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JAMA Theme Issue Media Briefing New York, NY

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Presentation on theme: "JAMA Theme Issue Media Briefing New York, NY"— Presentation transcript:

1 JAMA Theme Issue Media Briefing New York, NY

2 In the U.S., severe obesity is rapidly increasing at a rate greater than moderate obesity There are a projected 31 million Americans meeting criteria for bariatric surgery Long-term studies relating the health benefits of gastric bypass surgery remain limited

3 Prospectively compare clinical outcomes in severely obese patients receiving RYGB surgery with similarly severely obese controls See bariatric surgery types on JAMAs Patient Page (page 1173) - banding not approved in US and the sleeve not performed when Utah study initiated

4 Exam Exam 2 Utah Obesity Study Design Exam 1 2 Years 6 Years 321 Utah Health Family Tree Program Baseline 417 No Surgery 418 RYGB Surgical Center

5 Type 2 diabetes: Fasting blood glucose 126 mg/dL, HgA1c 6.5% or antidiabetic medication Dyslipidemia: Fasting LDL-C 160 mg/dL, fasting HDL-C < 40 mg/dL, or fasting triglycerides 200 mg/dL or using lipid lowering medication Hypertension: Resting clinic blood pressure 140/90 mmHg or antihypertensive medication Quality of Life (QOL): Obesity-specific QOL tool and SF-36 (physical and mental)

6 Propensity scores – this analysis adjusts for differences in groups Logistic regression – this analysis adjusts for any remaining differences Remission of baseline prevalent disease defined as clinically normal levels of fasting glucose and lipids and of resting blood pressure – each without reported medication use at examination three

7 Variables RYGB Surgery (418) Control Group 1 (417) Control Group 2 (321) Female, % * Age, y * BMI * SBP, mm Hg DBP, mm Hg Glucose, mg/dL101107* Quality of life *54.4* * Statistical difference between groups

8 % Surgery GroupControl Group 1Control Group 2

9 mg/dL Surgery GroupControl Group 1Control Group 2

10 mg/dL Surgery GroupControl Group 1Control Group 2

11 mg/dL Surgery GroupControl Group 1Control Group 2

12 Only surgical patients Percent Weight Change


14 At 6 years: 96% of the RYGB group had maintained more than 10% of weight loss from baseline 76% had maintained more than 20% weight loss from baseline

15 At 6 years, RYGB had: Decrease in fasting glucose of 23.7 mg/dL relative to control group 1 Decrease of 19.5 mg/dL relative to control group 2

16 Group Baseline Prevalence IncidenceRemission Surgery22%2%62% Control 125%17%8% Control 229%15%6% OR: 0.11 OR: 0.21 OR: 16.5 OR: 21.5

17 Group Baseline Prevalence IncidenceRemission Surgery43%16%42% Control 143%31%18% Control 252%33%9% OR: 0.40 OR: 0.47 OR: 2.9 OR: 5.0

18 Group Baseline Prevalence IncidenceRemission Surgery20%4%53% Control 118%25%22% Control 221%30%10% OR: 0.12 OR: 0.14 OR: 4.4 OR: 6.8

19 Group Baseline Prevalence IncidenceRemission Surgery41%5%67% Control 145%32%34% Control 236%38%18% OR: 0.10 OR: 3.8 OR: 6.2

20 GroupBaseline Prevalence IncidenceRemission Surgery43%3%71% Control 141%25%33% Control 241%28%34% OR: 0.10 OR: 0.13 OR: 5.1 OR: 3.4

21 v RYGB surgery provided long-term diabetes, hypertension, and abnormal lipid remission and improvement in other risk factors when compared with severely obese patients not having surgery v There was a 5- to 9-fold reduction in the risk of new diabetes in surgical patients compared with severely obese controls who did not have surgery v The large improvement in fasting glucose seen at 2 years follow-up, continued to 6 years v Significant weight loss was sustained for an average of 6 years

22 Available at TD Adams and coauthors Health Benefits of Gastric Bypass Surgery After 6 Years


24 CategoryBMIFemaleMale Normal weight lb166 lb Overweight lb203 lb Obese Class I (moderately obese) lb240 lb Obese Class II (severely obese) lb277 lb Obese Class III (very severely obese) > lb347 lb (67 in) (72 in)

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