Rationale:

• Surgery produces long-term weight loss that can be more than 25% of body weight in 1 year.
• Lost weight tends to be regained only slowly, if at all.
• Surgery improves quality of life.

Evidence:

• A prospective controlled study (350) and a retrospective chart study (351) showed that bariatric surgery reduces mortality by 30% to 54% with 7 to 10.9 years follow-up.
• Surgery may be recommended to individuals with progressive obesity, a BMI >40 kg/m², or a BMI >35 kg/m² with comorbidities (472).
• For individuals with sleep apnea, bariatric surgery may be beneficial (339; 473).
• Surgical therapy reduces body weight by 20% to 35% (339).
• Gastric bypass procedures generally produce more maintainable weight loss than gastroplasty or gastric banding (277), a finding supported by a systematic review (474).
• The Swedish adjustable band and the Lap-Band produce comparable weight losses in a randomized trial (475).
• Weight loss through surgery or other means reduces risks to health, including hypertension and diabetes (277; 339; 352; 353; 476; 477; 478).
• Weight loss by surgery improves social functioning (278; 477).
• A 2-year, randomized, controlled trial in 80 people with a BMI between 30 and 35 kg/m² showed a 21.6% weight loss in the laparoscopic adjustable gastric band group compared to 5.5% in the control group (479). Intraoperative use of dexmedetomidine, an α₂-agonist, decreased pentanyl and anti-emetic therapy, and shortened length of stay in the postanesthesia care unit (480).
• A meta-analysis showed that risk of gallstones after bariatric surgery was reduced from 27.7% to 8.8% with ursodeoxycholic acid (481).
• A propylene mesh used in wound closure significantly lowered postoperative hernia (482).
• Intragastric balloons in a meta-analysis of 15 studies produced a 12.2% (14.7 kg) weight loss; complications were mild and 4.2% required early removal (483).
• Surgical weight loss lengthens life by reducing mortality (350; 351).

Comments:

• None.