Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up

Obes Surg. 2009 Jan;19(1):3-12. doi: 10.1007/s11695-008-9675-8. Epub 2008 Sep 16.

Abstract

Background: No long-term, high participation study of the outcome of bariatric surgery has examined how a multi-intervention approach to the treatment of severe obesity can achieve and sustain weight loss after an initial bariatric procedure.

Methods: We employed a multi-intervention treatment that combines adjustable gastric banding with intensive follow-up to support patient life-style change and use of an algorithm allowing reoperation-to bypass, if necessary-in the event of complications. Four hundred four severely obese patients with an average BMI = 42.6 at the outset had initial AGB surgery and were followed with a high rate of face-to-face consultations for 7 years. Seventy-five percent of the patients retained a gastric band throughout the study. Weight loss, complications, and comorbidities were studied, and quality of life was assessed using Bariatric Analysis and Reporting Outcome System (BAROS).

Results: Three hundred eighty-eight (96%) patients completed the 7-year follow-up. Average BMI reduction at 5 years was 28% and remained stable through year 7, at which the mean excess weight loss was 61%. The preoperative prevalence of metabolic syndrome, 59.7%, decreased to 13.3% at 7 years and was abolished for patients with more than 40% loss of initial BMI. Similar changes were seen for all components of metabolic syndrome. More than 60% of patients had a "good" or higher BAROS score; 10.1% were considered failures. Patients converted to gastric bypass, and those retaining gastric bands throughout the study had very similar outcomes.

Conclusions: Long-term, multi-intervention treatment of severe obesity can achieve and preserve weight loss and thus improved quality of life and sustained reduction or disappearance of all components of metabolic syndrome, for a high proportion of severely obese patients with preoperative BMI between 35 and 55.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Body Mass Index
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Gastric Bypass*
  • Gastroplasty*
  • Humans
  • Life Style*
  • Male
  • Middle Aged
  • Obesity, Morbid / therapy*
  • Patient Education as Topic*
  • Prospective Studies
  • Reoperation
  • Treatment Outcome
  • Young Adult