Bariatric surgery effective for obesity

Clinical question: 
How effective is bariatric (weight loss) surgery for obesity?
Bottom line: 
Surgery for obesity results in greater weight loss than conventional treatment, and the results are maintained at least up to 10 years. Furthermore, the weight loss is associated with reductions in comorbidities, such as diabetes and hypertension, and medication use. Short term (2 year) improvements in health-related quality of life were reported, but longer term (10 year) effects are less clear, with improvements in some aspects of quality of life, but not others. Surgery is associated with adverse effects and the possibility of postoperative mortality. There are a number of different bariatric procedures available (gastric bypass, vertical banded gastroplasty, adjustable gastric banding, isolated sleeve gastrectomy, biliopancreatic diversion and banded gastric bypass). Weight loss and quality of life is similar between procedures carried out through open or laparoscopic surgery. More wound problems and hernias occurred with open surgery, while anastomotic stricture and reoperation were more common after laparoscopic surgery.
Caveat: 
Data on the comparative safety of the bariatric procedures were limited; all procedures were associated with adverse events, but few trials compared data statistically and none were powered to do so. Due to the limited evidence and poor quality of the trials, caution is required when interpreting the comparative safety and effectiveness of these procedures.
Context: 
Obesity is associated with many health problems and a higher risk of death. Bariatric surgery for obesity is usually only considered when all other treatments have failed. People who are eligible for surgery have a body mass index (BMI) greater than 40 or greater than 35 with related conditions, such as type 2 diabetes.
Review CD#: 
CD003641
PEARLS No: 
178
Date: 
July, 2009
Authored by: 
Brian R McAvoy