Citation

Arterburn DE, Courcoulas AP. BMJ 2014; 349.

Copyright

(Copyright © 2014, BMJ Publishing Group)

DOI

10.1136/bmj.g3961

PMID

unavailable

Abstract

This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.

Language: en

Keywords

Humans; adult; human; suicide; Suicide; Cardiovascular Diseases; Substance-Related Disorders; Treatment Outcome; quality of life; Quality of Life; prevalence; malnutrition; complication; addiction; treatment outcome; Obesity; disease severity; psychology; Reoperation; review; obesity; Bariatric Surgery; weight reduction; priority journal; medical decision making; practice guideline; nutritional deficiency; psychosocial disorder; cardiovascular disease; cost benefit analysis; metabolic disorder; non insulin dependent diabetes mellitus; conservative treatment; surgical mortality; patient participation; postoperative complication; body mass; clinical effectiveness; bariatric surgery; Postoperative Complications; Roux Y anastomosis; procedures; reoperation; Diabetes Mellitus, Type 2; surgical risk; adverse outcome; gastroplasty; jejunoileal bypass; Malnutrition; gastric banding