Bariatric surgery leads to significantly greater weight loss and resolution of diabetes and metabolic syndrome as compared with nonsurgical approaches to obesity, a meta-analysis of randomized trials showed.

On average, patients lost an additional 57 lbs when bariatric surgery was added to conventional nonsurgical approaches to weight loss. Patients who had surgery were more than five times as likely to have remission of diabetes and twice as likely to have remission of metabolic syndrome, as compared with patients who were treated only with nonsurgical interventions.

The results add to evidence of bariatric surgery's efficacy from observational studies, but more long-term follow-up data are needed, Viktoria L. Gloy, PhD, of the University Hospital Basel in Switzerland, and colleagues reported online in BMJ.

"This meta-analysis provides comprehensive evidence that, compared with nonsurgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome," the authors concluded.

"The evidence beyond 2 years of follow-up, in particular on adverse events, cardiovascular diseases, and mortality remains unclear and calls for further research on the topic," they added.

A previous systematic review suggested that bariatric surgery improved weight loss and control of comorbid conditions better than nonsurgical weight-loss interventions did. The review included only three trials, and the number has increased since publication of the review, Gloy and colleagues noted.

To bring the data up to date, they performed a systematic review of the literature, which yielded nine randomized, controlled trials suitable for inclusion. For the analysis, obesity was defined as a body mass index (BMI) ≥30 kg/m2.

The analysis was not limited to a specific type of bariatric procedure, and included studies that used Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, biliopancreatic diversion, or biliopancreatic diversion with duodenal switch. All trials had follow-up of at least 6 months.

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