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CONTEXT Obesity is a risk factor for cardiovascular events . Weight loss might protect against cardiovascular events , but solid evidence is lacking . OBJECTIVE To study the association between bariatric surgery , weight loss , and cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) study is an ongoing , nonr and omized , prospect i ve , controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care . Patients were recruited between September 1 , 1987 , and January 31 , 2001 . Date of analysis was December 31 , 2009 , with median follow-up of 14.7 years ( range , 0 - 20 years ) . Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women . Exclusion criteria were identical in surgery and control patients . Surgery patients underwent gastric bypass ( 13.2 % ) , b and ing ( 18.7 % ) , or vertical b and ed gastroplasty ( 68.1 % ) , and controls received usual care in the Swedish primary health care system . Physical and biochemical examinations and data base cross-checks were undertaken at preplanned intervals . MAIN OUTCOME MEASURES The primary end point of the SOS study ( total mortality ) was published in 2007 . Myocardial infa rct ion and stroke were predefined secondary end points , considered separately and combined . RESULTS Bariatric surgery was associated with a reduced number of cardiovascular deaths ( 28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group ; adjusted hazard ratio [ HR ] , 0.47 ; 95 % CI , 0.29 - 0.76 ; P = .002 ) . The number of total first time ( fatal or nonfatal ) cardiovascular events ( myocardial infa rct ion or stroke , whichever came first ) was lower in the surgery group ( 199 events among 2010 patients ) than in the control group ( 234 events among 2037 patients ; adjusted HR , 0.67 ; 95 % CI , 0.54 - 0.83 ; P < .001 ) . CONCLUSION Compared with usual care , bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Background and Aims Small intestinal bacterial overgrowth ( SIBO ) has been described in obese patients . The aim of this study was to prospect ively evaluate the prevalence and consequences of SIBO in obese patients before and after bariatric surgery . Patients and Methods From October 2001 to July 2009 , in obese patients referred for bariatric surgery ( BMI > 40 kg/m2 or > 35 in association with comorbidities ) , a glucose hydrogen ( H2 ) breath test ( BT ) was performed before and /or after either Roux-en-Y gastric bypass ( RYGBP ) or adjustable gastric b and ing ( AGB ) to assess the presence of SIBO . Weight loss and serum vitamin concentrations were measured after bariatric surgery while a multivitamin supplement was systematic ally given . Results Three hundred seventy-eight ( mean ± SD ) patients who performed a BT before and /or after surgery were included : before surgery , BT was positive in 15.4 % ( 55/357 ) . After surgery , BT was positive in 10 % ( 2/20 ) of AGB and 40 % ( 26/65 ) of RYGBP ( p < 0.001 compared to preoperative situation ) . After RYGBP , patients with positive BT had similar vitamin levels , a lower caloric intake ( 983 ± 337 vs. 1271 ± 404 kcal/day , p = 0.014 ) but a significant lower weight loss ( 29.7 ± 5.6 vs. 37.7 ± 12.9 kg , p = 0.002 ) and lower percent of total weight loss ( 25.6 ± 6.0 vs. 29.2 ± 6.9 % , p = 0.044 ) . Conclusion In this study , SIBO is present in 15 % of obese patients before bariatric surgery . This prevalence does not increase after AGB while it rises up to 40 % of patients after RYGBP and it is associated with lower weight loss Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 Introduction Bariatric surgery is considered the most effective treatment for obesity . A recent worldwide survey demonstrated that Laparoscopic Sleeve Gastrectomy ( LSG ) is the most commonly performed bariatric procedure , while Laparoscopic Adjustable Gastric B and ing ( LAGB ) has been almost ab and oned . Objectives The aim of this retrospective study was to compare 5-year results of LSG and LAGB at our Institution . Material s and Methods Prospect i ve maintained data base of our Institution was review ed to find all patients who had undergone LSG between January 2009 and December 2011 . Inclusion criteria were BMI of 40–50 kg/m2 and age of 18–60 years old . Patients with Class I and II obesity , superobese subjects , and patients with previous history of bariatric surgery were excluded . Data on sex , age , pre-operative BMI , obesity-related diseases ( diabetes , hypertension , dyslipidemia ) , and early and late complications were collected . Each subject who underwent LSG was matched one-to-one with a patient that had undergone LAGB . Outcomes were analyzed at 1 , 3 , and 5 years of follow-up . Results A total number of 122 patients were included in this study , 61 in each group .  Better % EWL was observed in the LSG group at 1 , 3 , and 5 years . Both procedures induced improvements of obesity-related diseases without significant difference . In the LAGB group , ten patients underwent uneventful b and removal . In the LSG group , two patients had serious postoperative complications . Conclusion LSG achieves better % EWL than LAGB within 5 years , but comorbidities improvement is not significantly different . Severity of complication is higher after LSG . LAGB is still a good option for selected patients BACKGROUND It is well known that citizens of developed countries are more likely to be overweight than they were 20 years ago . The most serious health problems are not associated with overweight or moderate obesity , however , but with clinical ly severe or morbid obesity ( e.g. more than 100 pounds ( 45 kg ) overweight ) . There is no reason to expect that morbid obesity trends parallel overweight or moderate obesity . If morbid obesity is a rare pathological condition that has biological causes , the more than 10-fold increase in bariatric surgery procedures over the past eight years in the USA could have even lowered the prevalence of morbid obesity- and may very well stem the problem in other countries . OBJECTIVE To estimate trends for extreme weight categories ( BMI > 40 and > 50 ) for the period between 1986 and 2005 in the USA , and to investigate whether trends have changed since 2000 . METHODS Data from The Behavioral Risk Factor Surveillance System ( a r and om-digit telephone survey of the household population of the USA ) , for the period from 1986 to 2005 , were analysed . The main outcome measure was body mass index ( BMI ) , calculated from self-reported weight and height . RESULTS From 2000 to 2005 , the prevalence of obesity ( self-reported BMI over 30 ) increased by 24 % . However , the prevalence of a ( self-reported ) BMI over 40 ( about 100 pounds ( 45 kg ) overweight ) increased by 50 % and the prevalence of a BMI over 50 increased by 75 % , two and three times faster , respectively . The heaviest BMI groups have been increasing at the fastest rates for 20 years . CONCLUSIONS The prevalence of clinical ly severe obesity is increasing at a much faster rate among adults in the USA than is the prevalence of moderate obesity . This is consistent with the public health idea that the population weight distribution is shifting , which disproportionately increases extreme weight categories . Because comorbidities and result ing service use are much higher among severely obese individuals , the widely published trends for overweight/obesity underestimate the consequences for population health . The aggressive and costly expansion of bariatric surgery in recent years has had no visible effect on containing morbid obesity rates in the USA BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery Background The incidence of venous thromboembolism ( VTE )  after bariatric surgery  is uncertain . Methods Using the re sources of the Rochester Epidemiology Project and the Mayo Bariatric Surgery Registry , we identified all residents of Olmsted County , Minnesota , with incident VTE after undergoing bariatric surgery from 1987 through 2005 . Using the date s of bariatric surgery and VTE events , we determined the cumulative incidence of VTE after bariatric surgery by using the Kaplan – Meier estimator . Cox proportional hazards modeling was used to assess patient age , sex , weight , and body mass index as potential predictors of VTE after bariatric surgery . Results We identified 396 residents who underwent 402 bariatric operations . The most common operation was an open Roux-en-Y gastric bypass ( n = 228 ) . Eight patients had VTE that developed within 6 months ( 7 within 1 month ) after surgery ; five events occurred after hospital discharge but within 1 month after bariatric surgery . The cumulative incidence of VTE at 7 , 30 , 90 , and 180 days was 0.3 , 1.9 , 2.1 , and 2.1 % , respectively ( 180-day 95 % confidence interval ( CI ) , 0.7–3.6 % ) . Patient age was a predictor of postoperative VTE ( hazard ratio , 1.89 per 10-year increase in age ; 95 % CI , 1.01–3.55 ; P = 0.05 ) . Conclusions In our population -based study , bariatric surgery had a high risk of VTE , especially for older patients . Because most VTE events occurred after hospital discharge , a r and omized controlled trial of extended outpatient thromboprophylaxis is warranted in patients undergoing open Roux-en-Y gastric bypass for medically complicated obesity Introduction Laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) are commonly performed bariatric procedures in obesity management . Gastroesophageal reflux disease ( GERD ) in this population has reported rates of 23–100 % . GERD after LSG has been noted with recent studies demonstrating de novo reflux or symptom exacerbation despite weight loss . Fundoplication is not an option , and medically refractory GERD after LSG is usually treated with conversion to RYGB . GERD post-RYGB is a unique entity , and management poses a clinical and technical challenge . We evaluate safety and effectiveness of magnetic sphincter augmentation after bariatric surgery . Material s and methods A retrospective review of a prospect ively maintained data base was performed identifying patients that underwent LINX placement for refractory GERD after LSG , LRYGB , or duodenal switch across three institutions . Outcomes included complications , length of stay , PPI use , GERD-HRQL scores , and patient overall satisfaction . Results From March 2014 through June 2018 , 13 identified patients underwent LINX placement after bariatric surgery : 8 LSG , 4 LRYGB , and 1 duodenal switch .  The patients were 77 % female , with mean age 43 and average BMI 30.1 .  Average pre-operative DeMeester score was 24.8 . Pre-operatively , 5 patients were on daily PPI , 6 on BID PPI , and 1 on PPI + H2 blocker . We noted decreased medication usage post-operatively , with 4 patients taking daily PPI , and 9 off medication completely . A GERD-HRQL score was obtained pre- and post-operatively in 6 patients with average reduction from 25 to 8.5 ( p value 0.002 ) . Two patients experienced complications requiring endoscopic dilation after LINX placement . 100 % of patients reported overall satisfaction post procedure . Conclusion LINX placement is a safe , effective treatment option for surgical management of refractory GERD after bariatric surgery . It can relieve symptoms and obviate the requirement of high-dose medical management . Magnetic lower esophageal sphincter augmentation should be another tool in the surgeon ’s toolbox for managing reflux after bariatric surgery in select patients Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative Our purpose was to assess the cost , quality of life impact , and the cost – utility of bariatric surgery in a managed care population . We studied 221 patients who underwent bariatric surgery between 2001 and 2005 . We analyzed medical cl aims data for all patients and survey data for 122 survey respondents ( 55 % response rate ) . Patients were generally middle-aged , female , and white . Sixty-four percent underwent open and 33 % underwent laparoscopic Roux-en-Y procedures .  One year after surgery , mean body mass index fell from 51 to 31 kg/m2 in women and from 59 to 35 kg/m2 in men with substantial improvements in comorbidities . Postsurgical mortality and morbidity were low . Total per member per month costs increased in the 6 months before bariatric surgery , were lower in the 12 months after bariatric surgery , but increased somewhat over the next 12 months . When presurgical quality of life was assessed prospect ively , average health utility scores improved by 0.14 one year after surgery . In analyses that took a lifetime time horizon , projected future costs based on age and obesity and discounted costs and health utilities at 3 % per year , the cost – utility ratio for bariatric surgery versus no surgery was approximately $ 1,400 per quality -adjusted life-year gained . In sensitivity analyses , bariatric surgery was more cost-effective in women , non-whites , more obese patients , and when performed laparoscopically . Although not cost-saving , bariatric surgery represents a very good value for money . Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity OBJECTIVE Obesity is as an independent risk factor for poor neurocognitive outcomes , including Alzheimer 's disease .  Bariatric surgery has recently been shown to result in improved memory at 12-weeks postoperatively . However , the long-term effects of bariatric surgery on cognitive function remain unclear . DESIGN AND METHODS Eighty-six individuals ( 63 bariatric surgery patients , 23 obese controls ) were recruited from a prospect i ve study examining the neurocognitive effects of bariatric surgery .  All participants completed  self-report measurements and a computerized cognitive test battery  prior to surgery and at 12-week and 24-month follow-up ; obese controls completed measures at equivalent time points . RESULTS Bariatric surgery patients exhibited high rates of pre-operative cognitive impairments in attention , executive function , memory , and language . Relative to obese controls , repeated measures ANOVA showed improvements in memory from baseline to 12-weeks and 24-months postoperatively ( P < 0.05 ) . Regression analyses controlling for baseline factors revealed that a lower BMI at 24-months demonstrated a trend toward significance for improved memory ( β = -.30 , P = 0.075 ) . CONCLUSION These findings suggest that cognitive benefits of bariatric surgery may extend to 24-months postoperatively . Larger prospect i ve studies with extended follow-up periods are needed to eluci date whether bariatric surgery decreases risk for cognitive decline and possibly the development of dementia The profound effects of bariatric surgery on glycemic control are well established in many studies , including several r and omized trials that compared surgery versus intensive medical and lifestyle treatment of type 2 diabetes mellitus ( T2DM ) ( 17 ) . Remission of T2DM is common after bariatric surgery , and Roux-en-Y gastric bypass ( RYGB ) outperforms sleeve gastrectomy ( SG ) in most reports ( 4 , 8 , 9 ) . More important than improvements in glycemic control is whether these glycemic changes reduce the incidence of major complications , such as microvascular events . In the United States , T2DM is the primary cause of nephropathy , end-stage renal disease , adult blindness , and neuropathy , which together lead to significant downstream costs and decreased quality of life ( 1012 ) . Thus , a major goal of diabetes treatment is to mitigate the risk for these long-term sequelae ( 13 ) . We have previously shown that in patients with T2DM who have bariatric surgery  , risk for incident microvascular disease is reduced for every year of remission from T2DMeven if patients eventually relapse back to T2DM ( indicating a legacy effect ) ( 14 ) . However , a detailed 2016 review of long-term microvascular outcomes of diabetes concluded that data were inadequate to support a superior effect of bariatric surgery compared with medical therapy ( 15 ) . Two recently published studies help inform this question ( 4 , 16 ) . The STAMPEDE ( Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently ) trial ( 4 ) r and omly assigned 150 patients with obesity and T2DM to have RYGB , SG , or an intensive medical and lifestyle intervention . After 5 years , urinary albumincreatinine ratios had decreased in the SG group only . Retinopathy did not change in any group , and neuropathy was not examined . STAMPEDE was limited by a relatively small sample size , which made it underpowered for rare outcomes . The prospect i ve SOS ( Swedish Obesity Subjects ) matched cohort study ( 16 ) followed 2010 patients who had bariatric surgery ( 13 % RYGB , 19 % gastric b and ing , and 68 % vertical-b and ed gastroplasty ) and 2037 matched patients who received usual care .  The incidence of microvascular disease after 15 years of follow-up was significantly lower in the surgery group than the control group ( hazard ratio [ HR ] , 0.56 [ 95 % CI , 0.48 to 0.66 ] ) , including among subgroups with prediabetes ( HR , 0.18 [ CI , 0.11 to 0.30 ] ) , established diabetes ( HR , 0.54 [ CI , 0.40 to 0.72 ] ) , and normoglycemia ( HR , 0.63 [ CI , 0.48 to 0.81 ] ) at baseline . The SOS study was limited by the small number of RYGB procedures and lack of SG procedures , which are now the 2 most common bariatric procedures worldwide ( 17 ) . To address these gaps in the literature , we did a matched cohort study to determine whether bariatric surgery was associated with lower incidence of microvascular disease than usual care for severe obesity and T2DM . We hypothesized that patients having  bariatric surgery would have lower risk for any incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . We further hypothesized that patients having bariatric surgery would have lower risk for incident retinopathy , nephropathy , and neuropathy than nonsurgical patients . Methods Setting s We did a retrospective observational cohort study of adults with T2DM who had bariatric surgery between 2005 and 2011 while enrolled in 1 of 4 integrated health care systems from the Health Care Systems Research Network : Kaiser Permanente ( KP ) Washington in Washington state , HealthPartners in Minnesota , KP Northern California , and KP Southern California . All study procedures were review ed and approved by the institutional review board at each site , and we were permitted to do the research without explicit consent from participants . Data Sources At each study site , staff used st and ardized electronic medical records , insurance cl aims , and other data systems ( 18 ) to extract enrollee data , including enrollment and insurance coverage ; demographics ; blood pressure ; height ; weight ; laboratory values ; medications dispensed ; deaths ; outpatient , inpatient , and emergency department use ; and inpatient and outpatient diagnosis and procedure codes . Surgical Participants The bariatric population included adults ( aged 19 to 79 years ) with severe obesity ( body mass index [ BMI ] 35 kg/m2 ) and T2DM who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 . Following an approach adopted in prior studies ( 14 , 19 , 20 ) , we used a combination of bariatric registries ; review of medical records ; codes from the International Classification of Diseases , Ninth Revision ( ICD-9 ) ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) to identify bariatric procedures .  Patients were classified as having T2DM if they had a hemoglobin A1c ( HbA1c ) level of at least 6.5 % or fasting plasma glucose level of at least 6.99 mmol/L ( 126 mg/dL ) at the most recent measurement within 2 years before surgery , or a current prescription for any diabetes medication . After selecting the population , we applied the following exclusion criteria based on information in the 2 years before surgery : less than 1 full year of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; metformin as the sole indicator of possible T2DM ( that is , no other T2DM medications , laboratory values , or diagnoses ) ; preexisting neuropathy , retinopathy , or nephropathy ( defined in Outcome and Censoring Definitions ) ; and maximum preoperative BMI less than 35 kg/m2 . This left 4972 patients . We further excluded 850 patients who were missing values for BMI , HbA1c level , or serum creatinine concentration in the 2 years before surgery . Surgical patients who were missing these values differed from those who had complete data ( Appendix Table 1 ) . Specifically , they were more likely to be non-Hispanic white , to be from the HealthPartners site , to have had their procedure in the first year of our study ( 2005 ) , and to have had a shorter observed duration of T2DM at the time of surgery . Of the remaining 4122 patients , 4024 could be matched to at least 1 nonsurgical patient ( Figure 1 ) . Figure 1 . Flow diagram for identification of eligible patients with T2DM and no history of microvascular disease who had bariatric surgery .  BMI = body mass index ; EHR= electronic health record ; HbA1c= hemoglobin A1c ; T2DM= type 2 diabetes mellitus . * Adults aged 2079 y who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 .  Bariatric procedures were identified using a combination of bariatric registries ; review of medical records ; International Classification of Diseases , Ninth Revision , codes ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) . We excluded patients with any of the following : < 1 y of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; preexisting neuropathy , nephropathy , or retinopathy ; metformin as the sole indicator of possible T2DM ( no other T2DM medications , laboratory values , or diagnoses ) ; or maximum BMI < 35 kg/m2 . Patients may have > 1 type of missing data ( BMI , creatinine concentration , or HbA1c level ) or have no follow-up time after surgery . 98 surgical patients could not be matched to a nonsurgical patient on site , age , BMI , insulin use , HbA1c level , and sex . Appendix Table 1 . Comparison of Characteristics of Surgical Patients Who Were Missing Values for BMI , HbA1c , or Serum Creatinine at Baseline Versus Those Who Had Complete Information on These Values at Baseline Matched Nonsurgical Participants For each surgical patient , we identified up to 3 matched nonsurgical control participants via a 2-step process . First , among all patients with diabetes and at least 1 BMI measurement of 35 kg/m2 or greater who did not have bariatric surgery during the study ( n= 320345 ) , we identified a pool of potential control participants who were enrolled at the time of the surgery ; satisfied the study inclusion criteria ; and matched the surgical patient on the basis of study site , sex , age ( 10 years ) , BMI ( 5 kg/m2 ) , HbA1c level ( 1.5 percentage points ) , and insulin use . Second , for each control participant in the pool , we calculated Mahalanobis distance from the surgical patient on the basis of age , BMI , HbA1c level , diabetes duration , and total days of health care use in the 7 to 24 months before the date of surgery ( 21 ) . Finally , up to 3 control participants were selected on the basis of the shortest Mahalanobis distance . Throughout , nonsurgical patients could be used as a control for only 1 surgical patient ( matching without replacement ) . The Appendix gives additional details on the process we used to establish the matched cohort . Outcome and Censoring Definitions The primary outcome measure was time to incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . Retinopathy was defined by the first appearance of either ICD-9 code 362.0x ( diabetic retinopathy ) or both a retinal surgical procedure code or other retinopathic code ( Appendix Table 2 ) and ICD-9 code 250.5x ( diabetes with ophthalmic manifestations ) . Neuropathy was identified on the basis of the first occurrence of ICD-9 code 250.6 ( diabetes with neurologic manifestations ) or 357.2 ( polyneuropathy in diabetes ) . Finally , nephropathy was defined by at least 2 measures of estimated glomerular filtration rate less than 60 mL/min/1.73 m2 separated by at least 90 days without any intervening values of 60 mL/min/1.73 m2 or greater . We approximated Objective : To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy ( LSG )  as compared to the laparoscopic adjustable gastric b and ( LAGB ) , the laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and the open Roux-en-Y gastric bypass ( ORYGB ) for the treatment of obesity and obesity-related diseases . Background : LSG is a newer procedure being done with increasing frequency . However , limited data are currently available comparing LSG to the other established procedures . We present the first prospect i ve , multiinstitutional , nationwide , clinical ly rich , bariatric-specific data comparing  sleeve gastrectomy to the adjustable gastric b and , and the gastric bypass . Methods : This is the initial report analyzing data from the American College of Surgeons — Bariatric Surgery Center Network accreditation program , and its prospect i ve , longitudinal , data collection system based on st and ardized definitions and collected by trained data review ers . Univariate and multivariate analyses compare 30-day , 6-month , and 1-year outcomes including morbidity and mortality , readmissions , and reoperations as well as reduction in body mass index ( BMI ) and weight-related comorbidities . Results : One hundred nine hospitals su bmi tted data for 28,616 patients , from July , 2007 to September , 2010 . The LSG has higher risk-adjusted morbidity , readmission and reoperation/intervention rates compared to the LAGB , but lower reoperation/intervention rates compared to the LRYGB and ORYGB . There were no differences in mortality . Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB . Conclusion : LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year . As obesity is a lifelong disease , longer term comparative effectiveness data are most critical , and are yet to be determined Introduction Roux-en-Y gastric bypass ( RYGB ) is considered the gold st and ard bariatric procedure with documented safety and effectiveness . Laparoscopic sleeve gastrectomy ( LSG ) is a newer procedure being done with increasing frequency . R and omized comparisons of LSG and other bariatric procedures are limited . We present the results of the first prospect i ve r and omized trial comparing LSG and RYGB in the Polish population . Aim To assess the efficacy and safety of LSG versus RYGB in the treatment of morbid obesity and obesity-related comorbidities . Material and methods Seventy-two morbidly obese patients were r and omized to RYGB ( 36 patients ) or LSG ( 36 patients ) . Both groups were comparable regarding age , gender , body mass index ( BMI ) and comorbidities . The follow-up period was at least 12 months . Baseline and 6 and 12 month outcomes were analyzed including assessment of percent excess weight lost ( % EWL ) , reduction in BMI , morbidity ( minor , major , early and late complications ) , mortality , reoperations , comorbidities and nutritional deficiencies . Results There was no 30-day mortality and no significant difference in major complication rate ( 0 % after RYGB and 8.3 % after LSG , p > 0.05 ) or minor complication rate ( 16.6 % after RYGB and 10.1 % after LSG , p > 0.05 ) . There were no early reoperations after RYGB and 2 after LSG ( 5.5 % ) ( p > 0.05 ) . Weight loss was significant after RYGB and LSG but there was no difference between both groups at 6 and 12 months of follow-up . At 12 months % EWL in RYGB and LSG groups reached 64.2 % and 67.6 % respectively ( p > 0.05 ) . There was no significant difference in the overall prevalence of comorbidities and nutritional deficiencies . Conclusions Both LSG and RYGB produce significant weight loss at 6 and 12 months after surgery . The procedures are equally effective with regard to % EWL , reduction in BMI and amelioration of comorbidities at 6 and 12 months of follow-up . Laparoscopic sleeve gastrectomy and RYGB are comparably safe techniques with no significant differences in minor and major complication rates at 6 and 12 months Background : Approximately 20 - 30 % of obese patients do not achieve successful weight outcomes after bariatric surgery . Objective : We examined whether short-term changes ( ≤0.5 y postsurgery ) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change . Design : Participants were recruited from the Swedish Obese Subjects ( SOS ) study , which was a matched ( nonr and omized ) prospect i ve trial that compared bariatric surgery with usual care for obese patients . A total of 2010 patients who underwent bariatric surgery were included in the study .  Physical examinations ( e.g. , weight ) and question naires ( e.g. , dietary question naire ) were completed before and 0.5 , 1 , 2 , 3 , 4 , 6 , 8 , and 10 y after surgery . For the main analytic strategy , a linear mixed model was implemented , which included repeated measures with a r and om intercept and an unstructured covariance matrix . Results : Short-term changes in energy intake ( P < 0.001 ) and in relative proportions of energy from carbohydrates ( P < 0.001 ) , fat ( P < 0.001 ) , and protein ( P < 0.05 ) were associated with 10-y weight change after bariatric surgery . At the 10-y follow-up , men and women with the largest reductions in energy intake had lost 7.3 % and 3.9 % more weight , respectively , compared with that of subjects with the smallest intake reductions ( P < 0.001 ) . Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition ( P < 0.05 ) . Conclusions : The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss . Weight loss is also associated with a changing dietary macronutrient composition . This trial was registered at clinical trials.gov as NCT01479452 CONTEXT The polycystic ovary syndrome ( PCOS ) is frequently associated with obesity . However , there are very few data about PCOS in morbid obesity , especially with regard to its evolution after bariatric surgery . OBJECTIVE The objective of this study was to evaluate the response of PCOS to the sustained and marked weight loss achieved by  bariatric surgery in morbidly obese women . DESIGN This was a longitudinal prospect i ve nonr and omized evaluation . SETTING S The study was performed at an academic hospital . PATIENTS Thirty-six consecutive premenopausal women su bmi tted to bariatric surgery were screened for PCOS , which was present in 17 . INTERVENTIONS Bariatric surgery was performed . MAIN OUTCOME MEASURES Hyper and rogenism , menstrual function , and insulin resistance were estimated before and at least 6 months after bariatric surgery in 12 patients with PCOS . RESULTS Weight loss ( 41 + /- 9 kg after 12 + /- 5 months ) was paralleled by decreases in the hirsutism score ( from 9.5 + /- 6.8 to 4.9 + /- 4.2 ; P = 0.001 ) , total ( 69 + /- 32 to 42 + /- 19 ng/dl ; P < 0.02 ) and free testosterone ( from 1.6 + /- 0.7 to 0.6 + /- 0.3 ng/dl ; P < 0.005 ) , and rostenedione ( from 4.1 + /- 1.5 to 3.0 + /- 0.9 ng/ml ; P < 0.02 ) , and dehydroepi and rosterone sulfate ( from 2000 + /- 1125 to 1353 + /- 759 ng/ml ; P < 0.005 ) ; amelioration of insulin resistance estimated by homeostasis model assessment ( from 6.0 + /- 3.0 to 1.6 + /- 1.0 ; P < 0.001 ) ; and restoration of regular menstrual cycles and /or ovulation in all patients . CONCLUSIONS The PCOS is a frequent finding in women with morbid obesity and may resolve after weight loss induced by bariatric surgery OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential BACKGROUND Data regarding the management of bariatric patients with cirrhosis are scarce , and there is no strong evidence that supports a specific approach for this group of patients . The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery .  METHODS A prospect ively maintained data base was review ed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery ( unknown cirrhosis ) . RESULTS From April 2004 to September 2011 , 23 patients ( 12 with known cirrhosis and 11 with unknown cirrhosis ) met inclusion criteria . There were 14 females and 9 males with a mean age of 51.5 ± 8.3 and a mean body mass index of 48.2 ± 8.6 kg/m2 . Child-Pugh classes were A ( n = 22 ) and B ( n = 1 ) . Patients had a high frequency of diabetes ( 83 % ) , dyslipidemia ( 61 % ) , and hypertension ( 83 % ) . Procedures performed were laparoscopic Roux-en-Y gastric bypass ( LRYGB ) ( n = 14 ) , laparoscopic sleeve gastrectomy ( LSG ) ( n = 8) , and laparoscopic adjustable gastric b and ing ( n = 1 ) . Two patients underwent LSG successfully after transjugular intrahepatic portosystemic shunt . Mean length of hospital stay was 4.3 ± 2.7 days . Complications developed in 8 patients . One patient died of unknown cause 9 months after surgery . No patients had liver decompensation after surgery . The patients lost 67.4 % ± 30.9 % of their excess weight at 12 months follow-up and 67.7 % ± 24.8 % at 37 months follow-up . CONCLUSION LRYGB and LSG can be performed without prohibitive complication rates in carefully selected patients with cirrhosis . In our experience , bariatric patients with cirrhosis achieved excellent weight loss and improvement in obesity-related co-morbidities Background Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) is currently the gold st and ard bariatric procedure for the treatment of morbid obesity . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively innovative procedure which has been increasingly applied lately as a sole bariatric procedure . A r and omized trial was conducted in a Greek population to evaluate perioperative safety and 3-years results . Methods Sixty patients with body mass index ( BMI ) ≤ 50 Kg/m2 were r and omized to LRYGB or LSG .  Patients were monitored for 3 years postoperatively and throughout the study period weight loss , in terms of percent excess weight loss ( % EWL ) , early and late complications , improvement of obesity related comorbidities and nutritional deficiencies were compared between groups . Results There was no death in either group and there was no significant difference in early ( 10 % after LRYGB and 13 % after LSG , P > 0.05 ) and late morbidity ( 10 % in each group ) . Weight loss was significantly better after LSG in the first years of the study and at 3 years % EWL reached 62 % after LRYGB and 68 % after LSG ( p = 0.13 ) . There was no significant difference in the overall improvement of comorbidities . Nutritional deficiencies occurred at the same rate in the two groups except to vitamin B12 deficiency which was more common after LRYGB ( P = 0.05 ) . Conclusion LSG and LRYGB are equally safe and effective in the amelioration of comorbidities , while LSG is associated with fewer postoperative metabolic deficiencies , without the need of supplementation . Furthermore , LSG is a promising bariatric procedure , equally effective to LRYGB at 3 years follow up on weight reduction Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes BACKGROUND To improve decision making in the treatment of extreme obesity , the risks of bariatric surgical procedures require further characterization . METHODS We performed a prospect i ve , multicenter , observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007 . A composite end point of 30-day major adverse outcomes ( including death ; venous thromboembolism ; percutaneous , endoscopic , or operative reintervention ; and failure to be discharged from the hospital ) was evaluated among patients undergoing first-time bariatric surgery .  RESULTS There were 4776 patients who had a first-time bariatric procedure ( mean age , 44.5 years ; 21.1 % men ; 10.9 % nonwhite ; median body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 46.5 ) . More than half had at least two coexisting conditions . A Roux-en-Y gastric bypass was performed in 3412 patients ( with 87.2 % of the procedures performed laparoscopically ) , and laparoscopic adjustable gastric b and ing was performed in 1198 patients ; 166 patients underwent other procedures and were not included in the analysis . The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing was 0.3 % ; a total of 4.3 % of patients had at least one major adverse outcome . A history of deep-vein thrombosis or pulmonary embolus , a diagnosis of obstructive sleep apnea , and impaired functional status were each independently associated with an increased risk of the composite end point . Extreme values of body-mass index were significantly associated with an increased risk of the composite end point , whereas age , sex , race , ethnic group , and other coexisting conditions were not . CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics . In helping patients make appropriate choices , short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese . ( Clinical Trials.gov number , NCT00433810 . BACKGROUND Obesity is a risk factor for self-reported asthma and makes asthma management more difficult . The effects of bariatric surgery on asthma in severely obese subjects remain to be documented . METHODS In this prospect i ve study , 12 asthmatic patients with severe obesity were evaluated before , 6 and 12 months after bariatric surgery .  Each had methacholine inhalation tests , measures of expiratory flows and lung volumes , measurements of C-reactive protein and question naires on asthma medication , asthma symptoms and co-morbid conditions . Eleven severely obese patients with asthma ( considered as controls ) underwent the same evaluations . Primary endpoint was airway responsiveness to methacholine and secondary endpoints were lung volumes and markers of systemic inflammation . RESULTS Mean body mass index decreased from 51.2 to 34.4 kg/m(2 ) twelve months post-surgery . Mean PC(20 ) methacholine improved from 0.84 to 6.2 mg/ml ( P < 0.001 ) ; FEV(1 ) , FVC , FRC , FRC/TLC and ERV all improved ( P ≤ 0.006 ) . C-reactive protein decreased from 8.6 to 1.7 mg/L ( P < 0.001 ) Asthma symptoms total score was significantly reduced ( P = 0.03 ) and asthma medication needs decreased , ten patients being able to stop all asthma drugs . No significant changes of these parameters from baseline were observed in asthmatic controls . Improvements in airway responsiveness and lung volumes happened in parallel and correlated with reductions of body mass index ( r = 0.58 , P = 0.049 ) , C-reactive protein levels ( r = -0.74 , P = 0.004 ) . CONCLUSION Airway responsiveness , lung volumes and asthma severity/control markedly improved with weight loss following bariatric surgery in severely obese patients Background  Osteopontin ( OPN  ) is a multifunctional matrix glycoprotein associated with bone metabolism and has been linked to chronic inflammation , insulin resistance , and atherosclerosis . Diet-induced weight loss decreases elevated OPN concentrations in obese patients . The aim of the current study was to investigate the role of OPN after bariatric surgery , where not only improvements of chronic inflammation , insulin resistance and comorbidities , but also malabsorption and altered bone metabolism have been reported . Methods OPN plasma concentrations  were determined in 31 morbidly obese patients ( 5 men , 26 women , BMI 46.2 ± 7.1 kg/m2 , age 41 ± 11 years ; mean ± SD ) before and 18 months after bariatric surgery , together with parameters of bone metabolism and inflammation . Results OPN concentrations increased by + 20.3 ± 26.6 ng/ml ( mean ± SD , p < 0.01 ) , concomitant to a weight loss of −38 ± 22 kg , and a decrease in BMI by −13.1 ± 7.7 kg/m2 ( both p < 0.01 ) . HOMA-index improved from 5.2 ± 3.4 to 1.5 ± 1.0 ( p < 0.01 ) . Calcium concentrations slightly decreased , and phosphate increased ( −0.06 ± 0.13 mmol/l and + 0.08 ± 0.16 mmol/l , respectively ; both p < 0.05 ) , while 25-OH-VitaminD3 remained unchanged and PTH tended to increase ( + 5.1 ± 14.0 pg/ml , p = 0.054 ) . Monocyte chemoattractant protein 1 and interleukin 18 were significantly decreased and associated with HOMA both before and after bariatric surgery . ΔOPN was correlated with ΔPTH , but not with other parameters .  Conclusions OPN plasma concentrations increased concomitant to weight loss after bariatric surgery , which was independent from an improvement of insulin sensitivity and a decrease of inflammatory markers . Further studies are needed to differentiate whether these changes in bone metabolism after bariatric surgery are secondary to calcium deficiency or an adaptation to weight loss Background Gastric bypass ( GBP ) is more efficient than adjustable gastric b and ing ( AGB ) on weight loss and comorbidities , but potentially induces more nutritional deficits . However , no study has compared the prevalence of nutritional deficiencies after these two bariatric procedures .We prospect ively comparedTo prospect ively compare the prevalence of nutritional deficiencies after AGB and GBP . Methods We have performed a 1-year prospect i ve study of nutritional parameters in 70 consecutive severe obese patients , who had undergone bariatric surgery , 21 AGB and 49 GBP .  After GBP , multivitamin supplements were systematic ally prescribed and vitamin B12 supplementation was introduced if a deficiency was observed . Results Patients lost more weight after GBP than after AGB ( 40 ± 13 vs 16 ± 8 kg , p < 0.001 ) . Vitamins B1 and C and iron deficiencies were frequent before surgery but were not worsened by GBP . AGB only induced a slight decrease of vitamin B1 at 1 year , whereas GBP induced significant decreases of vitamins B12 and E , serum prealbumin , and creatinine concentrations , with only minor clinical consequences . Anemia was observed in 10 % of the patients after bariatric surgery . Hemoglobin concentration was not correlated to vitamin B12 or folate concentrations but was related to iron status . Risk of iron deficiency anemia was better assessed by transferrin saturation than by serum ferritin concentration in this obese population . ConclusionS evere nutritional deficits can be avoided after bariatric surgery if patients are systematic ally supplemented with multivitamin and carefully monitored . However , specific care is required to avoid iron and vitamin B12 deficiencies , anemia , and protein malnutrition HYPOTHESIS Modest , preoperative weight loss will improve perioperative outcomes among high-risk , morbidly obese patients undergoing Roux-en-Y gastric bypass .  DESIGN A prospect i ve , longitudinal assessment of characteristics and outcomes of gastric bypass patients . SETTING All patients undergoing open or laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity or its comorbid medical problems at Geisinger Medical Center in Danville , Pennsylvania , during a 3-year period from May 31 , 2002 , to February 24 , 2006 , were included in this analysis . Patients were required to participate in a st and ardized multidisciplinary preoperative program that encompasses medical , psychological , nutritional , and surgical interventions and education . In addition , patients were encouraged to achieve a 10 % loss of excess body weight prior to surgical intervention . RESULTS Of the 884 subjects , 425 ( 48 % ) lost more than 10 % of their excess body weight prior to the operation . After surgery ( mean follow-up , 12 months ) , this group was more likely to achieve 70 % loss of excess body weight ( P < .001 ) . Those who lost more than 5 % of excess body weight prior to surgery were statistically less likely to have a length of stay of greater than 4 days ( P = .03 ) . CONCLUSIONS This study shows that high-risk morbidly obese c and i date s for bariatric surgery who are able to achieve a loss of 5 % to 10 % excess body weight prior to surgery have a higher probability of a shorter length of hospital stay and more rapid postoperative weight loss Objectives : Research increasingly suggests that obesity is an exacerbating factor for migraine . However , it is less clear whether weight loss may help to alleviate  migraine in obese individuals . We examined whether weight loss after bariatric surgery is associated with improvements in migraine headaches . Methods : In this prospect i ve observational study , 24 patients who had migraine according to the ID-Migraine screener were assessed before and 6 months after bariatric surgery .  At both time points , patients had their weight measured and reported on frequency of headache days , average headache pain severity , and headache-related disability over the past 90 days via the Migraine Disability Assessment question naire . Changes in headache measures and the relation of weight loss to these changes were assessed using paired- sample t tests and logistic regression , respectively . Results : Patients were mostly female ( 88 % ) , middle-aged ( mean age 39.3 ) , and severely obese ( mean body mass index 46.6 ) at baseline  . Mean ( ±SD ) number of headache days was reduced from 11.1 ± 10.3 preoperatively to 6.7 ± 8.2 postoperatively ( p < 0.05 ) , after a mean percent excess weight loss ( % EWL ) of 49.4 % . The odds of experiencing a ≥50 % reduction in headache days was related to greater % EWL , independent of surgery type ( p < 0.05 ) . Reductions in severity were also observed ( p < 0.05 ) and the number of patients reporting moderate to severe disability decreased from 12 ( 50.0 % ) before surgery to 3 ( 12.5 % ) after surgery ( p < 0.01 ) . Conclusions : Severely obese migraineurs experience marked alleviation of headaches after significant weight reduction via bariatric surgery . Future studies are needed to determine whether more modest , behaviorally produced weight losses can effect similar migraine improvements . Classification of evidence : This study provides Class III evidence that bariatric surgery is associated with reduction of migraine headaches in severely obese individuals Importance Bariatric surgery is a life-changing treatment for patients with severe obesity , but little is known about its association with interpersonal relationships . Objectives To investigate if relationship status is altered after bariatric surgery . Design , Setting , and Participants Changes in relationship status after bariatric surgery were examined in 2 cohorts : ( 1 ) the prospect i ve Swedish Obese Subjects ( SOS ) study , which recruited patients undergoing bariatric surgery from September 1 , 1987 , to January 31 , 2001 , and compared their care with usual nonsurgical care in matched obese control participants ; and ( 2 ) participants from the Sc and inavian Obesity Surgery Registry ( SOReg ) , a prospect i ve , electronically captured register that recruited patients from January 2007 through December 2012 and selected comparator participants from the general population matched on age , sex , and place of residence . Data was collected in surgical departments and primary health care centers in Sweden . The current analysis includes data collected up until July 2015 ( SOS ) and December 2012 ( SOReg ) . Data analysis was completed from June 2016 to December 2017 . Main Outcomes and Measures In the SOS study , information on relationship status was obtained from question naires . In the SOReg and general population cohort , information on marriage and divorce was obtained from the Swedish Total Population Registry . Results The SOS study included 1958 patients who had bariatric surgery ( of whom 1389 [ 70.9 % ] were female ) and 1912 matched obese controls ( of whom 1354 [ 70.8 % ] were female ) and had a median ( range ) follow-up of 10 ( 0.5 - 20 ) years . The SOReg cohort included 29 234 patients who had gastric bypass surgery ( of whom 22 131 [ 75.6 % ] were female ) and 283 748 comparators from the general population ( of whom 214 342 [ 75.5 % ] were female ) , and had a median ( range ) follow-up of 2.9 ( 0.003 - 7.0 ) years . In the SOS study , the surgical patients received gastric b and ing ( n = 368 ; 18.8 % ) , vertical b and ed gastroplasty ( n = 1331 ; 68.0 % ) , or gastric bypass ( n = 259 ; 13.2 % ) ; controls received usual obesity care . In SOReg , all 29 234 surgical participants received gastric bypass surgery . In the SOS study , bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship ( adjusted hazard ratio [ aHR ] = 1.28 ; 95 % CI , 1.03 - 1.60 ; P = .03 ) and increased incidence of marriage or new relationship ( aHR = 2.03 ; 95 % CI , 1.52 - 2.71 ; P < .001 ) in those who were unmarried or single at baseline . In the SOReg and general population cohort , gastric bypass was associated with increased incidence of divorce compared with married control participants ( aHR = 1.41 ; 95 % CI , 1.33 - 1.49 ; P < .001 ) and increased incidence of marriage in those who were unmarried at baseline ( aHR = 1.35 ; 95 % CI , 1.28 - 1.42 ; P < .001 ) . Within the surgery groups , changes in relationship status were more common in those with larger weight loss . Conclusions and Relevance In addition to its association with obesity comorbidities , bariatric surgery – induced weight loss is also associated with changes in relationship status Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 ( or 35 with co morbidities ) . A minority of patients , however , either do not show the desired loss of excess weight or show weight regain by follow up . Research highlights some of the reasons for this variability , most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body , psychological issues relating to dietary control , self esteem , coping and emotional eating remain neglected . The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service ( BRS ) on patient health outcomes . The bariatric rehabilitation service will provide information , support and mentoring pre and post surgery and will address psychological issues such as dietary control , self esteem , coping and emotional eating . The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes . Methods / Design The study is a r and omised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery . Follow up measures of weight loss and psychological issues will be taken at baseline ( 2 weeks preoperatively ) , 3 , 6 and 12 months postoperatively . The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups ( BOSPA & WLSinfo ) . This study will take place in St Richard 's Hospital in Chichester in the UK . Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life , dietary control , self esteem , coping and emotional eating . This also has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term . Trial registration Clinical Trials.gov NCT01264120 Background Obesity is considered a low- grade chronic inflammatory condition as reflected by increased C-reactive protein ( CRP ) levels . Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome . Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infa rct ion . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss . The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels . Methods This study is part of an ongoing , prospect i ve , cohort study to evaluate LSG impact on iron indices . CRP levels were compared preoperatively and 6 months after surgery . Similarly , demographics including body mass index and excess weight were also compared at these same study points . Data were analyzed using Student paired t test and Pearson product moment correlation analysis . Results Twenty-nine morbidly obese patients were included . There was significant decrease in body mass index ( BMI ) between the preoperative and 6-month period ( 50.9 ± 13.2 and 35.1 ± 6.85 , respectively ; P < 0.001 ) . Also CRP levels were statistically significantly lower at 6 months after surgery ( preoperative 12.3 ± 7.53 mg/L and postoperative 5.6 ± 4.2 mg/L. P < 0.0001 ) . The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels . Conclusions Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels , which could reduce the risk of cardiovascular diseases in these patients OBJECTIVE The aim of this investigation was to assess the effect of malabsorptive bariatric surgery ( BS ) on the quality of life ( QoL ) , applying the Nottingham Health Profile ( NHP ) and the bariatric analysis and reporting outcome system ( BAROS ) . DESIGN A prospect i ve cohort study was performed in 100 adult patients ( > 18 years ) undergoing bariatric surgery by malabsorptive technique for one year . RESEARCH METHODS AND PROCEDURES Patients were monitored from the beginning of the BS program until a year after the intervention , applying the NHP and the BAROS test . At baseline , the mean weight of the women was 132 ± 22 kg and the Body Mass Index ( BMI ) was 50.7 kg/m² . RESULTS The values obtained from different areas applying the NHP question naire showed statistical significant differences ( p < 0.001 ) with respect to baseline values . According to the BAROS test , 48 % of patients lost 25 - 49 % of weight excess and 80.8 % had resolved major comorbidities at 1 yr . According to the Moorehead-Ardelt QoL score , there were major improvements in employment and self-esteem in 89 % and 87 % of patients , respectively , and improvements in physical activity , sexual and social relationships . According to the total mean BAROS score , the outcome was considered " very good " . CONCLUSION NHP and BAROS question naires appear to be useful and easily applicable tools to assess the QoL of obese patients Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a body mass index of 30 kg/m2 to 35 kg/m2 ; had identifiable problems , including an obesity-related comorbid condition ( such as hypertension , dyslipidemia , diabetes , obstructive sleep apnea , or gastroesophageal reflux disease ) , severe physical limitations , or clinical ly significant psychosocial problems associated with their obesity ; had attempted to reduce weight over at least the previous 5 years ; could underst and the options offered and the r and omization process ; and were willing to comply with the requirements of each program . Exclusion Criteria We excluded c and i date s with a history of bariatric surgery or medical problems that contraindicated treatment in either study group , such as impaired mental status , drug or alcohol addiction , or portal hypertension . In addition , we excluded participants if they had undergone an intensive , physician-supervised program that used very-low-calorie diets or pharmacotherapy or if they did not attend the 2 initial patient information visits . Assessment We provided detailed information about the problems of obesity and about the 2 study groups through at least 2 discussion periods and a patient information booklet . Initial assessment included anthropometric measures ; identification of medical , physical , or psychosocial problems ( both weight-related and other ) ; and a discussion of previous weight loss efforts . The assessment included a detailed dietary history by the trial dietitian and a review by a specialist physician to determine the presence and severity of associated medical conditions . Initial investigations included measurements of fasting blood glucose level ; serum insulin level ; and a lipid profile , including HDL cholesterol and LDL cholesterol levels . After initial assessment , we instituted a program of advice on appropriate eating patterns and exercise and followed each patient on a monthly basis for 3 months . During this time , we assessed the patients ' fulfillment of tasks , such as completion of a food diary , and overall adherence to appointments . R and omization Process We r and omly allocated eligible patients to receive a conventional , intensive , nonsurgical program or laparoscopic adjustable gastric b and ing .  A computer-derived r and om allocation sequence , without blocking or stratification , performed the r and omization . This was prepared at the trial office . The trial coordinator enrolled participants and informed them of the trial allocation . After assessment had confirmed a participant 's suitability for r and omization , the coordinator contacted the trial office by telephone for allocation . The study was not blinded . Description of Nonsurgical and Surgical Interventions Common Program We instructed and encouraged all patients to follow appropriate lifestyle behavior of good eating practice s and increased exercise and activity . We also encouraged them to exercise for at least 200 minutes per week . Nonsurgical Program This program centered on the use of behavioral modification , very-low-calorie diet , and pharmacotherapy with education and professional support on appropriate eating and exercise behavior . During the 2-year period , 3 trained physicians developed a program using all the available modalities for each individual on the basis of guidelines prepared and continually review ed by a panel of experienced bariatric physicians . The program began with an intensive 6-month period of very-low-calorie diet ( 500 to 550 kcal/d ) using 1 to 3 packets of Optifast ( Novartis , Fremont , Michigan ) daily for 12 weeks , followed by a transition phase over 4 weeks combining some very-low-calorie meals with 120 mg of orlistat before nonvery-low-calorie diet meals , and then 120 mg of orlistat before all meals until the completion of the intensive phase . This intensive 6-month program was followed by further courses of very-low-calorie diets or orlistat as tolerated , as well as continual behavioral , dietary , and exercise advice to assist the participant in maintaining weight loss over a prolonged period . Sibutramine was not approved for use in Australia during the first 12 months of the study and , therefore , was not incorporated into the medical program . The management program for each individual was design ed to reflect good clinical practice . A physician saw each patient every 2 weeks during the very-low-calorie diet program and every 4 to 6 weeks during the rest of the study . All patients were seen at least every 6 weeks . Surgical Program Two experienced surgeons performed the laparoscopic adjustable gastric b and ( LAP-B AND System ) procedure , by a st and ardized method ( 14 ) , within 1 month of r and omization . The b and was placed along the perigastric pathway in all cases ( 16 ) . The treating surgeon review ed patient progress every 4 to 6 weeks during the study period and made adjustments to the volume of saline within the b and in the office by using st and ard clinical criteria ( 17 ) . Adverse Events All patients in the study were question ed about the occurrence of adverse events at each consultation , and physicians recorded the Background Many insurance payors m and ate that bariatric surgery c and i date s undergo a medically supervised weight management ( MSWM ) program as a prerequisite for surgery . However , there is little evidence to support this requirement . We evaluated in a r and omized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric b and ing ( LAGB ) in a publicly insured population . Methods This pilot r and omized trial was conducted in a large academic urban public hospital . Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a m and atory 6-month MSWM program  were r and omized to a MSWM program with monthly visits over 6 months ( individual or group ) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively . Demographics , weight , and patient behavior scores , including patient adherence , eating behavior , patient activation , and physical activity , were collected at baseline and at 6 months ( immediately preoperatively and postoperatively ) . Results A total of 55 patients were enrolled in the study with complete follow-up on 23 patients . Participants r and omized to a MSWM program attended an average of 2 sessions preoperatively . The majority of participants were female and non-Caucasian , mean age was 46 years , average income was less than $ 20,000/year , and most had Medicaid as their primary insurer , consistent with the demographics of the hospital ’s bariatric surgery program . Data analysis included both intention-to-treat and completers ’ analyses . No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively , suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB . Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively . Conclusion MSWM does not appear to confer additional benefit as compared to the st and ard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population Objective : To assess different factors influencing adiponectinemia in obese and normal-weight women ; to identify factors associated with the variation ( Δ ) in adiponectinemia in obese women following a 6-month weight loss program  , according to surgical/non-surgical interventions . Methods : We studied 100 normal-weight women and 112 obese premenopausal women ; none of them was on any medical treatment . Women were characterized for anthropometrics , daily macronutrient intake , smoking status , contraceptives use , adiponectin as well as IL-6 and TNF-α serum concentrations . Results : Adiponectinemia was lower in obese women ( p < 0.001 ) , revealing an inverse association with waist-to-hip ratio ( p < 0.001 ; r = -0.335 ) . Normal-weight women presented lower adiponectinemia among smokers ( p = 0.041 ) ; body fat , waist-to-hip ratio , TNF-α levels , carbohydrate intake , and smoking all influence adiponectinemia ( r2 = 0.436 ) . After weight loss interventions , a significant modification in macronutrient intake occurs followed by anthropometrics decrease ( chiefly after bariatric procedures ) and adiponectinemia increase ( similar after surgical and non-surgical interventions ) . After bariatric intervention , Δ adiponectinemia was inversely correlated to Δ waist circumference and Δ carbohydrate intake ( r2 = 0.706 ) . Conclusion : Anthropometrics , diet , smoking , and TNF-α levels all influence adiponectinemia in normal-weight women , although explaining less than 50 % of it . In obese women , anthropometrics modestly explain adiponectinemia . Opposite to non-surgical interventions , after bariatric  surgery adiponectinemia increase is largely explained by diet composition and anthropometric changes OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors BACKGROUND Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed . OBJECTIVE To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period . SETTING Bariatric Center of Excellence at a large , urban medical center . METHODS C and i date s for bariatric surgery were r and omized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care . The lifestyle intervention consisted of 8 weekly face-to-face sessions , followed by 16 weeks of face-to-face and telephone sessions before surgery ; the intervention also included 3 monthly telephone contacts after surgery . Assessment s were conducted 6 , 12 , and 24 months after surgery . RESULTS Participants who underwent surgery ( n = 143 ) were 90.2 % female and 86.7 % White . Average age was 44.9 years , and average body mass index was 47.5 kg/m(2 ) at study enrollment . At follow-up , 131 ( 91.6 % ) , 126 ( 88.1 % ) , 117 ( 81.8 % ) patients participated in the 6- , 12- , and 24-month assessment s , respectively . Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups , but at 24 months after surgery , the lifestyle group had significantly smaller percent weight loss compared with the usual care group ( 26.5 % versus 29.5 % , respectively , P = .02 ) . CONCLUSIONS Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery . The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients Background : Morbid obesity requires life-long treatment , and bariatric surgery provides the best results . Among the bariatric procedures , laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) has been considered to be superior . However , it requires advanced laparoscopic skills and a learning curve . We analyzed our results in an initial series of 100 patients . Methods : Data of 100 consecutive patients who underwent LRYGBP for morbid obesity in a 2.5-year period were prospect ively collected and analyzed with emphasis on results and complications . Results : Mean age was 31±5 years . There were 63 woman and 37 men . Preoperative BMI was 50±9 kg/m2 . 33 patients were considered super-obese ( BMI > 50 )  . Mean operative time was 3.8 ± 0.7 hours . Two patients required conversion to open surgery . Mean hospital stay was 6 days . Complications occurred in 10 patients . Mortality rate was 2 % . Excess body weight loss was as follows : 33 ± 8 % at 3 months ( n=92 ) , 47 ± 2 % at 6 months ( n=82 ) , 62 ± 4 % at 1 year ( n= 70 ) , 66 ± 5 % at 18 months ( n= 63 ) and 67 ± 8 % at 2 years ( n= 35 ) . There was significant improvement in several co-morbid conditions , such as diabetes and hypertension . Conclusion : LRYGBP is a reproducible technique . It requires the combination of bariatric and laparoscopic expertise INTRODUCTION The South Pacific has a high prevalence of obesity and super-obesity . We review ed our experience with laparoscopic sleeve gastrectomy ( LSG ) to evaluate its efficacy and safety . METHODS A retrospective review of a prospect ively collected data base of LSGs carried out by one surgeon in one center . The percentage of excess weight loss and the rate of resolution or improvement of comorbidities reflected efficacy , and major complications or mortalities reflected safety . RESULTS From January 2008 to February 2013 , we performed 510 surgeries and included 494 consecutive patients ( 367 females ) ( 45.5 ± 11.2 years ) in our study .  LSG was the primary procedure in 384 patients , 6 patients had redo bariatric surgery after failure of initial LSG , 57 patients had a history of gastric b and ing with insufficient weight loss or b and -related complications , and 46 super-obese patients had an intragastric balloon placed before LSG . Average starting body mass index was 47.8 kg m(-2 ) . Mean percent excess weight loss was 64.3 % at 1 year ; 67.3 % at 2 years and 66.4 % at 3 years . The percentages of resolved comorbidities were as follows : hypertension : 48.3 % , type 2 diabetes mellitus : 72.5 % , dyslipidemia : 61.0 % , and obstructive sleep apnea : 77.8 % . The mortality rate was 1/494 . The postoperative morbidity included gastric fistula in 3.0 % , hemorrhaging in 2.4 % , and postoperative gastroesophageal reflux in 9.4 % . CONCLUSIONS In the South Pacific , LSG is a safe and effective means of treating morbid obesity with sustained weight loss and resolution of comorbid medical conditions BACKGROUND Surgery remains the most effective intervention for obesity and its comorbidities . However , the long-term efficacy of bariatric procedures is rarely reported . This study addresses operative trends , efficiency , and long-term outcomes from a large bariatric program . STUDY DESIGN Data were prospect ively collected on 3,460 patients undergoing 3,503 operations from January 2004 to March 2013 . Primary procedures included  Roux-en-Y gastric bypass  ( RY ; n = 2,966 ) , adjustable b and ( AB ; n = 352 ) , and sleeve gastrectomy ( SG ; n = 118 ) . There were 67 revisional procedures ( RP ) . Mean operative time , hospital length of stay , major 30-day morbidity/mortality , follow-up compliance , and weight loss per procedure at follow-up were recorded . RESULTS Mean operative times decreased to the following : RY , 53 minutes ; AB , 35 minutes ; SG , 46 minutes ; and RP , 71 minutes . Mean length of stay was reduced to the following : RY , 1.53 days ; AB , 0.97 days ; SG , 2.12 days ; and RP , 2.68 days . Major complications were mortality , 0.09 % ; leak , 0.51 % ; bleed , 2.37 % ; pneumonia , 0.63 % ; venous thromboembolism , 0.40 % ; and reoperation , 2.34 % . The complication rate was lowest for AB and highest for SG ( p < 0.05 ) . Adjustable b and was the initial procedure in 73 % of cases requiring RP . Follow-up compliance was 93 % at 1 year , 79 % at 3 years , 71 % at 5 years , and 33 % at 9 years . Adjustable b and offered significant weight loss at 1 and 3 years ( p < 0.0001 ) , but less than RY or SG ( p < 0.0001 ) . Excess weight loss was not significantly different between RY and SG at 1 year . Significant weight loss with RY persisted at 7 to 9 years ( p < 0.0001 ) . CONCLUSIONS Our bariatric program experienced an increase in SG and RP and a decrease in AB . Optimization of care reduced operative time and length of stay . All procedures achieved significant weight loss in the first year . Adjusted b and had the lowest morbidity , but inferior weight loss and greater need for revision . Long-term weight-loss data are only available for RY OBJECTIVE Bariatric surgery reverses obesity-related comorbidities , including type 2 diabetes mellitus . Several studies have already described differences in anthropometrics and body composition in patients undergoing Roux-en-Y gastric bypass compared with laparoscopic adjustable gastric b and ing  , but the role of adipokines in the outcomes after the different types of surgery is not known . Differences in weight loss and reversal of insulin resistance exist between the 2 groups and correlate with changes in adipokines . METHODS Fifteen severely obese women ( mean body mass index [ BMI ] : 46.7 kg/m(2 ) ) underwent 2 types of laparoscopic weight loss surgery ( Roux-en-Y gastric bypass=10 , adjustable gastric b and ing=5 ) .  Weight , waist and hip circumference , body composition , plasma metabolic markers , and lipids were measured at set intervals during a 24-month period after surgery . RESULTS At 24 months , patients who underwent Roux-en-Y were overweight ( BMI 29.7 kg/m(2 ) ) , whereas patients who underwent gastric b and ing remained obese ( BMI 36.3 kg/m(2 ) ) . Patients who underwent Roux-en-Y lost significantly more fat mass than patients who underwent gastric b and ing ( mean difference 16.8 kg , P<.05 ) . Likewise , leptin levels were lower in the patients who underwent Roux-en-Y ( P=.003 ) , and levels correlated with weight loss , loss of fat mass , insulin levels , and Homeostasis Model of Assessment 2 . Adiponectin correlated with insulin levels and Homeostasis Model of Assessment 2 ( r=-0.653 , P=.04 and r=-0.674 , P=.032 , respectively ) in the patients who underwent Roux-en-Y at 24 months . CONCLUSION After 2 years , weight loss and normalization of metabolic parameters were less pronounced in patients who underwent gastric b and ing  compared with patients who underwent Roux-en-Y gastric bypass . Our findings require confirmation in a prospect i ve r and omized trial OBJECTIVES : To document the attitudes and practice s of French general practitioners ( GPs ) regarding  obesity management .  RESEARCH METHODS AND PROCEDURES : A cross-sectional survey of a r and omly selected sample of 744 French GPs was conducted , of which 607 question naires were returned . The measures included views on weight management , definitions of success , approaches to and strategies recommended for weight management and prevention , problems , frustrations , and expectations in managing obesity . RESULTS : GPs have a high awareness of obesity as a medically relevant issue , with 90 % of them considering it to be a disease . However , they are only 42 % to consider themselves well prepared to manage obesity and 51 % to find obesity management professionally rewarding . They are 66 % to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals , with only 20 % of them considering weight maintenance as a success . They do not consider collaboration with other health professionals like dietitians as a priority . Only 34 % of the GPs believe that the currently available drugs are effective . Their views regarding bariatric surgery are in agreement with the recommendations of international experts . Their main expectations regarding obesity management are to improve their professional intervention through formation , education and easy-to-use tools , rather than improving their collaboration with other health professionals . DISCUSSION : There remains considerable opportunity to improve GPs ' practice in obesity management . Medical education , increased cooperation with dietitians , improved long-term follow-up , and implementing better use of the available documents are key issues Background Bariatric surgery leads to several anatomo-physiological modifications that may affect pharmacokinetic parameters and consequently alter the therapeutic effect of drugs , such as antibiotics . The pharmacokinetics of oral amoxicillin after Roux-en-Y gastric bypass ( RYGB ) surgery is unknown . Objectives The objective of this study was to evaluate the impact of bariatric surgery on the pharmacokinetics of  amoxicillin . Methods This study was performed as a r and omized , open-label , single-dose clinical trial , with two periods of treatment , in which obese subjects ( n = 8) received an amoxicillin 500 mg capsule orally before and 2 months after the RYGB surgery . The  amoxicillin plasma concentration was determined by liquid chromatography coupled to mass spectrometry ( LC-MS/MS ) . Results After the surgery , the mean weight loss was 17.03 ± 5.51 kg , and mean body mass index ( BMI ) decreased from 46.21 ± 2.82 to 38.82 ± 3.32 kg/m2 . The mean amoxicillin area under the plasma concentration versus time curve from time zero to the time of the last quantifiable concentration ( AUC0–tlast ) increased significantly ( 3.5-fold ) ; the maximum plasma concentration ( Cmax ) increased 2.8-fold after the bariatric surgery . No correlation was found between amoxicillin absorption , BMI , and weight loss percentage . Conclusion The alterations observed in the amoxicillin pharmacokinetics suggest that obese subjects included in this trial had a substantially increase in amoxicillin systemic exposure after RYGB surgery . However , despite this increase , its exposure was lower than the values reported for non-obese volunteers . Trial Registration Identifiers : BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure OBJECTIVE It is of vital importance to eluci date the triggering factors of obesity and type 2 diabetes to improve patient care . Bariatric surgery has been shown to prevent and even cure diabetes , but the mechanism is unknown . Elevated levels of lipopolysaccharide ( LPS ) predict incident diabetes , but the sources of LPS are not clarified . The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery .  RESEARCH DESIGN AND METHODS This was a prospect i ve observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls .  Main assessment s were plasma LPS , HbA1c , adipose tissue volumes ( computed tomography ) , and quantified bacterial DNA in adipose tissue compartments . RESULTS Plasma levels of LPS were elevated in obese individuals compared with controls ( P < 0.001 ) and were reduced after bariatric surgery ( P = 0.010 ) . LPS levels were closely correlated with HbA1c ( r = 0.56 ; P = 0.001 ) and intra-abdominal fat volumes ( r = 0.61 ; P < 0.001 ) , but only moderately correlated with subcutaneous fat volumes ( r = 0.33 ; P = 0.038 ) . Moreover , there was a decreasing gradient ( twofold ) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments ( P = 0.041 ) . Finally , reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c ( r = 0.85 ; P < 0.001 ) . CONCLUSIONS Our findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes , and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to , and even the result of , a reduction in plasma levels of LPS BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson Objective Few studies have examined brain changes in response to effective weight loss ; none have compared different methods of weight-loss intervention . We compared functional brain changes associated with a behavioral weight loss intervention to those associated with bariatric surgery . Methods 15 obese participants were recruited prior to adjustable gastric b and ing surgery and 16 obese participants were recruited prior to a behavioral diet intervention .  Groups were matched for demographics and amount of weight lost . fMRI scans ( visual food motivation paradigm while hungry and following a meal ) were conducted before , and 12 weeks after surgery/behavioral intervention . Results When compared to bariatric patients in the pre-meal analyses , behavioral dieters showed increased activation to food images in right medial PFC and left precuneus following weight loss . When compared to behavioral dieters , bariatric patients showed increased activation in in bilateral temporal cortex following the weight loss . Conclusions Behavioral dieters showed increased responses to food cues in medial PFC – a region associated with valuation and processing of self-referent information – when compared to bariatric patients . Bariatric patients showed increased responses to food cues in brain regions associated with higher level perception — when compared to behavioral dieters . The method of weight loss determines unique changes in brain function BACKGROUND Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery Objective To compare two bariatric surgical principles with regard to effects on blood pressure and salt intake . Background In most patients bariatric surgery induces a sustained weight loss and a reduced cardiovascular risk profile but the long-term effect on blood pressure is uncertain . Methods Cohort study with data from the prospect i ve , controlled Swedish Obese Subjects ( SOS ) study involving 480 primary health care centres and 25 surgical departments in Sweden . Obese patients treated with non-surgical methods ( Controls , n = 1636 and n = 1132 at 2 y and 10 y follow up , respectively ) were compared to patients treated with gastric bypass ( GBP , n = 245 and n = 277 , respectively ) or purely restrictive procedures ( vertical b and ed gastroplasty or gastric b and ing ;  VBG/B , n = 1534 and n = 1064 , respectively ) . Results At long-term follow-up ( median 10 y ) GBP was associated with lowered systolic ( mean : −5.1 mm Hg ) and diastolic pressure ( −5.6 mmHg ) differing significantly from both VBG/B ( −1.5 and −2.1 mmHg , respectively ; p<0.001 ) and Controls ( + 1.2 and −3.8 mmHg , respectively ; p<0.01 ) . Diurnal urinary output was + 100 ml ( P<0.05 ) and + 170 ml ( P<0.001 ) higher in GBP subjects than in weight-loss matched VBG/B subjects at the 2 y and 10 y follow-ups , respectively . Urinary output was linearly associated with blood pressure only after GBP and these patients consumed approximately 1 g salt per day more at the follow-ups than did VBG/B ( P<0.01 ) . Conclusions The purely restrictive techniques VBG/B exerted a transient blood pressure lowering effect , whereas gastric bypass was associated with a sustained blood pressure reduction and an increased diuresis . The daily salt consumption was higher after gastric bypass than after restrictive bariatric surgery
Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .