Effects Of Obesity Surgery Research Articles

Obesity Surgery Improves Hypogonadism and Sexual Function in Men without Effects in Sperm Quality.

(1) Background: Obesity is associated with hypogonadism, sexual dysfunction, and impaired fertility in men. However, its effects on semen parameters or sexual function remain debatable. (2) Methods: This paper involves a longitudinal study in men submitted for obesity surgery at a university tertiary hospital. Patients were studied at baseline and at 6, 12, and 18 months after obesity surgery. At each visit, anthropometry measures were collected and hormonal and semen parameters were studied. Sexual function was evaluated with the International Index of Erectile Function (IIEF). (3) Results: A total of 12 patients were included. The average body mass index of patients decreased from 42.37 ± 4.44 to 29.6 ± 3.77 kg/m2 at 18 months after surgery (p < 0.05). Hormonal parameters improved after obesity surgery. The proportion of sperm cells with normal morphology tended to decrease from baseline and became most significant at 18 months (5.83 ± 4.50 vs. 2.82 ± 2.08). No significant changes were found in the remaining semen parameters. Erectile function improved significantly at six months after surgery. (4) Conclusions: The authors believe that, in general, the effects of obesity surgery on fertility may be limited or even deleterious (at least in the short and midterm follow-up).

Effects of Obesity Surgery on GERD and Esophageal Motility

With the rising prevalence of obesity, bariatric surgery has become an increasingly popular treatment option. However, bariatric surgery can contribute to esophageal dysmotility and lead to worsening or development of GERD, two conditions that are already frequently seen in the obese population. We review the effects of the various types of bariatric surgeries on the esophagus, specifically focusing on sleeve gastrectomy, Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding.

The Effect of Obesity Surgery on Incontinence in Women and Nursing Approach

Obezite, yüksek enerji alımı nedeniyle vücutta aşırı yağ birikimi sonucu gelişmektedir. Dünya Sağlık Örgütü verilerinde dünyada 650 milyonu, ülkemizde de 16 milyonu aşkın kişinin obez olduğu bildirilmektedir. Cinsiyete göre kadınlarda obezite prevalansının erkeklerden daha fazla olduğu görülmektedir. Obez bireylerde inkontinans karın içi basınç artışı nedeni ile gelişmektedir. Üriner inkontinans (UI) “istemsiz idrar kaçırma şikâyeti” olarak tanımlanmaktadır. Yaş, parite, gebelik, doğum şekli, obezite, fiziksel aktivite, diyabet ve nörolojik hastalıklar UI risk faktörleridir. İnkontinans tiplerinin obezite ile ilişkili olduğu ve kadınlarda erkeklere oranla 3-4 kat daha fazla olduğu bildirilmektedir. Obezite cerrahisi inkontinans oranlarını azaltabilmektedir. Ancak cerrahi sonrası tekrarlayan kilo alımına paralel olarak inkontinans oranları tekrar artabilmektedir. Cerrahide başarı oranının artması ve inkontinans gelişiminin önlenmesi için iyi bir hasta bakımı gerekmektedir. Bu nedenle obezite cerrahisinde hemşirelik bakımı çok önemlidir. Hemşireler ameliyat öncesi dönemde hasta değerlendirilmesi, operasyon öncesi hazırlık, mevcut risklerin belirlenmesi, hasta eğitiminde rol alırlar. Ameliyat sırasında ise hemşireler hastanın operasyon için hazırlanması ve pozisyon verilmesi, hasta güvenliğinin ve mahremiyetin sağlanması, komplikasyonların önlenmesinden sorumludur. Ameliyat sonrası dönemde ise hemşireler hastaların yeni yaşam biçimine uyumunu sağlamak, tekrarlayan kilo alımını ve inkontinans gelişimini önlenmede eğitim ve danışmanlık rollerini üstlenmektedir. Ameliyat sonrası dönemde ilk olarak davranış terapileri tercih edilmekte, ameliyat öncesi dönemden itibaren hasta eğitimleri ile bakım desteklenmektedir. Diyet, mesane eğitimi, pelvik taban rehabilitasyonu, biofeedback, vajinal kon uygulaması ve fonksiyonel elektriksel stimülasyon yöntemleri kullanılabilmektedir. Uygun hemşirelik bakımı hastaların yaşayabilecekleri sorunları en aza indirmekte, hastaların uygun hızda kilo vermelerini sağlamakta ve tekrar kilo alımı ve inkontinans gelişimi önlemektedir.

Effects of Obesity Surgery on Blood Coagulation and Fibrinolysis: A Literature Review.

Obesity is characterized by a disturbed hemostatic balance with increased coagulation and impaired fibrinolysis. This increases the risk of thrombosis, and the risk is lowered after obesity surgery. Over the past 25 years, several studies have contributed to understand the mechanisms behind the antithrombotic effect of obesity surgery, and this literature review summarizes the results of these studies. A detailed literature search on the effects of obesity surgery on the hemostatic balance was conducted. The 25 relevant studies reviewed demonstrated that obesity surgery has favorable effects on many biomarkers of coagulation and fibrinolysis. The evidence is substantial for fibrinogen and plasminogen activator inhibitor type 1 with average reductions from 1 to 24 months after obesity surgery of 17 and 48%, respectively. For most other biomarkers, the evidence is moderate or weak with average effect sizes varying from 2% for fiber mass length ratio to 70% for prothrombin fragment 1 + 2 and with a large variation between studies. Many studies are small and of short duration, and the surgical techniques differ. Also, studies are confounded by changes in medication, comorbidity, diet, and exercise. It is unknown whether the hemostatic changes are mediated by weight loss alone or by the accompanying metabolic improvements. Despite issues of confounding, this review suggests that obesity surgery shifts the hemostatic balance in the antithrombotic direction, thereby reducing the thrombotic potential of people with obesity, but more studies are needed for most of the biomarkers.

Effects of Obesity Surgery on Overall and Disease-Specific Mortality in a 5-Country Population-Based Study.

Bariatric surgery might reduce overall mortality from obesity. We investigated whether the survival times of patients who have had bariatric surgery are similar to those of the general population and are longer than of obese individuals who did not receive surgery. We performed a population-based cohort study of persons with a diagnosis of obesity listed in nationwide registries from Nordic countries from 1980 through 2012. Bariatric surgery was analyzed in relation to all-cause mortality and the obesity-related morbidities cardiovascular disease, diabetes, cancer, and suicide. Poisson models provided standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). Multivariable Cox regression provided hazard ratios (HRs) for mortality in participants who did and did not have surgery. Among 505,258 participants, 49,977 had bariatric surgery. Overall all-cause SMR was increased after surgery (1.94; 95% CI, 1.83-2.05) and increased with longer follow-up, to 2.28 (95% CI, 2.07-2.51) at ≥15 years after surgery. SMRs were increased for cardiovascular disease (2.39; 95% CI, 2.17-2.63), diabetes (3.67; 95% CI, 2.85-4.72), and suicide (2.39; 95% CI, 1.96-2.92) but not for cancer (1.05; 95% CI, 0.95-1.17); SMRs increased with time. In obese participants who did not have surgery, all-cause SMR was 2.15 (95% CI, 2.11-2.20), which remained stable during follow-up. Compared with obese participants who did not have surgery, patients who had bariatric surgery had decreased overall mortality from all causes (HR, 0.63; 95% CI, 0.60-0.66), cardiovascular disease (HR, 0.57; 95% CI, 0.52-0.63), and diabetes (HR, 0.38; 95% CI, 0.29-0.49) but increased mortality from suicide (HR, 1.68; 95% CI, 1.32-2.14). Cancer mortality was decreased overall (HR, 0.84; 95% CI, 0.76-0.93) but increased at ≥15 years of follow-up (HR, 1.20; 95% CI, 1.02-1.42). In a study of persons with a diagnosis of obesity listed in nationwide registries of Nordic countries, we found that obese patients who have bariatric surgery have longer survival times than obese individuals who did not have bariatric surgery, but their mortality is higher than that of the general population and increases with time. Obesity-related morbidities could account for these findings.

Obesity surgery makes patients healthier and more functional: real world results from the United Kingdom National Bariatric Surgery Registry

BackgroundThe National Bariatric Surgery Registry (NBSR) is the largest bespoke database in the field in the United Kingdom. ObjectivesOur aim was to analyze the NBSR to determine whether the effects of obesity surgery on associated co-morbidities observed in small randomized controlled clinical trials could be replicated in a "real life" setting within U.K. healthcare. SettingUnited Kingdom. MethodsAll NBSR entries for operations between 2000 and 2015 with associated demographic and co-morbidity data were analyzed retrospectively. ResultsA total of 50,782 entries were analyzed. The patients were predominantly female (78%) and white European with a mean age of 45 ± 11 years and a mean body mass index of 48 ± 8 kg/m2. Over 5 years of follow-up, statistically significant reductions in the prevalence of type 2 diabetes, hypertension, dyslipidemia, sleep apnea, asthma, functional impairment, arthritis, and gastroesophageal reflux disease were observed. The "remission" of these co-morbidities was evident 1 year postoperatively and reached a plateau 2 to 5 years after surgery. Obesity surgery was particularly effective on functional impairment and diabetes, almost doubling the proportion of patients able to climb 3 flights of stairs and halving the proportion of patients with diabetes related hyperglycemia compared with preoperatively. Surgery was safe with a morbidity of 3.1% and in-hospital mortality of .07% and a reduced median inpatient stay of 2 days, despite an increasingly sick patient population. ConclusionsObesity surgery in the U.K. results not only in weight loss, but also in substantial improvements in obesity-related co-morbidities. Appropriate support and funding will help improve the quality of the NBSR data set even further, thus enabling its use to inform healthcare policy.

Alterations in fatty acid metabolism in response to obesity surgery combined with dietary counseling

Background:The effects of obesity surgery on serum and adipose tissue fatty acid (FA) profile and FA metabolism may modify the risk of obesity-related diseases.Methods:We measured serum (n=122) and adipose tissue (n=24) FA composition and adipose tissue mRNA expression of genes regulating FA metabolism (n=100) in participants of the Kuopio Obesity Surgery Study (KOBS, age 47.2±8.7 years, BMI 44.6±6.0, 40 men, 82 women) before and one year after obesity surgery. As part of the surgery protocol, all the subjects were instructed to add sources of unsaturated fatty acids, such as rapeseed oil and fatty fish, into their diet. The results were compared with changes in serum FA composition in 122 subjects from the Finnish Diabetes Prevention study (DPS) (age 54.3±7.1 years, BMI 32.2±4.6, 28 men, 94 women).Results:The proportion of saturated FAs decreased and the proportion of n-3 and n-6 FAs increased in serum triglycerides after obesity surgery (all P<0.002). Weight loss predicted changes in quantitative amounts of saturated FAs, monounsaturated FAs, n-3 and n-6 FAs in triglycerides (P<0.002 for all). Moreover, the changes in adipose tissue FAs reflected the changes in serum FAs, and some of the changes were associated with mRNA expression of elongases and desaturases in adipose tissue (all P<0.05). In line with this the estimated activity of elongase (18:1 n-7/16:1 n-7) increased significantly after obesity surgery in all lipid fractions (all P<4 × 10−7) and the increase in the estimated activity of D5D in triglycerides was associated with higher weight loss (r=0.415, P<2 × 10−6). Changes in serum FA profile were similar after obesity surgery and lifestyle intervention, except for the change in the absolute amounts of n-3 FAs between the two studies (P=0.044).Conclusions:Beneficial changes in serum and adipose tissue FAs after obesity surgery could be associated with changes in endogenous metabolism and diet.

Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: Prospective study.

Technically, obesity weakens the pelvic base muscles by causing an increase in the intraabdominal pressure and intravesical pressure due to increasing fat and it triggers the occurrence of lower urinary tract symptoms. However it is believed that weight loss will cause recovery of these symptoms. Our purpose in this study is to research about the effects of the weight loss achieved by using especially the Laparoscopic Sleeve Gastrectomy (LSG) technique of bariatric surgery which is being more and more widely used today. Out of all patients who had LSG surgery due to obesity earlier in our center during the period between April 2014 and March 2015, 22 applicable male patients were considered after a brief exclusion criteria application. Age, height, weight, and body mass index (BMI) data of these patients were recorded before the operation. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire - short from) (ICIQ-SF), Beck depression inventory (BECK) and Short form - 36 (SF-36) were filled for the patients and the data were recorded. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. After the procedure, the decrease in the averages of BECK depression inventory, IPSS, ICIQ-SF and the increase in the Mental and Physical subgroup scores of SF-36 were found statistically coherent. The adverse effect of obesity, which is observed more and more often in today's world, on lower urinary tract symptoms and on the quality of life is undeniable. In our study, we think that the bariatric surgery made by using the LSG technique, not only causes serious amount of weight loss, but also reduces urinary dysfunction and enhances the quality of life among males.

Validation of Obesity Surgery Data in the Swedish National Patient Registry and Scandinavian Obesity Registry (SOReg)

Swedish health registries are common sources of data for studies on the effects of obesity surgery, and there is a need to assess the quality of data in these registries. The aim of this study was to validate the registration of obesity surgery in the National Patient Registry (NPR) and the Scandinavian Obesity Surgery Registry (SOReg). We randomly selected 962 out of 8501 registrations of obesity surgery in 2011 from the NPR and SOReg. Registered surgical procedures in the NPR and SOReg were compared to the medical records, and concordance was analyzed by calculating positive predictive value (PPV) with 95% confidence interval (CI). We received 938 (98%) medical records for manual review. The overall PPV for obesity surgery was high in the NPR (PPV 97.0; 95% CI 95.6-98.4) and even higher in SOReg (PPV 99.7; 95% CI 99.3-100). Accuracy was higher for gastric bypass surgery than for other types of obesity surgery. Registrations that were misclassified as obesity surgery (n = 44) included reoperations due to complications or reconstruction to normal anatomy after previous obesity surgery (n = 11) and endoscopic procedures (n = 10). Obesity surgery registrations in the NPR and SOReg have high accuracy and are reliable sources of data to identify patients having undergone obesity surgery. When it is of importance to distinguish between specific surgical procedures, non-gastric bypass surgeries in the NPR should ideally be supplemented with data from other sources.

Long-Term Outcomes of Obesity Surgery and Implications for Health System Planning.

Weight loss surgery is currently the only treatment that offers significant and sustained weight loss for those with severe and complex obesity. Obesity levels have reached a sustained high, whereby several percent of a country's population would qualify for surgery based upon current national guidelines. Worldwide, the provision of surgery is highly variable and to treat all the affected population, it would require at least a 100-fold increase in the provision of services. This has important cost and commissioning implications for health-care planners. Reliable level 1 evidence of the long-term effects of obesity surgery is still lacking, and the long-term complication profiles and re-operation rates unclear, which could have significant impact on health-care systems in the future. The chronic disease management of obesity in a population must be integrated with education and prevention and the brief intervention of weight loss surgery and the management of its sequelae, to prevent significant future morbidity and mortality.

The effects of obesity surgery on diabetic retinopathy

The effects of obesity surgery on diabetic retinopathy

The effects of obesity surgery on diabetic nephropathy

The effects of obesity surgery on diabetic nephropathy

Obesity management — An opportunity for cancer prevention

There is increasing evidence of an association between obesity and the development, morbidity and mortality of cancers of the colorectum, (post menopausal) breast, endometrium, kidney, pancreas and oesophagus. In addition to obesity per se, waist circumference is now emerging as a clear indicator of disease risk. Weight gain during adult life also appears to increase risk for breast and colon cancers. Major causative factors which are influenced by excess energy storage include hormones involved in metabolic control (insulin and leptin), cell growth (IGF-I and IGF-binding proteins) and reproduction (steroids and leptin). In addition, raised oestrogens are likely to contribute to the greater risk of breast and endometrial cancers. In cancer survivors, there are also strong indications that being overweight increases the risk for recurrence and reduces the likelihood of survival. Whilst there are no robust data testing the effect of weight loss on recurrence, current guidance highlights that normal weight, overweight and obese patients should avoid weight gain and that a modest weight loss of 5-10% is likely to have significant health benefits. Two studies have now reported long-term effects of obesity surgery on cancer risk (in addition to reducing metabolic disorders and type 2 diabetes). It is becoming increasingly clear that multi-disciplinary groups (including surgeons) are needed to identify, monitor and evaluate programmes for both obesity prevention and management.

Laparoscopic obesity surgery in an Asian Institute: A 10‐year prospective study with review of literature

AbstractObjective: Obesity surgery is the most effective treatment for morbid obesity and leads to dramatic improvement in related co‐morbidities. The aim of this study was to present the long‐term results of a prospective trial studying the efficacy of laparoscopic obesity surgery in a group of oriental patients.Method: From April 1998 to March 2009, 2385 patients who underwent obesity surgery in a single bariatric center in Asia were recruited. Various procedures have been adopted so far, including laparoscopic vertical banded gastric partition in 652 patients (27.3%), laparoscopic gastric bypass (LGB) in 1228 patients (51.5%), laparoscopic adjustable gastric banding in 226 patients (9.5%), laparoscopic sleeve gastrectomy in 128 patients (5.4%), gastric balloon in 68 patients (2.8%) and laparoscopic revision surgery in 83 patients (3.5%). We evaluated the clinical data and effect of obesity surgery on different procedures.Results: Overall, the major complication rate and mortality were 1.5% and 0.12%. There was an increase of surgical risk in laparoscopic sleeve gastrectomy and laparoscopic revision surgery patients. The mean total weight loss for the population was 28.1%, 33.9%, 21.3% 18.7% and 17.4% at 1, 3, 5, 7 and 9 years after surgery, respectively. LGB had a better weight loss (30.1%) than that of the restrictive‐type procedures (20.9%) at 5 years after surgery. After surgery, most of the obesity‐associated co‐morbidities were resolved or improved in these patients.Conclusion: Laparoscopic obesity surgery resulted in significant and sustained weight loss in morbidly obese Asian patients with resolution of associated co‐morbidities. LGB had a better result in weight reduction than other restrictive procedures.

Effects of Obesity Surgery on Type 2 Diabetes Mellitus Asian Patients

Obesity is a major risk factor for the development of type 2 diabetes mellitus (T2DM). Surgery is the most effective treatment for morbid obesity, and it has been shown to lead to dramatic improvement in type T2DM. However, data concerning obese Asian patients have not been reported, and the mechanism of improving T2DM after bariatric surgery in this population remains speculative. From April 1997 to March 2006, 1,375 patients undergoing obesity surgery were recruited for our study of the effects of weight loss surgery on type 2 diabetes mellitus (T2DM). Laparoscopic vertical banded gastric partition (LVBG) was performed in 552 patients (40.1%), laparoscopic gastric bypass in 660 patients (48.0%), and laparoscopic adjustable gastric banding (LAGB) in 140 patients (10.2%). Another 23 patients (1.7%) received open or revision surgery. We evaluated the clinical data and effect of obesity surgery on T2DM, impaired fasting glucose (IFG) and compared the changes with those with normal fasting glucose. Among all the patients, 166 (12.1%) had impaired fasting glucose (IFG) and 247 (18.0%) had T2DM. Patients with IFG or DM were significantly older, more central obese, and they had higher insulin resistance and a higher HbA1C level than those with normal fasting glucose. The mean total weight loss for the population was 28.6%, 29.1%, 28.5%, 23.8%, and 24.4% (at 1, 2, 3, 5, and 7 years after surgery). There was no increase of surgical risk in T2DM or IFG patients. One year after operation, fasting plasma glucose returned to normal in 78.5% of T2DM patients and 94.7% of IFG patients. The HbA1C level returned to under 7.0 in 81.5% of T2DM and in 100% of IFG patients. Laparoscopic gastric bypass patients had a greater weight loss and a higher rate of glucose normalization (93.1%) than the LVBG patients (85.3%) and LAGB patients (73.9%), but no difference in HbA1C normalization. Obesity surgery resulted in significant and sustained weight loss with a cure rate of T2DM up to 80% in morbidly obese Asian patients. Gastric bypass surgery had a better result in T2DM cure rate than LVBG and LAGB because of better weight reduction.

The Effect of Obesity Surgery on Obesity Comorbidity

Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.

Circadian blood pressure variation in morbidly obese hypertensive patients undergoing gastric bypass surgery

Impaired blood pressure (BP) variation, often found in obesity and hypertension, is associated with increased cardiovascular risk. The effect of obesity surgery on BP variation is unknown. We performed this study to investigate the effect of gastric bypass surgery on circadian BP variation in morbidly obese hypertensive subjects. The study group consisted of eight patients (mean age 35.0 +/- 9.1 years), with impaired circadian BP rhythm. Controls were eight well-matched subjects (34.6 +/- 9.8 years) with normal BP rhythm. All patients underwent gastric bypass surgery. The 24-h ambulatory BP measurements were performed before (baseline) and 8 weeks after gastric bypass surgery. Mean body weight in the study group and controls decreased from baseline of 129.0 +/- 21.9 kg and 134.1 +/- 27.2 kg to 116.7 +/- 21.1 kg (by 9.5% +/- 2.1%) and 121.6 +/- 25.7 kg (by 9.3% +/- 1.7%) after the surgery, respectively (P < .0001 v baseline). Mean 24-h, daytime, and night-time BP values decreased significantly and similarly in both groups. In the study group mean 24-h systolic and diastolic BP decreased from 154.7 +/- 12.3 mm Hg and 105.6 +/- 8.1 mm Hg to 138.5 +/- 9.3 mm Hg and 90.8 +/- 6.7 mm Hg and in controls from 158.2 +/- 16.5 mm Hg and 106.2 +/- 10.0 mm Hg to 136.3 +/- 10.8 mm Hg and 92.9 +/- 6.3 mm Hg (P < .0001 v baseline), respectively. Circadian BP rhythm in the study group returned to the normal profile (mean systolic nocturnal fall increased from 4.0% +/- 2.4% to 16.4% +/- 4.0% and diastolic, from 5.1% +/- 3.0% to 17.3% +/- 5.5%; P < .0001 v baseline), whereas it remained normal in the controls. Surgery-induced body weight loss in morbidly obese hypertensive subjects with impaired circadian BP variation is not only associated with BP reduction, but also with the restoration of normal BP rhythm.

Effects of obesity surgery on the metabolic syndrome

Hypothesis: Individuals with the metabolic syndrome (MS), a clustering of risk factors (high levels of triglycerides and serum glucose, low level of high-densitylipoprotein cholesterol, high blood pressure, abdominal obesity) defined by the Third Report of the National Cholesterol Education Program Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATPIII), are athighriskofdevelopingcoronaryheartdiseaseandtype 2 diabetes mellitus and may benefit from surgically induced weight loss. Design: Prospectively controlled clinical study. Setting: A tertiary referral center.

Effects of Obesity Surgery on the Metabolic Syndrome

Individuals with the metabolic syndrome (MS), a clustering of risk factors (high levels of triglycerides and serum glucose, low level of high-density-lipoprotein cholesterol, high blood pressure, abdominal obesity) defined by the Third Report of the National Cholesterol Education Program Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATPIII), are at high risk of developing coronary heart disease and type 2 diabetes mellitus and may benefit from surgically induced weight loss. Prospectively controlled clinical study. A tertiary referral center. From December 1, 1999, to March 31, 2002, 645 consecutive morbidly obese patients were enrolled in a surgically supervised weight loss program, and the efficacy of weight loss 1 year after surgery was examined. Laparoscopic weight reduction surgery. Prevalence of the MS as defined by the ATPIII (>3 of the following): waist circumference greater than 102 cm in men and 88 cm in women; serum triglyceride level of at least 150 mg/dL (1.70 mmol/L); high-density lipoprotein cholesterol level less than 40 mg/dL (1.04 mmol/L) in men and 50 mg/dL (1.30 mmol/L) in women; blood pressure of at least 130/85 mm Hg; and serum glucose level of at least 110 mg/dL (6.11 mmol/L). Of 645 individuals, 337 (52.2%) met the ATPIII definition of the MS. Individuals with the MS had significant differences in age (31.5 years vs 28.1 years), sex (127 [37.7%] of 337 men vs 81 [26.3%] of 308 women), and many metabolic abnormalities compared with patients without the MS. Laparoscopic vertical banded gastroplasty was performed in 528 patients (81.9%) and laparoscopic gastric bypass in 117 (18.1%). A significant decrease in weight was found in both groups, but individuals who underwent laparoscopic gastric bypass lost significantly more weight (mean +/- SD, 38.4 +/- 14.4 kg vs 35.1 +/- 16.8 kg) and achieved a lower body mass index (29.3 +/- 4.8 vs 32.0 +/- 5.4) than individuals who underwent laparoscopic vertical banded gastroplasty. Substantial mean weight reduction (31.9%) of patients with the MS resulted in a substantial reduction of systolic (11.0 mm Hg) and diastolic (11.4 mm Hg) blood pressure and levels of glucose (46.1 mg/dL [2.56 mmol/L]), triglycerides (196.6 mg/dL [2.22 mmol/L]), and total cholesterol (33.7 mg/dL [0.88 mmol/L]) 1 year after surgery. These improvements resulted in a 95.6% resolution of the MS 1 year after surgery. There was no difference between operations (laparoscopic vertical banded gastroplasty or laparoscopic gastric bypass) in the resolution rate of the MS 1 year after surgery (95.0% vs 98.4%, respectively). The MS is prevalent in 52.2% of morbidly obese individuals enrolling in an obesity surgery program. Significant weight reduction 1 year after surgery markedly improved all aspects of the MS and resulted in a cure rate of 95.6%. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with the MS.

Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique

Hypothesis: Individuals with the metabolic syndrome (MS), a clustering of risk factors (high levels of triglycerides and serum glucose, low level of high-density-lipoprotein cholesterol, high blood pressure, abdominal obesity) defined by the Third Report of the National Cholesterol Education Program Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATPIII), are at high risk of developing coronary heart disease and type 2 diabetes mellitus and may benefit from surgically induced weight loss. Design: Prospectively controlled clinical study. Setting: A tertiary referral center. Patients: From December 1, 1999, to March 31, 2002, 645 consecutive morbidly obese patients were enrolled in a surgically supervised weight loss program, and the efficacy of weight loss 1 year after surgery was examined. Intervention: Laparoscopic weight reduction surgery. Main Outcome Measures: Prevalence of the MS as defined by the ATPIII (>3 of the following): waist circumference greater than 102 cm in men and 88 cm in women; serum triglyceride level of at least 150 mg/dL (1.70 mmol/ L); high-density lipoprotein cholesterol level less than 40 mg/dL (1.04 mmol/L) in men and 50 mg/dL (1.30 mmol/L) in women; blood pressure of at least 130/85 mm Hg; and serum glucose level of at least 110 mg/dL (6.11 mmol/L). Results: Of 645 individuals, 337 (52.2%) met the ATPIII definition of the MS. Individuals with the MS had significant differences in age (31.5 years vs 28.1 years), sex (127 [37.7%] of 337 men vs 81 [26.3%] of 308 women), and many metabolic abnormalities compared with patients without the MS. Laparoscopic vertical banded gastroplasty was performed in 528 patients (81.9%) and laparoscopic gastric bypass in 117 (18.1%). A significant decrease in weight was found in both groups, but individuals who underwent laparoscopic gastric bypass lost significantly more weight (mean±SD, 38.4±14.4 kg vs 35.1±16.8 kg) and achieved a lower body mass index (29.3±4.8 vs 32.0±5.4) than individuals who underwent laparoscopic vertical banded gastroplasty. Substantial mean weight reduction (31.9%) of patients with the MS resulted in a substantial reduction of systolic (11.0 mm Hg) and diastolic (11.4 mm Hg) blood pressure and levels of glucose (46.1 mg/dL [2.56 mmol/L]), triglycerides (196.6 mg/dL [2.22 mmol/L]), and total cholesterol (33.7 mg/dL [0.88 mmol/L]) 1 year after surgery. These improvements resulted in a 95.6% resolution of the MS 1 year after surgery. There was no difference between operations (laparoscopic vertical banded gastroplasty or laparoscopic gastric bypass) in the resolution rate of the MS I year after surgery (95.0% vs 98.4%, respectively). Conclusion: The MS is prevalent in 52.2% of morbidly obese individuals enrolling in an obesity surgery program. Significant weight reduction 1 year after surgery markedly improved all aspects of the MS and resulted in a cure rate of 95.6%. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with the MS.