Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .
Bariatric surgery versus intensive medical therapy in obese patients with diabetes.
BACKGROUND Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery . METHODS In this r and omized , nonblinded , single-center trial , we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes . The mean ( ±SD ) age of the patients was 49±8 years , and 66 % were women . The average  glycated hemoglobin level was 9.2±1.5 % . The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0 % or less 12 months after treatment . RESULTS Of the 150 patients , 93 % completed 12 months of follow-up . The proportion of patients with the primary end point was 12 % ( 5 of 41 patients ) in the medical-therapy group versus 42 % ( 21 of 50 patients ) in the gastric-bypass group ( P=0.002 ) and 37 % ( 18 of 49 patients ) in the sleeve-gastrectomy group ( P=0.008 ) . Glycemic control improved in all three groups , with a mean glycated hemoglobin level of 7.5±1.8 % in the medical-therapy group , 6.4±0.9 % in the gastric-bypass group ( P<0.001 ) , and 6.6±1.0 % in the sleeve-gastrectomy group ( P=0.003 ) . Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group ( -29.4±9.0 kg and -25.1±8.5 kg , respectively ) than in the medical-therapy group ( -5.4±8.0 kg ) ( P<0.001 for both comparisons ) . The use of drugs to lower glucose , lipid , and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) improved significantly after bariatric surgery . Four patients underwent reoperation . There were no deaths or life-threatening complications . CONCLUSIONS In obese patients with uncontrolled type 2 diabetes , 12 months of medical therapy plus bariatric surgery  achieved glycemic control in significantly more patients than medical therapy alone . Further study will be necessary to assess the durability of these results . ( Funded by Ethicon Endo-Surgery and others ; Clinical Trials.gov number , NCT00432809 . )
Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .