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

  • de Guzman C
  • Lao L
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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.

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de Guzman, C. K. C., & Lao, L. T. (2017). Comparison of Outcomes of Bariatric Surgery vs Medical Therapy in the Management of Adult Patients with Class I Obesity. Journal of the American College of Surgeons, 225(4), e55–e56. https://doi.org/10.1016/j.jamcollsurg.2017.07.668

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