In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .
Bariatric surgery and long-term cardiovascular events.
CONTEXT Obesity is a risk factor for cardiovascular events . Weight loss might protect against cardiovascular events , but solid evidence is lacking . OBJECTIVE To study the association between bariatric surgery , weight loss , and cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) study is an ongoing , nonr and omized , prospect i ve , controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care . Patients were recruited between September 1 , 1987 , and January 31 , 2001 . Date of analysis was December 31 , 2009 , with median follow-up of 14.7 years ( range , 0 - 20 years ) . Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women . Exclusion criteria were identical in surgery and control patients . Surgery patients underwent gastric bypass ( 13.2 % ) , b and ing ( 18.7 % ) , or vertical b and ed gastroplasty ( 68.1 % ) , and controls received usual care in the Swedish primary health care system . Physical and biochemical examinations and data base cross-checks were undertaken at preplanned intervals . MAIN OUTCOME MEASURES The primary end point of the SOS study ( total mortality ) was published in 2007 . Myocardial infa rct ion and stroke were predefined secondary end points , considered separately and combined . RESULTS Bariatric surgery was associated with a reduced number of cardiovascular deaths ( 28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group ; adjusted hazard ratio [ HR ] , 0.47 ; 95 % CI , 0.29 - 0.76 ; P = .002 ) . The number of total first time ( fatal or nonfatal ) cardiovascular events ( myocardial infa rct ion or stroke , whichever came first ) was lower in the surgery group ( 199 events among 2010 patients ) than in the control group ( 234 events among 2037 patients ; adjusted HR , 0.67 ; 95 % CI , 0.54 - 0.83 ; P < .001 ) . CONCLUSION Compared with usual care , bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults
In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .