.4 , 6.4 ± 1.6 , and 8.8 ± 1.0 min ; and distance walked was 401.8 ± 139.1 , 513.4 ± 159.9 , and 690.5 ± 76.2 m. For these variables , significant results ( p = 0.0000 ) were observed for the two postoperative periods in relation to the preoperative period . Severely obese individuals increased their aerobic capacity after successful bariatric surgery . The data also suggests that a positive and progressive relationship between weight loss and improvement in fitness as a moderate loss of weight 6 months after surgery already showed some benefit and an additional reduction in weight was associated with a better performance in the aerobic capacity tests at the 12-month follow-up BACKGROUND Laparoscopic sleeve gastrectomy ( LSG ) became the most frequent bariatric procedure performed in France ( 2011 ) and in the United States ( 2013 ) , but studies reporting long-term results are still rare . SETTING Private hospital , France . METHODS This is a retrospective analysis of a prospect i ve cohort of 168 patients who underwent LSG between 2005 and 2008 . The objective of this study was to present the 8-year outcome concerning weight loss , modification of co-morbidities , and to report the revisional surgery after sleeve . RESULTS The preoperative mean body mass index was 42.8 kg/m2 ( 31.1 - 77.9 ) , 35 patients were super obese , and 64 patients had a previous gastric b and . For LSG as a definitive bariatric procedure , 8 years of follow-up data were available for 116 patients ( follow-up : 69 % ) . Of the remainder , 23 patients underwent revisional surgery and 29 were lost to follow-up . For the entire cohort , the mean excess weight loss ( EWL ) was 76 % ( 0 - 149 ) at 5 years and 67 % ( 4 - 135 ) at 8 years , respectively . Of the 116 patients with 8 years of follow-up , 82 patients had>50 % EWL at 8 years ( 70.7 % ) . Percentages of co-morbidities resolved were hypertension , 59.4 % ; type 2 diabetes , 43.4 % ; and obstructive sleep apnea , 72.4 % . Twenty-three patients had revisional surgery for weight regain ( n = 14 ) or for severe reflux ( n = 9 ) at a mean period of 50 months ( 9 - 96 ) . Twelve patients underwent resleeve gastrectomy , 6 patients underwent conversion to a bypass , and 5 patients to duodenal switch ( 1 single anastomosis duodeno-ileostomy ) . A total of 31 % of patients reported gastroesophageal reflux symptoms at 8 years . CONCLUSIONS At 8 years postoperatively , the LSG as a definitive bariatric procedure remained effective for 59 % of cases . The results appear to be more favorable especially for the non-super-obese patients and primary procedures . LSG is a well-tolerated bariatric procedure with low long-term complication rates
Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures .
Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric B and ing .
Though long-term control of hypertension following surgery remains a concern , available follow-up post-operative data of up to 10 years suggests a sustained , if lessened , effect on hypertension control over time
Obesity continues to increase in prevalence worldwide .
Hypertension has long been associated with obesity , and weight loss continues to be a first-line therapy in the treatment of hypertension .
Lifestyle modification and pharmacologic therapy , however , often meet with treatment failure .
Bariatric surgery continues to be the most successful approach to sustained weight loss .
This review focuses on the underlying physiologic mechanisms of obesity-hypertension , and the impact of bariatric surgery on the treatment of hypertension .