Research Results: Roux-en-Y, Sleeve, Dieting

[James Marusek 5,244]

Many times people question which type of weight loss surgery should they choose. The following article discusses the results from the latest studies.

Bariatric surgery can successfully deal with the excess weight, and both prevent the occurrence of diabetes and, in some cases, cause its remission. However, there are several procedures that can be used: Roux-en-Y gastric bypass; sleeve gastrectomy; adjustable gastric banding. How to choose among them can be gleaned from a group of articles in the Journal of the American Medical Association (JAMA). Two of these involved trials in which participants were randomly assigned to various treatments (e.g., types of surgery), and compared the outcomes with respect to various parameters. In the third, surgery was compared to medical management.

Weight Loss

Salminen et al. (1) compared the amount of excess weight loss five years post-surgery in 240 severely obese patients (average BMI = 46) who were randomly assigned to receive either Roux-en-Y or sleeve gastrectomy surgery. All surgeries were performed via laparoscopy. Most of the patients had some co-morbidity — diabetes, dyslipidemia, and hypertension. Those who underwent the sleeve gastrectomy had lost 49 percent of their excess weight by five years, while those in the gastric bypass group lost 57 percent. This difference was not statistically significant. The comorbidities were ameliorated in both groups — 37 percent of those in the gastrectomy group had partial or complete remission of their diabetes, compared to 45 percent of those in the bypass group. The dyslipidemia was similarly impacted: medication was discontinued in both groups —for 47 percent of those with gastrectomy and 60 percent of those with gastric bypass. Discontinuation of hypertension medications occurred for 29 and 51 percent of those in the gastrectomy and bypass groups respectively.

Similarly, Peterli et al. also compared the 5-year effects of gastric bypass and sleeve gastrectomy on weight loss in severely obese people. In this study, 107 participants underwent sleeve gastrectomy, and 100 had gastric bypass surgery. They were randomly assigned to each treatment. In this study, the average BMI was 44. Five years post-surgery, those undergoing sleeve gastrectomy lost 61 percent of their excess BMI, while the gastric bypass surgery resulted in a 68 percent loss of excess BMI. These differences were not statistically significant. However, 32 percent of patients undergoing sleeve gastrectomy experienced a worsening of gastroesophageal reflux (GERD) symptoms, compared to only 6 percent of the bypass group. By five years post-surgery, 19 percent of the gastrectomy group had had to have re-operations or other interventions, versus 22 percent of those with the gastric bypass surgery.

Surgery vs. Medical Management (diet and exercise)

In a third random controlled trial, Ikramuddin et al. examined the impact of either Roux-en-Y bypass surgery or medical management on indicators of diabetes control (hemoglobin A1c or HbA1c[4]), heart risk (LDL cholesterol: goal <100 mg/dl), and systolic blood pressure (<130 mm Hg) 5 years post-intervention. The study included 120 individuals whose initial BMI ranged from 30 to 39.9; their HbA1c levels were 9.6 percent. After five years, 23 percent of patients in the surgery group vs. only 4 percent of those in the medical management group had achieved the goal levels for the three indicators, although further observation suggested that the differences between the groups tended to wane over time. Also, 16 of the surgery patients achieved partial or full remission of their diabetes, compared to 5 of those in the non-surgical group. As expected, those in the surgery group lost more weight as a percent of initial body weight — 22 percent vs. 10 percent of those receiving only medical management.

Thus the results of these randomized trials support the efficacy of both Roux-en-Y gastric bypass surgery and the gastric sleeve surgery when it comes to weight loss, and gastric bypass was also superior to medical management. However, anyone considering such surgeries must also consider adverse events — for example, the sleeve gastrectomy exacerbates pre-existing GERD, and thus wouldn't be recommended for such patients. Both of the surgeries involve some modification of the GI tract — most extensively with the bypass type. And thus the bypass is more likely to result in nutritional deficiencies than the gastric sleeve operation. A positive aspect of these studies is that the benefits of the surgeries were durable — an important issue for anyone considering undergoing them.

https://www.acsh.org/news/2018/01/22/which-bariatric-surgery-procedure-best-it-depends-12442

[blizair09 3,250]

I find all of the research and statistics to be interesting; however, I still believe that it comes down to an individual's commitment and perseverance to changing his/her relationship with food and finding a way of eating that is sustainable and that supports maintaining and healthy weight more so that which procedure he/she chooses.

I weighed 400 pounds when I started my journey. I never wanted the bypass and insisted on the sleeve from the very beginning. While the NP did talk statistics, she and the surgeon were very supportive. I have lost over 100% of my excess weight (I am below goal), and have maintained for several months beautifully. There is no reason to think will regain because I have no intention of not following a Keto way of eating, and I always keep my calories below 2000.

In my experience the people that don't lose their excess weight and/or regain do (or don't) do so because of the choices they make around food and drink. I realize that there are exceptions to this, but that has been the case so many times on BP and is definitely the case with most of the people I know that have had one procedure or the other.

Still, I do find the research interesting...

[Healthy_life2 8,319]

2 hours ago, James Marusek said:

Many times people question which type of weight loss surgery should they choose. The following article discusses the results from the latest studies.

Bariatric surgery can successfully deal with the excess weight, and both prevent the occurrence of diabetes and, in some cases, cause its remission. However, there are several procedures that can be used: Roux-en-Y gastric bypass; sleeve gastrectomy; adjustable gastric banding. How to choose among them can be gleaned from a group of articles in the Journal of the American Medical Association (JAMA). Two of these involved trials in which participants were randomly assigned to various treatments (e.g., types of surgery), and compared the outcomes with respect to various parameters. In the third, surgery was compared to medical management.

Weight Loss

Salminen et al. (1) compared the amount of excess weight loss five years post-surgery in 240 severely obese patients (average BMI = 46) who were randomly assigned to receive either Roux-en-Y or sleeve gastrectomy surgery. All surgeries were performed via laparoscopy. Most of the patients had some co-morbidity — diabetes, dyslipidemia, and hypertension. Those who underwent the sleeve gastrectomy had lost 49 percent of their excess weight by five years, while those in the gastric bypass group lost 57 percent. This difference was not statistically significant. The comorbidities were ameliorated in both groups — 37 percent of those in the gastrectomy group had partial or complete remission of their diabetes, compared to 45 percent of those in the bypass group. The dyslipidemia was similarly impacted: medication was discontinued in both groups —for 47 percent of those with gastrectomy and 60 percent of those with gastric bypass. Discontinuation of hypertension medications occurred for 29 and 51 percent of those in the gastrectomy and bypass groups respectively.

Similarly, Peterli et al. also compared the 5-year effects of gastric bypass and sleeve gastrectomy on weight loss in severely obese people. In this study, 107 participants underwent sleeve gastrectomy, and 100 had gastric bypass surgery. They were randomly assigned to each treatment. In this study, the average BMI was 44. Five years post-surgery, those undergoing sleeve gastrectomy lost 61 percent of their excess BMI, while the gastric bypass surgery resulted in a 68 percent loss of excess BMI. These differences were not statistically significant. However, 32 percent of patients undergoing sleeve gastrectomy experienced a worsening of gastroesophageal reflux (GERD) symptoms, compared to only 6 percent of the bypass group. By five years post-surgery, 19 percent of the gastrectomy group had had to have re-operations or other interventions, versus 22 percent of those with the gastric bypass surgery.

Surgery vs. Medical Management (diet and exercise)

In a third random controlled trial, Ikramuddin et al. examined the impact of either Roux-en-Y bypass surgery or medical management on indicators of diabetes control (hemoglobin A1c or HbA1c[4]), heart risk (LDL cholesterol: goal <100 mg/dl), and systolic blood pressure (<130 mm Hg) 5 years post-intervention. The study included 120 individuals whose initial BMI ranged from 30 to 39.9; their HbA1c levels were 9.6 percent. After five years, 23 percent of patients in the surgery group vs. only 4 percent of those in the medical management group had achieved the goal levels for the three indicators, although further observation suggested that the differences between the groups tended to wane over time. Also, 16 of the surgery patients achieved partial or full remission of their diabetes, compared to 5 of those in the non-surgical group. As expected, those in the surgery group lost more weight as a percent of initial body weight — 22 percent vs. 10 percent of those receiving only medical management.

Thus the results of these randomized trials support the efficacy of both Roux-en-Y gastric bypass surgery and the gastric sleeve surgery when it comes to weight loss, and gastric bypass was also superior to medical management. However, anyone considering such surgeries must also consider adverse events — for example, the sleeve gastrectomy exacerbates pre-existing GERD, and thus wouldn't be recommended for such patients. Both of the surgeries involve some modification of the GI tract — most extensively with the bypass type. And thus the bypass is more likely to result in nutritional deficiencies than the gastric sleeve operation. A positive aspect of these studies is that the benefits of the surgeries were durable — an important issue for anyone considering undergoing them.

https://www.acsh.org/news/2018/01/22/which-bariatric-surgery-procedure-best-it-depends-12442

Statics are interesting.

My surgeons office follows patients for five years. Many patients stop coming to follow up appointments at two years out. They admit, Statistics are not accurate.

I agree with @blizair09

What I have noticed...is if you don't change behaviors you will gain. Is that the same for all bariatric surgery types?

I knew early on I didn't want to be a statistic. Lost 120 pounds in six months and maintaining three years seven months out. Hope for the best in the years to come. I want this long term.

[blizair09 3,250]

2 hours ago, jenn1 said:

Statics are interesting.

My surgeons office follows patients for five years. Many patients stop coming to follow up appointments at two years out. They admit, Statistics are not accurate.

I agree with @blizair09

What I have noticed...is if you don't change behaviors you will gain. Is that the same for all bariatric surgery types?

I knew early on I didn't want to be a statistic. Lost 120 pounds in six months and maintaining three years seven months out. Hope for the best in the years to come. I want this long term.

All of the folks in my life who have regained (which is almost all of them) never changed any behaviors and went right back to eating how they ate (and drank) pretty quickly after the surgery. (While they claim they eat smaller portions, those portions grew and grew as time went on, and the frequency of eating did as well...) Yes, they lost weight at first, but with the exception of my mom (who is still probably 50-60 pounds below her highest weight), everyone else gained back EVERY SINGLE POUND.

I'm like you. I put my body through too much trauma to gain any weight back. Not even 10 pounds. food is not that important in my life any more, thank goodness. I'll just stick to my Keto way of eating and my 2000 calories. That formula will not fail me.

@jenn1, congratulations on your success and maintenance!

[Frustr8 7,886]

So we all have,our reasons for the surgery chosen , what were yours and how satisfied are you?