Background\nBariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence\nof the long-term effects of contemporary surgery on a broad range of clinical outcomes\nin large populations treated in routine clinical practice is lacking. The objective of this\nstudy was to measure the association between bariatric surgery, weight, body mass index,\nand obesity-related co-morbidities.\nMethods and Findings\nThis was an observational retrospective cohort study using data from the United Kingdom\nClinical Practice Research Datalink. All 3,882 patients registered in the database and with\nbariatric surgery on or before 31 December 2014 were included and matched by propensity\nscore to 3,882 obese patients without surgery. The main outcome measures were change\nin weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus\n(T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive\nsleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight\nmeasures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5\nand 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery\npatients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98\nkg/mo (95% CI 4.88ââ?¬â??5.08). Slower weight loss was sustained to the end of 4 y. Gastric\nbypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial\nweight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were\ndetected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55ââ?¬â??0.83); hypertension,\n0.35 (95% CI 0.27ââ?¬â??0.45); angina, 0.59 (95% CI 0.40ââ?¬â??0.87);MI, 0.28 (95% CI 0.10ââ?¬â??0.74);\nand obstructive sleep apnoea, 0.55 (95% CI 0.40ââ?¬â??0.87). Strong associations were found\nbetween bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84ââ?¬â??12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64\n(95% CI 2.65ââ?¬â??11.99). No association was detected between bariatric surgery and fractures,\ncancer, or stroke. Effect estimates for mortality found no protective association with bariatric\nsurgery overall, with a HR of 0.97 (95% CI 0.66ââ?¬â??1.43). The data used were recorded for the\nmanagement of patients in primary care and may be subject to inaccuracy, which would\ntend to lead to underestimates of true relative effect sizes.\nConclusions\nBariatric surgery as delivered in the UK healthcare system is associated with dramatic\nweight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial\nimprovements in pre-existing T2DM and hypertension, as well as a reduced risk of\nincident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the\navailability of bariatric surgery could lead to substantial health benefits for many people who\nare morbidly obese.
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