Comparison of Outcomes of Bariatric Surgery vs Medical Therapy in the Management of Adult Patients with Class I Obesity

Abstract

INTRODUCTION: Lifestyle modification and medical therapy is the mainstay of treatment for obese patients. Bariatric surgery is an established option for obese patients with a BMI >35 (Class II-II Obesity). Studies suggest benefits of bariatric surgery for patients with a BMI of 30-35 (Class I Obesity). This study compares the effectiveness of bariatric surgery versus medical therapy in Class I obesity. METHODS: Randomized controlled trials comparing bariatric surgery and medical therapy in obesity were reviewed. Included are trials with adult, obese (Class I) populations with a 1 year follow-up period. Studies with patients with severe medical conditions, uncontrolled diabetes and/or previous bariatric/major surgery or published more than 5 years ago were excluded. Studies included were subjected to individual critical appraisal and statistical analysis. RESULTS: One hundred forty-four out of 280 patients underwent Bariatric surgery (Group A) and 136 out of 280 received medical management (Group B). Group A is associated with better glycemic control (MD -1.16, 95% CI) and weight loss (MD -15.64 kg, 95% CI), with reduced fasting plasma glucose (MD -57.60, 95% CI), triglycerides (MD -43.83, 95% CI) and systolic and diastolic BP (Systolic- MD -9.34, 95% CI; Diastolic- MD -2.61, 95%CI) with increased incidence of short-term complications (RR 2.03, 95% CI). No difference was observed in plasma cholesterol and LDL levels. HDL levels were increased in Group B (MD 12.27, 95% CI). CONCLUSIONS: In Class I Obesity patients, bariatric surgery is associated with better glycemic control and weight loss, with reduced blood glucose, triglycerides, systolic and diastolic BP. Medical therapy has less short-term complications with higher HDL levels. No difference was seen in plasma cholesterol and LDL levels.