jama theme issue media briefing new york, ny [email protected]
TRANSCRIPT
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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
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Prospectively compare clinical outcomes in severely obese patients receiving RYGB surgery with similarly severely obese controls
See bariatric surgery types on JAMA’s Patient Page (page 1173) - banding not approved in US and the sleeve not performed when Utah study initiated
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315
387
388
Exam 3
319
410
400
Exam 2
Utah Obesity Study DesignUtah Obesity Study Design
Exam 1
2 Years 6 Years
321
Utah Health Family Tree
Program
Baseline
417
No Surgery
418
RYGBSurgical Center
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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)
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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
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VariablesRYGB
Surgery (418)
Control Group 1
(417)
Control Group 2
(321)
Female, % 84.4 84.4 76.0*
Age, y 42.5 43.0 49.4*
BMI 47.3 46.3 43.8*
SBP, mm Hg 126.3 125.6 128.8
DBP, mm Hg 71.9 72.0 72.3
Glucose, mg/dL 101 107* 107*
Quality of life 31.4 34.9* 54.4*
* Statistical difference between groups
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%
Surgery Group Control Group 1 Control Group 2
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mg
/dL
Surgery Group Control Group 1 Control Group 2
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mg
/dL
Surgery Group Control Group 1 Control Group 2
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mg
/dL
Surgery Group Control Group 1 Control Group 2
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Only surgical patients
Percent Weight Change
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Percent Weight Change
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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
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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
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GroupBaseline
PrevalenceIncidence Remission
Surgery 22% 2% 62%
Control 1 25% 17% 8%
Control 2 29% 15% 6%
OR: 0.11
OR: 0.21
OR: 16.5
OR: 21.5
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GroupBaseline
PrevalenceIncidence Remission
Surgery 43% 16% 42%
Control 1 43% 31% 18%
Control 2 52% 33% 9%
OR: 0.40
OR: 0.47
OR: 2.9
OR: 5.0
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GroupBaseline
PrevalenceIncidence Remission
Surgery 20% 4% 53%
Control 1 18% 25% 22%
Control 2 21% 30% 10%
OR: 0.12
OR: 0.14
OR: 4.4
OR: 6.8
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GroupBaseline
PrevalenceIncidence Remission
Surgery 41% 5% 67%
Control 1 45% 32% 34%
Control 2 36% 38% 18%
OR: 0.10
OR: 0.10
OR: 3.8
OR: 6.2
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Group Baseline Prevalence
Incidence Remission
Surgery 43% 3% 71%
Control 1 41% 25% 33%
Control 2 41% 28% 34%
OR: 0.10
OR: 0.13
OR: 5.1
OR: 3.4
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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
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
The large improvement in fasting glucose seen at 2 years follow-up, continued to 6 years
Significant weight loss was sustained for an average of 6 years
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Available at www.jama.com
TD Adams and coauthors
Health Benefits of Gastric Bypass Surgery After 6 Years
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Category BMI Female Male
Normal weight 18.5 - 25 140 lb 166 lb
Overweight 25 - 30 176 lb 203 lb
Obese Class I (moderately obese)
30 - 35 208 lb 240 lb
Obese Class II (severely obese)
35 - 40 239 lb 277 lb
Obese Class III (very severely obese)
> 40 300 lb 347 lb
(67 in) (72 in)