What are the long-term results 8 years after sleeve gastrectomy? 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 Melanocortin-4 Receptor Mutations and Polymorphisms Do Not Affect Weight Loss after Bariatric Surgery Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Improvement of migraine headaches in severely obese patients after bariatric surgery The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. The By-Band study: gastric bypass or adjustable gastric band surgery to treat morbid obesity: study protocol for a multi-centre randomised controlled trial with an internal pilot phase National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Results of our Learning Curve in 100 Consecutive Patients Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. 10-year Follow-up of Laparoscopic Vertical Banded Gastroplasty: Good Results in Selected Patients Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Two-year changes in generic and obesity-specific quality of life after gastric bypass Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 Years Experience from an Asian Center of Excellence The long-term effectiveness of a lifestyle intervention in severely obese individuals. Effects of bariatric surgery on mortality in Swedish obese subjects.
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 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 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 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 Objectives : Research increasingly suggests that obesity is an exacerbating factor for migraine . However , it is less clear whether weight loss may help to alleviate  migraine in obese individuals . We examined whether weight loss after bariatric surgery is associated with improvements in migraine headaches . Methods : In this prospect i ve observational study , 24 patients who had migraine according to the ID-Migraine screener were assessed before and 6 months after bariatric surgery .  At both time points , patients had their weight measured and reported on frequency of headache days , average headache pain severity , and headache-related disability over the past 90 days via the Migraine Disability Assessment question naire . Changes in headache measures and the relation of weight loss to these changes were assessed using paired- sample t tests and logistic regression , respectively . Results : Patients were mostly female ( 88 % ) , middle-aged ( mean age 39.3 ) , and severely obese ( mean body mass index 46.6 ) at baseline  . Mean ( ±SD ) number of headache days was reduced from 11.1 ± 10.3 preoperatively to 6.7 ± 8.2 postoperatively ( p < 0.05 ) , after a mean percent excess weight loss ( % EWL ) of 49.4 % . The odds of experiencing a ≥50 % reduction in headache days was related to greater % EWL , independent of surgery type ( p < 0.05 ) . Reductions in severity were also observed ( p < 0.05 ) and the number of patients reporting moderate to severe disability decreased from 12 ( 50.0 % ) before surgery to 3 ( 12.5 % ) after surgery ( p < 0.01 ) . Conclusions : Severely obese migraineurs experience marked alleviation of headaches after significant weight reduction via bariatric surgery . Future studies are needed to determine whether more modest , behaviorally produced weight losses can effect similar migraine improvements . Classification of evidence : This study provides Class III evidence that bariatric surgery is associated with reduction of migraine headaches in severely obese individuals 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 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 Background The prevalence of severe and complex obesity is increasing worldwide and surgery may offer an effective and lasting treatment . Laparoscopic adjustable gastric b and and Roux-en-Y gastric bypass surgery are the two main surgical procedures performed . Design This open parallel-group r and omised controlled trial will compare the effectiveness , cost-effectiveness and acceptability of gastric b and ( B and ) versus gastric bypass ( Bypass ) in adults with severe and complex obesity . It has an internal pilot phase ( in two centres ) with integrated qualitative research to establish effective and optimal methods for recruitment . Adults with a body mass index ( BMI ) of 40 kg/m2 or more , or a BMI of 35 kg/m2 or more and other co-morbidities will be recruited . At the end of the internal pilot the study will exp and into more centres if the pre-set progression criteria of numbers and rates of eligible patients screened and r and omised are met and if the expected rates of retention and adherence to treatment allocation are achieved . The trial will test the joint hypotheses that Bypass is non-inferior to B and with respect to more than 50 % excess weight loss and that Bypass is superior to B and with respect to health related quality of life ( HRQOL , EQ-5D ) at three years . Secondary outcomes include other weight loss measures , waist circumference and remission/resolution of co-morbidities ; generic and symptom-specific HRQOL ; nutritional blood test results ; re source use ; eating behaviours and adverse events . A core outcome set for reporting the results of obesity surgery will be developed and a systematic review of the evidence for sleeve gastrectomy undertaken to inform the main study design . Discussion By-B and is the first pragmatic study to compare the two most commonly performed bariatric surgical procedures for severe and complex obesity . The design will enable and empower surgeons to learn to recruit and participate in a r and omised study . Early evidence shows that timely recruitment is possible . Trial registration Current Controlled Trials IS RCT N00786323 BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical Background : Morbid obesity requires life-long treatment , and bariatric surgery provides the best results . Among the bariatric procedures , laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) has been considered to be superior . However , it requires advanced laparoscopic skills and a learning curve . We analyzed our results in an initial series of 100 patients . Methods : Data of 100 consecutive patients who underwent LRYGBP for morbid obesity in a 2.5-year period were prospect ively collected and analyzed with emphasis on results and complications . Results : Mean age was 31±5 years . There were 63 woman and 37 men . Preoperative BMI was 50±9 kg/m2 . 33 patients were considered super-obese ( BMI > 50 )  . Mean operative time was 3.8 ± 0.7 hours . Two patients required conversion to open surgery . Mean hospital stay was 6 days . Complications occurred in 10 patients . Mortality rate was 2 % . Excess body weight loss was as follows : 33 ± 8 % at 3 months ( n=92 ) , 47 ± 2 % at 6 months ( n=82 ) , 62 ± 4 % at 1 year ( n= 70 ) , 66 ± 5 % at 18 months ( n= 63 ) and 67 ± 8 % at 2 years ( n= 35 ) . There was significant improvement in several co-morbid conditions , such as diabetes and hypertension . Conclusion : LRYGBP is a reproducible technique . It requires the combination of bariatric and laparoscopic expertise The profound effects of bariatric surgery on glycemic control are well established in many studies , including several r and omized trials that compared surgery versus intensive medical and lifestyle treatment of type 2 diabetes mellitus ( T2DM ) ( 17 ) . Remission of T2DM is common after bariatric surgery , and Roux-en-Y gastric bypass ( RYGB ) outperforms sleeve gastrectomy ( SG ) in most reports ( 4 , 8 , 9 ) . More important than improvements in glycemic control is whether these glycemic changes reduce the incidence of major complications , such as microvascular events . In the United States , T2DM is the primary cause of nephropathy , end-stage renal disease , adult blindness , and neuropathy , which together lead to significant downstream costs and decreased quality of life ( 1012 ) . Thus , a major goal of diabetes treatment is to mitigate the risk for these long-term sequelae ( 13 ) . We have previously shown that in patients with T2DM who have bariatric surgery  , risk for incident microvascular disease is reduced for every year of remission from T2DMeven if patients eventually relapse back to T2DM ( indicating a legacy effect ) ( 14 ) . However , a detailed 2016 review of long-term microvascular outcomes of diabetes concluded that data were inadequate to support a superior effect of bariatric surgery compared with medical therapy ( 15 ) . Two recently published studies help inform this question ( 4 , 16 ) . The STAMPEDE ( Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently ) trial ( 4 ) r and omly assigned 150 patients with obesity and T2DM to have RYGB , SG , or an intensive medical and lifestyle intervention . After 5 years , urinary albumincreatinine ratios had decreased in the SG group only . Retinopathy did not change in any group , and neuropathy was not examined . STAMPEDE was limited by a relatively small sample size , which made it underpowered for rare outcomes . The prospect i ve SOS ( Swedish Obesity Subjects ) matched cohort study ( 16 ) followed 2010 patients who had bariatric surgery ( 13 % RYGB , 19 % gastric b and ing , and 68 % vertical-b and ed gastroplasty ) and 2037 matched patients who received usual care .  The incidence of microvascular disease after 15 years of follow-up was significantly lower in the surgery group than the control group ( hazard ratio [ HR ] , 0.56 [ 95 % CI , 0.48 to 0.66 ] ) , including among subgroups with prediabetes ( HR , 0.18 [ CI , 0.11 to 0.30 ] ) , established diabetes ( HR , 0.54 [ CI , 0.40 to 0.72 ] ) , and normoglycemia ( HR , 0.63 [ CI , 0.48 to 0.81 ] ) at baseline . The SOS study was limited by the small number of RYGB procedures and lack of SG procedures , which are now the 2 most common bariatric procedures worldwide ( 17 ) . To address these gaps in the literature , we did a matched cohort study to determine whether bariatric surgery was associated with lower incidence of microvascular disease than usual care for severe obesity and T2DM . We hypothesized that patients having  bariatric surgery would have lower risk for any incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . We further hypothesized that patients having bariatric surgery would have lower risk for incident retinopathy , nephropathy , and neuropathy than nonsurgical patients . Methods Setting s We did a retrospective observational cohort study of adults with T2DM who had bariatric surgery between 2005 and 2011 while enrolled in 1 of 4 integrated health care systems from the Health Care Systems Research Network : Kaiser Permanente ( KP ) Washington in Washington state , HealthPartners in Minnesota , KP Northern California , and KP Southern California . All study procedures were review ed and approved by the institutional review board at each site , and we were permitted to do the research without explicit consent from participants . Data Sources At each study site , staff used st and ardized electronic medical records , insurance cl aims , and other data systems ( 18 ) to extract enrollee data , including enrollment and insurance coverage ; demographics ; blood pressure ; height ; weight ; laboratory values ; medications dispensed ; deaths ; outpatient , inpatient , and emergency department use ; and inpatient and outpatient diagnosis and procedure codes . Surgical Participants The bariatric population included adults ( aged 19 to 79 years ) with severe obesity ( body mass index [ BMI ] 35 kg/m2 ) and T2DM who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 . Following an approach adopted in prior studies ( 14 , 19 , 20 ) , we used a combination of bariatric registries ; review of medical records ; codes from the International Classification of Diseases , Ninth Revision ( ICD-9 ) ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) to identify bariatric procedures .  Patients were classified as having T2DM if they had a hemoglobin A1c ( HbA1c ) level of at least 6.5 % or fasting plasma glucose level of at least 6.99 mmol/L ( 126 mg/dL ) at the most recent measurement within 2 years before surgery , or a current prescription for any diabetes medication . After selecting the population , we applied the following exclusion criteria based on information in the 2 years before surgery : less than 1 full year of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; metformin as the sole indicator of possible T2DM ( that is , no other T2DM medications , laboratory values , or diagnoses ) ; preexisting neuropathy , retinopathy , or nephropathy ( defined in Outcome and Censoring Definitions ) ; and maximum preoperative BMI less than 35 kg/m2 . This left 4972 patients . We further excluded 850 patients who were missing values for BMI , HbA1c level , or serum creatinine concentration in the 2 years before surgery . Surgical patients who were missing these values differed from those who had complete data ( Appendix Table 1 ) . Specifically , they were more likely to be non-Hispanic white , to be from the HealthPartners site , to have had their procedure in the first year of our study ( 2005 ) , and to have had a shorter observed duration of T2DM at the time of surgery . Of the remaining 4122 patients , 4024 could be matched to at least 1 nonsurgical patient ( Figure 1 ) . Figure 1 . Flow diagram for identification of eligible patients with T2DM and no history of microvascular disease who had bariatric surgery .  BMI = body mass index ; EHR= electronic health record ; HbA1c= hemoglobin A1c ; T2DM= type 2 diabetes mellitus . * Adults aged 2079 y who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 .  Bariatric procedures were identified using a combination of bariatric registries ; review of medical records ; International Classification of Diseases , Ninth Revision , codes ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) . We excluded patients with any of the following : < 1 y of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; preexisting neuropathy , nephropathy , or retinopathy ; metformin as the sole indicator of possible T2DM ( no other T2DM medications , laboratory values , or diagnoses ) ; or maximum BMI < 35 kg/m2 . Patients may have > 1 type of missing data ( BMI , creatinine concentration , or HbA1c level ) or have no follow-up time after surgery . 98 surgical patients could not be matched to a nonsurgical patient on site , age , BMI , insulin use , HbA1c level , and sex . Appendix Table 1 . Comparison of Characteristics of Surgical Patients Who Were Missing Values for BMI , HbA1c , or Serum Creatinine at Baseline Versus Those Who Had Complete Information on These Values at Baseline Matched Nonsurgical Participants For each surgical patient , we identified up to 3 matched nonsurgical control participants via a 2-step process . First , among all patients with diabetes and at least 1 BMI measurement of 35 kg/m2 or greater who did not have bariatric surgery during the study ( n= 320345 ) , we identified a pool of potential control participants who were enrolled at the time of the surgery ; satisfied the study inclusion criteria ; and matched the surgical patient on the basis of study site , sex , age ( 10 years ) , BMI ( 5 kg/m2 ) , HbA1c level ( 1.5 percentage points ) , and insulin use . Second , for each control participant in the pool , we calculated Mahalanobis distance from the surgical patient on the basis of age , BMI , HbA1c level , diabetes duration , and total days of health care use in the 7 to 24 months before the date of surgery ( 21 ) . Finally , up to 3 control participants were selected on the basis of the shortest Mahalanobis distance . Throughout , nonsurgical patients could be used as a control for only 1 surgical patient ( matching without replacement ) . The Appendix gives additional details on the process we used to establish the matched cohort . Outcome and Censoring Definitions The primary outcome measure was time to incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . Retinopathy was defined by the first appearance of either ICD-9 code 362.0x ( diabetic retinopathy ) or both a retinal surgical procedure code or other retinopathic code ( Appendix Table 2 ) and ICD-9 code 250.5x ( diabetes with ophthalmic manifestations ) . Neuropathy was identified on the basis of the first occurrence of ICD-9 code 250.6 ( diabetes with neurologic manifestations ) or 357.2 ( polyneuropathy in diabetes ) . Finally , nephropathy was defined by at least 2 measures of estimated glomerular filtration rate less than 60 mL/min/1.73 m2 separated by at least 90 days without any intervening values of 60 mL/min/1.73 m2 or greater . We approximated Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson BACKGROUND Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone . In an analysis of data from a nonr and omized , prospect i ve , controlled study , we examined the effects of bariatric surgery on the prevention of type 2 diabetes . METHODS In this analysis , we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls ( with matching performed on a group , rather than individual , level ) . None of the participants had diabetes at baseline . Patients in the bariatric-surgery cohort underwent b and ing  ( 19 % ) , vertical b and ed gastroplasty ( 69 % ) , or gastric bypass ( 12 % ) ; nonr and omized , matched , prospect i ve controls received usual care . Participants were 37 to 60 years of age , and the body-mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) was 34 or more in men and 38 or more in women . This analysis focused on the rate of incident type 2 diabetes , which was a prespecified secondary end point in the main study . At the time of this analysis ( January 1 , 2012 ) , participants had been followed for up to 15 years . Despite matching , some baseline characteristics differed significantly between the groups ; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group . At 15 years , 36.2 % of the original participants had dropped out of the study , and 30.9 % had not yet reached the time for their 15-year follow-up examination . RESULTS During the follow-up period , type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group , corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years , respectively ( adjusted hazard ratio with bariatric surgery , 0.17 ; 95 % confidence interval , 0.13 to 0.21 ; P<0.001 ) . The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose ( P=0.002 for the interaction ) but not by BMI ( P=0.54 ) . Sensitivity analyses , including end-point imputations , did not change the overall conclusions . The postoperative mortality was 0.2 % , and 2.8 % of patients who underwent bariatric surgery required reoperation within 90 days owing to complications . CONCLUSIONS Bariatric surgery appears to be markedly more efficient than usual care in the prevention of  type 2 diabetes in obese persons . ( Funded by the Swedish Research Council and others ; Clinical Trials.gov number , NCT01479452 . ) Objective : To evaluate the long-term results of laparoscopic vertical b and ed gastroplasty ( VBG )  for morbid obesity . Background : Laparoscopic VBG , a safe and straightforward bariatric procedure characterized by good short-term results , has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure . Nevertheless , some authors have recently reported long-term efficacy in selected patients . Methods : All patients who underwent laparoscopic VBG  were included in a prospect i ve data base . Patients reaching 10-year follow-up received a complete evaluation including clinical , endoscopic , and biochemical examinations . Results : Between January 1996 and March 1999 , 266 morbidly obese patients underwent bariatric procedures . Among them , 213 were selected for laparoscopic VBG ; exclusion criteria were as follows : contraindications to pneumoperitoneum , gastroesophageal reflux disease , and psychological contraindications to restrictive procedures . Mean age , preoperative weight , and body mass index were 36.9 years , 123.6 kg , and 45.4 kg/m2 , respectively .  Intraoperative complication rate and conversion rate were 0.9 % and 0.9 % , respectively . Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 % . Mean hospital length of stay was 6.3 days . Mortality was nil . The 10-year follow-up rate was 70.4 % ( 150 patients ) . Late postoperative complication rate was 14.7 % , and 10-year revisional surgery rate was 10.0 % . The excess weight loss percentages at 3 , 5 , and 10 years were 65.0 % , 59.9 % , and 59.8 % , respectively . The resolution and /or improvement rate for comorbidity were 47.5 % for hypertension , 55.6 % for diabetes , 75 % for sleep apnea , and 47.4 % for arthritis . Mean Moorehead-Ardelt Quality of Life Question naire and BAROS values were 1.4 and 3.8 , respectively . Conclusions : The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures . Given the low postoperative morbidity for laparoscopic VBG , its present clinical role should be , in our opinion , reevaluated IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes . The long-term outcomes for remission and diabetes-related complications are not known . OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) is a prospect i ve matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden . Of patients recruited between September 1 , 1987 , and January 31 , 2001 , 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline . For the current analysis , diabetes status was determined at SOS health examinations until May 22 , 2013 . Information on diabetes complications was obtained from national health registers until December 31 , 2012 . Participation rates at the 2- , 10- , and 15-year examinations were 81 % , 58 % , and 41 % in the control group and 90 % , 76 % , and 47 % in the surgery group . For diabetes assessment , the median follow-up time was 10 years ( interquartile range [ IQR ] , 2 - 15 ) and 10 years ( IQR , 10 - 15 ) in the control and surgery groups , respectively . For diabetes complications , the median follow-up time was 17.6 years ( IQR , 14.2 - 19.8 ) and 18.1 years ( IQR , 15.2 - 21.1 ) in the control and surgery groups , respectively . INTERVENTIONS Adjustable or nonadjustable b and ing ( n = 61 ) , vertical b and ed gastroplasty ( n = 227 ) , or gastric bypass ( n = 55 ) procedures were performed in the surgery group , and usual obesity and diabetes care was provided to the control group . MAIN OUTCOMES AND MEASURES Diabetes remission , relapse , and diabetes complications . Remission was defined as blood glucose < 110 mg/dL and no diabetes medication . RESULTS The diabetes remission rate 2 years after surgery was 16.4 % ( 95 % CI , 11.7%-22.2 % ; 34/207 ) for control patients and 72.3 % ( 95 % CI , 66.9%-77.2 % ; 219/303 ) for bariatric surgery  patients ( odds ratio [ OR ] , 13.3 ; 95 % CI , 8.5 - 20.7 ; P < .001 ) . At 15 years , the diabetes remission rates decreased to 6.5 % ( 4/62 ) for control patients and to 30.4 % ( 35/115 ) for bariatric surgery patients ( OR , 6.3 ; 95 % CI , 2.1 - 18.9 ; P < .001 ) . With long-term follow-up , the cumulative incidence of microvascular complications was 41.8 per 1000 person-years ( 95 % CI , 35.3 - 49.5 ) for control patients and 20.6 per 1000 person-years ( 95 % CI , 17.0 - 24.9 ) in the surgery group ( hazard ratio [ HR ] , 0.44 ; 95 % CI , 0.34 - 0.56 ; P < .001 ) . Macrovascular complications were observed in 44.2 per 1000 person-years ( 95 % CI , 37.5 - 52.1 ) in control patients and 31.7 per 1000 person-years ( 95 % CI , 27.0 - 37.2 ) for the surgical group ( HR , 0.68 ; 95 % CI , 0.54 - 0.85 ; P = .001 ) . CONCLUSIONS AND RELEVANCE In this very long-term follow-up observational study of obese patients with type 2 diabetes , bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care . These findings require confirmation in r and omized trials . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01479452 Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative 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 BACKGROUND  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  has been the " gold st and ard " for weight loss surgery . Long-term data are limited , and reporting methods for LRYGB outcomes vary in the literature . In addition , follow-up compliance within bariatric centers is poor due to insurance and access to care issues , making long-term follow-up evaluation difficult . OBJECTIVE Evaluate long-term LRYGB outcomes using st and ard outcome reporting definitions . SETTING Integrated multispecialty health system . METHODS A retrospective review of our institution 's prospect i ve bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015 . Data were defined according to the 2015 St and ards for Outcome Reporting . RESULTS During the study period , 1402 patients underwent primary LRYGB ; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2 , respectively . Early complications included anastomotic leak ( 0.2 % ) , venous thromboembolism ( 0.6 % ) , surgical site infections ( 1.4 % ) , and urinary tract infections ( 1.6 % ) . The 30-day readmission rate was 3.5 % . There were no 30-day mortalities . Follow-up weight data were available for>70 % of eligible patients through 12 years postoperative . The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79 % and 30.1 kg/m2 , respectively . Remission of diabetes , dyslipidemia , and hypertension were observed through 8 years postoperatively . CONCLUSION This is the first report of long-term ( > 10-year ) outcomes from a single integrated health system using the 2015 St and ards for Outcome Reporting . LRYGB results in significant , sustained weight loss and durable improvement and remission of obesity-related co-morbidities . Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up The study objectives were to assess 2-year changes in health-related quality of life ( HRQL ) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery . This was a prospect i ve intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country . We used both generic ( Short Form Health Survey , SF-36 and EuroQol , EQ-5D ) , and specific question naires ( Moorehead-Ardelt , MA II and Obesity-related Problems Scale , OP ) . Effect sizes and receiver operating characteristic ( ROC ) curves were calculated to assess the change in quality of life . Spearman ’s correlation coefficient was calculated to assess whether there was an association between changes in body mass index ( BMI ) and HRQL . Of 82 patients who underwent surgery , 79 were followed-up for 2 years . Mean weight loss was 37 % of body weight ( 49 kg ) and BMI fell from 50.6 to 31.8 . The initial problems and final improvements were greater in the physical dimensions . Considerable benefits were observed in assessment s with all the instruments used . However , the changes in weight/ BMI and HRQL were not linear . The comparison with general population showed a similar profile in SF-36 dimensions after surgery . Severely obese patients have lower perceived health across all dimensions of quality of life . Moreover , the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment . ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI Background Laparoscopic sleeve gastrectomy ( LSG ) is emerging as a popular “ st and -alone ” bariatric procedure . We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress , learning curve , complications , and follow-up results . Methods Prospect ively collected data of 228 patients ( 145 females and 83 males ) , who underwent LSG for morbid obesity , from February 2007 to March 2012 , was retrospectively analyzed . Results The mean age was 34.68 years ( range , 18–62 years ) and the mean preoperative body mass index ( BMI ) was 37.42 ± 4.75 kg/m2 ( range , 32.08–65.69 kg/m2 ) . Mean operative time was 60.63 ± 27.37 min . The mean BMI decreased to 26.15 ± 3.71 kg/m2 at 3 years ( p < 0.001 ) and to 27.94 ± 4.08 kg/m2 at 5 years ( p < 0.001 ) . Mean percentage excess weight loss was 71.96 ± 21.30 % at 3 years and 63.71 ± 20.08 % at 5 years . The 30-day readmission rate was 3.07 % .Overall complication rate was 4.3 % , including strictures , leaks , peritonitis , gastrocutaneous fistula , and one ( 0.43 % ) mortality . One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass  . Complication rates significantly decreased after the first 50 cases ( p = 0.022 ) , suggesting an initial learning curve . Resolution of diabetes , hypertension , and hyperlipidemia was 66.67 , 100 , and 50 % , respectively , at 5 years . Conclusions LSG as a single-stage bariatric procedure is safe and durable , achieving weight loss and resolution of comorbidities up to 5 years . Adherence to technical details is pivotal in reducing complications associated with the initial learning phase OBJECTIVE Severe obesity ( body mass index [ BMI ] ≥40 kg/m(2 ) ) is a serious public health concern . Although bariatric surgery is an efficacious treatment approach , it is limited in reach ; thus , nonsurgical treatment alternatives are needed . We examined the 4-year effects of an intensive lifestyle intervention  on body weight and cardiovascular disease risk factors among severely obese , compared with overweight ( 25 ≤ BMI < 30 ) , class I ( 30 ≤ BMI < 35 ) , and class II obese ( 35 ≤ BMI < 40 ) participants . METHODS There were 5145 individuals with type 2 diabetes ( 45 - 76 years , BMI ≥25 kg/m(2 ) ) r and omized to an intensive lifestyle intervention or diabetes support and education .  The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings , a ≥10 % weight loss goal , calorie restriction , and increased physical activity . Diabetes support and education received a less intense educational intervention . Four-year changes in body weight and cardiovascular disease risk factors were assessed . RESULTS Across BMI categories , 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( Ps < .05 ) . At year 4 , severely obese lifestyle participants lost 4.9%±8.5 % , which was similar to class I ( 4.8%±7.2 % ) and class II obese participants ( 4.4%±7.6 % ) , and significantly greater than overweight participants ( 3.4%±7.0 % ; P < .05 ) . Four-year changes in low-density-lipoprotein cholesterol , triglycerides , diastolic blood pressure , HbA(1c ) , and blood glucose were similar across BMI categories in lifestyle participants ; however , the severely obese had less favorable improvements in high-density-lipoprotein cholesterol ( 3.1±0.4 mg/dL ) and systolic blood pressure ( -1.4±0.7 mm Hg ) compared with the less obese ( Ps < .05 ) . CONCLUSION Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality
Gastric bypass has better outcomes than gastric b and procedures for long-term weight loss , type 2 diabetes control and remission , hypertension , and hyperlipidemia .
Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections
IMPORTANCE Bariatric surgery is an accepted treatment for obesity .
Despite extensive literature , few studies report long-term follow-up in cohorts with adequate retention rates .
OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss , type 2 diabetes , hypertension , and hyperlipidemia in severely obese adults .