Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year The By-Band study: gastric bypass or adjustable gastric band surgery to treat morbid obesity: study protocol for a multi-centre randomised controlled trial with an internal pilot phase The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial Prevalence of Sleep Apnea in Morbidly Obese Patients who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apnea before Weight Loss Surgery Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Consequences of Small Intestinal Bacterial Overgrowth in Obese Patients Before and After Bariatric Surgery BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. A randomised control trial assessing the impact of an investment based intervention on weight-loss, beliefs and behaviour after bariatric surgery: study protocol Laparoscopic adjustable gastric banding for patients with body mass index of <or=35 kg/m2. Effects of bariatric surgery on mortality in Swedish obese subjects. Two-year changes in generic and obesity-specific quality of life after gastric bypass The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Effect of Weight Loss on Aerobic Capacity in Patients with Severe Obesity Before and After Bariatric Surgery Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial.
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 The prevalence of severe and complex obesity is increasing worldwide and surgery may offer an effective and lasting treatment . Laparoscopic adjustable gastric b and and Roux-en-Y gastric bypass surgery are the two main surgical procedures performed . Design This open parallel-group r and omised controlled trial will compare the effectiveness , cost-effectiveness and acceptability of gastric b and ( B and ) versus gastric bypass ( Bypass ) in adults with severe and complex obesity . It has an internal pilot phase ( in two centres ) with integrated qualitative research to establish effective and optimal methods for recruitment . Adults with a body mass index ( BMI ) of 40 kg/m2 or more , or a BMI of 35 kg/m2 or more and other co-morbidities will be recruited . At the end of the internal pilot the study will exp and into more centres if the pre-set progression criteria of numbers and rates of eligible patients screened and r and omised are met and if the expected rates of retention and adherence to treatment allocation are achieved . The trial will test the joint hypotheses that Bypass is non-inferior to B and with respect to more than 50 % excess weight loss and that Bypass is superior to B and with respect to health related quality of life ( HRQOL , EQ-5D ) at three years . Secondary outcomes include other weight loss measures , waist circumference and remission/resolution of co-morbidities ; generic and symptom-specific HRQOL ; nutritional blood test results ; re source use ; eating behaviours and adverse events . A core outcome set for reporting the results of obesity surgery will be developed and a systematic review of the evidence for sleeve gastrectomy undertaken to inform the main study design . Discussion By-B and is the first pragmatic study to compare the two most commonly performed bariatric surgical procedures for severe and complex obesity . The design will enable and empower surgeons to learn to recruit and participate in a r and omised study . Early evidence shows that timely recruitment is possible . Trial registration Current Controlled Trials IS RCT N00786323 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 Background Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term . The objective of this paper is to determine the long-term ( 10 years ) outcome for patients from a r and omised controlled trial ( RCT ) . Methods A RCT in 2002 compared laparoscopic adjustable gastric b and ( LAGB ) for obesity  with non-surgical therapy . Follow-up has been conducted at 10 years . Eighty patients ( BMI 30–35 ) were r and omised to a non-surgical or a surgical program .  Outcome data are available on 37 ( 92.5 % ) of the surgical patients and 27 ( 62.5 % ) of the non-surgical patients at 10 years . Results Weight change , the metabolic syndrome , quality of life , adverse events and direct costs of the surgical cohort were the main results of the study . A durable weight loss is present in the surgical group with a mean ( SD ) 10-year weight loss of 14.1 ( 7.7 ) kg ( 63.4 % EWL ) , better than the non-surgical group ( mean ( SD ) = 0.4 ( 10.5 ) kg ; p < 0.001 ) . The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups . Proximal gastric enlargements occurred in 17 ( 30 % ) of the 57 who had LAGB and removal of the b and occurred in 7 ( 12 % ) . The annual maintenance costs including additional surgery was AUD $ 765 per patient per year . Conclusions Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy . There is also a sustained reduction of the metabolic syndrome . There is a significant maintenance requirement after LAGB The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery . This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases . Obstructive sleep apnea ( OSA ) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery . The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent . A retrospective review of our prospect ively collected data base was performed . All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study . The  overall incidence of sleep apnea in our patients was 78 per cent ( 227 of 290 ) . All 227 were diagnosed by formal sleep study . There were 63 ( 22 % ) males and 227 ( 78 % ) females . The mean age was 43 years ( range , 17–75 years ) . The mean body mass index ( BMI ) was 52 kg/m2 ( range , 31–94 kg/m2 ) . The prevalence of OSA in the severely obese group ( BMI 35–39.9 kg/m2 ) was 71 per cent . For the morbidly obese group ( BMI 40–40.9 kg/m2 ) , the prevalence was 74 per cent and for the superobese group ( BMI 50–59.9 kg/m2 ) 77 per cent . Those with a BMI 60 kg/m2 or greater , the prevalence of OSA rose to 95 per cent . The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study . Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery STUDY OBJECTIVES To evaluate the effect of bariatric surgery on  sleep apnea symptoms and obesity-associated morbidity  in patients with severe obesity . DESIGN Prospect i ve study . SETTING University hospitals and community centers in Sweden . INTERVENTION We investigated the influence of  weight loss surgery ( n=1729 ) on  sleep apnea symptoms and obesity-related morbidity using a  conservatively treated group ( n=1748 ) as a control . MEASUREMENTS AND RESULTS Baseline BMI in surgical group ( 42.2+/-4.4 kg/m(2 ) ) and control group ( 40.1+/-4.6 kg/m(2 ) ) changed -9.7+/-5 kg/m(2 ) and 0+/-3 kg/m(2 ) , respectively , at 2-year follow-up . In the surgery group , there was a marked improvement in all obstructive sleep apnea ( OSA ) symptoms compared with the control group ( P < 0.001 ) . Persistence of snoring ( 21.6 vs 65.5 % , adjusted OR 0.14 , 95 % CI 0.10 - 0.19 ) and apnea ( 27.9 vs 71.3 % , adjusted OR 0.16 , 95 % I 0.10 - 0.23 ) were much less in the surgery group compared with controls . Compared with subjects with no observed apnea at follow-up ( n=2453 ) , subjects who continued to have or developed observed apnea ( n=404 ) had a higher incidence of diabetes ( adjusted OR 2.03 , 95 % CI 1.19 - 3.47 ) and hypertriglyceridemia ( adjusted OR 1.86 , 95 % CI 1.07 - 3.25 ) but not hypertension ( adjusted OR 1.09 , 95 % CI 0.65 - 1.83 ) or hypercholesterolemia ( adjusted OR 0.91 , 95 % CI 0.53 - 1.58 ) . CONCLUSION Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years . Despite adjustment for weight change and baseline central obesity , subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia . Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone OBJECTIVE Severe obesity ( body mass index [ BMI ] ≥40 kg/m(2 ) ) is a serious public health concern . Although bariatric surgery is an efficacious treatment approach , it is limited in reach ; thus , nonsurgical treatment alternatives are needed . We examined the 4-year effects of an intensive lifestyle intervention  on body weight and cardiovascular disease risk factors among severely obese , compared with overweight ( 25 ≤ BMI < 30 ) , class I ( 30 ≤ BMI < 35 ) , and class II obese ( 35 ≤ BMI < 40 ) participants . METHODS There were 5145 individuals with type 2 diabetes ( 45 - 76 years , BMI ≥25 kg/m(2 ) ) r and omized to an intensive lifestyle intervention or diabetes support and education .  The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings , a ≥10 % weight loss goal , calorie restriction , and increased physical activity . Diabetes support and education received a less intense educational intervention . Four-year changes in body weight and cardiovascular disease risk factors were assessed . RESULTS Across BMI categories , 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( Ps < .05 ) . At year 4 , severely obese lifestyle participants lost 4.9%±8.5 % , which was similar to class I ( 4.8%±7.2 % ) and class II obese participants ( 4.4%±7.6 % ) , and significantly greater than overweight participants ( 3.4%±7.0 % ; P < .05 ) . Four-year changes in low-density-lipoprotein cholesterol , triglycerides , diastolic blood pressure , HbA(1c ) , and blood glucose were similar across BMI categories in lifestyle participants ; however , the severely obese had less favorable improvements in high-density-lipoprotein cholesterol ( 3.1±0.4 mg/dL ) and systolic blood pressure ( -1.4±0.7 mm Hg ) compared with the less obese ( Ps < .05 ) . CONCLUSION Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals 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 Roux-en-Ygastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation . A systematic review revealed a similar excess weight loss ( EWL ) 2 years postoperatively between SG and RYGB . However , there is a lack of r and omized controlled multi-centre trials comparing SG and RYGB , not only concerning EWL , but also in terms of remission of obesity-related co-morbidities , gastroesophageal reflux disease ( GERD ) and quality of life ( QoL ) in the mid- and long-term . Methods The BariSurg trial was design ed as a multi-centre , r and omized controlled patient and observer blind trial . The trial protocol was approved by the corresponding ethics committees of the centres . To demonstrate EWL non-inferiority of SG compared to RYGB , power calculation was performed according to a non-inferiority study design . Morbidity , mortality , remission of obesity-related co-morbidities , GERD course and QoL are major secondary endpoints . 248 patients between 18 and 70 years , with a body mass index ( BMI ) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3- guidelines will be r and omized . The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6 , 12 , 24 , 36 , 48 and 60 months postoperatively . Discussion With its five year follow-up , the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL , remission of obesity-related co-morbidities , the course of GERD and QoL.Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004766 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 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 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 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 Background Although obesity surgery is currently the most effective method for achieving weight loss , not all patients lose the desired amount of weight and some show weight regain . Previous research shows that successful weight loss may be associated with the amount of investment the patient feels that they have made in their operation . For example , those who feel that it has taken more time and effort to organise , has cost more money , has been more disruptive to their lives and has caused pain are more likely to lose weight after their operation . Therefore , it seems as if the greater the sense of investment , the greater the motivation to make the operation a success . The present study aims to build on these findings by encouraging weight loss surgery patients to focus on the investment they have made , thus making their investment more salient to them and a means to improve weight loss outcomes . Methods The study involves an open r and omised parallel group control trial with patients allocated either to the control or investment intervention group . Using third party blinded r and omization , half the patients will be asked to rate and describe the investment they have made in their operation just before surgery then 3 and 6 months after surgery . All patients will record their weight , beliefs about food , intentions to change and actual eating and exercise behaviour at baseline then 3 , 6 and 12 months follow up . Patients will be recruited from the bariatric surgery pre- assessment clinic at University College Hospital , London . The primary outcome is to explore the impact of the investment based intervention on patient ’s weight and BMI , with secondary outcomes of patients ’ beliefs about foods , behavioural intentions and diet and exercise behaviours . Discussion It is predicted that the investment intervention will improve excess weight loss post-surgery , together with beliefs about food , intentions to change and actual change in diet and exercise behaviour . This 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 and this simple , easy to administer and low cost intervention could become routine practice for bariatric patients .Trial registration Clinical Trials.gov identifier NCT02045628 ; December 2 , 2013 BACKGROUND Many mild-to-moderately obese individuals ( body mass index [ BMI ] 30 - 35 kg/m(2 ) ) have serious diseases related to their obesity . Nonoperative therapy is ineffective in the long term , yet surgery has never been made widely available to this population . METHODS Between 1996 and 2004 , 93 patients with a BMI of 30 - 35 kg/m(2 ) underwent laparoscopic adjustable gastric b and ing with the LAP-B AND . All patients were referred by their primary physician , entered into a comprehensive bariatric surgery program at one Australian center , and operated on by one surgeon . Data on all patients were collected prospect ively and entered into an electronic registry . The study parameters included preoperative age , gender , BMI , presence of co-morbidities , percentage of excess weight loss , and resolution of co-morbidities . RESULTS The mean age was 44.6 years ( range 16 - 76 ) , mean weight was 98 kg , and the mean BMI was 32.7 kg/m(2 ) ( range 30 - 34 ) . Of the 93 patients , 42 ( 45 % ) had co-morbidities , including asthma , diabetes , hypertension , and sleep apnea .  The proportion of patients in follow-up was 79 % , 85 % , and 89 % at 1 , 2 , and 3 years , respectively . The mean weight was reduced to 71 kg at 1 year , 72 kg at 2 years , and 72 kg at 3 years . The mean BMI was reduced to 27.2 + /- 2.2 , 27.3 + /- 3.1 , and 27.6 + /- 3.7 kg/m(2 ) , respectively , and the mean percentage of excess weight loss was 57.9 % + /- 24.5 % , 57.6 + /- 29.3 % , and 53.8 % + /- 32.8 % at 1 , 2 , and 3 years , respectively . At 3 years , the BMI was 18 - 24 kg/m(2 ) in 34 % , 25 - 29 kg/m(2 ) in 51 % , and 30 - 35 kg/m(2 ) in 10 % . At 3 years , the percentage of excess weight loss was < 25 % in 10 % , 25 - 50 % in 24 % , 50 - 75 % in 51 % , and > 75 % in 10 % . The co-morbidities improved or completely resolved in most patients . No mortality occurred . CONCLUSION We are very encouraged by this series of low BMI patients treated with the LAP-B AND . Their weight loss has been good , the complications have been minimal , and the co-morbidities have partially or wholly resolved . With additional study , it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30 - 35 kg/m(2 ) BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality The study objectives were to assess 2-year changes in health-related quality of life ( HRQL ) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery . This was a prospect i ve intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country . We used both generic ( Short Form Health Survey , SF-36 and EuroQol , EQ-5D ) , and specific question naires ( Moorehead-Ardelt , MA II and Obesity-related Problems Scale , OP ) . Effect sizes and receiver operating characteristic ( ROC ) curves were calculated to assess the change in quality of life . Spearman ’s correlation coefficient was calculated to assess whether there was an association between changes in body mass index ( BMI ) and HRQL . Of 82 patients who underwent surgery , 79 were followed-up for 2 years . Mean weight loss was 37 % of body weight ( 49 kg ) and BMI fell from 50.6 to 31.8 . The initial problems and final improvements were greater in the physical dimensions . Considerable benefits were observed in assessment s with all the instruments used . However , the changes in weight/ BMI and HRQL were not linear . The comparison with general population showed a similar profile in SF-36 dimensions after surgery . Severely obese patients have lower perceived health across all dimensions of quality of life . Moreover , the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment . ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI 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 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 Severe obesity has been associated with adverse effects on physical capacity . In a prospect i ve study , the aerobic capacity of severely obese patients was measured in order to observe the physiological response to weight loss from bariatric surgery .  Sixty-five consecutive patients ( 40.4 ± 8.4 years old ; 93.8 % female ; body mass index = 49.4 ± 5.4 kg/m2 ) were evaluated before bariatric surgery and then 6 and 12 months after surgery . Aerobic capacity was assessed with a scientific treadmill to measure maximal oxygen consumption ( VO2max ) , heart rate , blood pressure , time on the treadmill , and distance walked ( modified Bruce test )  . For the three observational periods , VO2max was 25.4 ± 9.3 , 29.8 ± 8.1 , and 36.7 ± 8.3 ml/kg/min ; time on the treadmill was 5.4 ± 1.4 , 6.4 ± 1.6 , and 8.8 ± 1.0 min ; and distance walked was 401.8 ± 139.1 , 513.4 ± 159.9 , and 690.5 ± 76.2 m. For these variables , significant results ( p = 0.0000 ) were observed for the two postoperative periods in relation to the preoperative period . Severely obese individuals increased their aerobic capacity after successful bariatric surgery . The data also suggests that a positive and progressive relationship between weight loss and improvement in fitness as a moderate loss of weight 6 months after surgery already showed some benefit and an additional reduction in weight was associated with a better performance in the aerobic capacity tests at the 12-month follow-up OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity IMPORTANCE Questions remain about the role and durability of bariatric surgery for type 2 diabetes mellitus ( T2DM ) . OBJECTIVE To compare the remission of T2DM following surgical and nonsurgical treatments . DESIGN , SETTING , AND PARTICIPANTS In this 3-arm r and omized clinical trial conducted at the University of Pittsburgh Medical Center from October 1 , 2009 , to June 26 , 2014 , in Pittsburgh , Pennsylvania , outcomes were assessed 3 years after treating 61 obese participants aged 25 to 55 years with T2DM . Analysis was conducted with an intent-to-treat population . INTERVENTIONS Participants were r and omized to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments ( Roux-en-Y gastric bypass [ RYGB ] or laparoscopic adjustable gastric b and ing [ LAGB ] ) followed by low-level lifestyle intervention in years 2 and 3 . MAIN OUTCOMES AND MEASURES Primary end points were partial and complete T2DM remission and secondary end points included diabetes medications and weight change . RESULTS Body mass index ( calculated as weight in kilograms divided by height in meters squared ) was less than 35 for 26 participants ( 43 % ) , 50 ( 82 % ) were women , and 13 ( 21 % ) were African American .  Mean ( SD ) values were 100.5 ( 13.7 ) kg for weight , 47.3 ( 6.6 ) years for age , 7.8 % ( 1.9 % ) for hemoglobin A1c level , and 171.3 ( 72.5 ) mg/dL for fasting plasma glucose level . Partial or complete T2DM remission was achieved by 40 % ( n = 8) of RYGB , 29 % ( n = 6 ) of LAGB , and no intensive lifestyle weight loss intervention participants ( P = .004 ) . The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention-alone group , with 65 % of RYGB , 33 % of LAGB , and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year 3 ( P < .001 ) . Mean ( SE ) reductions in percentage of body weight at 3 years were the greatest after RYGB at 25.0 % ( 2.0 % ) , followed by LAGB at 15.0 % ( 2.0 % ) and lifestyle treatment at 5.7 % ( 2.4 % ) ( P < .01 ) . CONCLUSIONS AND RELEVANCE Among obese participants with T2DM , bariatric surgery with 2 years of an adjunctive low-level lifestyle intervention result ed in more disease remission than did lifestyle intervention alone . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01047735
Behavioural interventions appear to improve weight loss at 12 months after bariatric surgery .
Background Significant , sustained weight loss through conventional , non-surgical interventions is often unattainable for people with severe obesity ( e.g. BMI ≥40 or ≥35 kg/m2 with co-morbidities ) .
Bariatric surgery is effective in treating severe obesity , but surgery alone without additional behaviour change management may not result in optimum long-term weight loss and maintenance .
This systematic review and meta- analysis of r and omised controlled trials evaluated the effectiveness of lifestyle interventions before and /or after bariatric surgery .