ATLANTA, Georgia — A new study comparing 1-year outcomes in obese patients who followed a medical weight-loss program vs others who had bariatric surgery has found that both groups lost weight and had improved levels of HDL cholesterol and other obesity-linked biomarkers but the improvements were greater in those who underwent surgery.

Author Bobbi Paull-Fourney, RN, MPH, from the University of Kansas School of Medicine-Wichita, explained to Medscape Medical News that they compared obese men and women who followed the Health Management Resources (HMR) diet and behavior-modification medical program at their center vs others who underwent gastric bypass. She reported the research in a poster at Obesity Week 2013: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting.

James Early, MD, medical director of Via Christi Regional Medical Center's Solutions for Life, Wichita, Kansas, who was not involved with this particular study, said the findings show that "we have 2 pathways for obesity treatment that are effective. We certainly send people to surgery, but not if they're doing well medically and don't need to get the surgery."

Weight Loss Parallel in 2 Groups for First 6 Months

According to the authors, previous research suggests that bariatric surgery leads to significantly greater, more sustained weight loss than diet, exercise, or lifestyle modifications but few studies have directly compared surgery with a multifaceted medical program.

They performed a retrospective chart review of all adults aged 18 years and older with a body mass index (BMI) of at least 30 kg/m2 who enrolled in a medical program in their weight-management clinic or who underwent gastric bypass surgery from January 2002 to December 2011 and for whom there was 1 year of follow-up data.

The medical program consisted of "a low-calorie diet [from] meal replacements (shakes, entrées, and bars)…coupled with an intensive behavior-[modification] program, with classes on a weekly basis that teach lifestyle skills," Ms. Paull-Fourney explained. The patients ate meal replacements for about 12 weeks and then transitioned to a normal, healthy diet with lots of fruit and vegetables, she added.

A total of 2054 participants enrolled in the medical program and 557 underwent gastric bypass; more than 90% of the participants were white. Compared with patients who underwent surgery, those in the medical program were slightly older with a mean age of 49 vs 45.6and had a slightly lower BMI of 43.1 vs 46.5.

The surgical group included more women (83%) than the medical group (67%).

Only 520 patients who had enrolled in the medical program and 379 patients who had undergone surgery had 1-year follow-up data.

From baseline to 6 months, weight change in the 2 groups followed a parallel course: mean weight dropped from 276.8 to 240.3 pounds for patients in the medical-treatment program vs from 286 to 236.3 pounds for those who underwent surgery.

Is Surgery Superior to Medical Management?

However, from 6 months to 1 year, although mean weight for participants who underwent surgery continued to fall, reaching 187.8 pounds, mean weight in the medical-treatment group stayed about the same, at around 220 pounds.

So, from baseline to one year, although both groups achieved significant weight loss, overall it was greater in the surgical arm, with an average percent initial body weight loss of 19.7% for the medical treatment group vs 34.4% for the bypass group.

Also at 1 year:

  • Systolic blood pressure improved significantly in both groups.

  • In the medical-management group, triglycerides decreased by 28.1% and HDL cholesterol increased by 5%.

  • In the surgical-treatment group, triglycerides decreased by 45.6%, HDL cholesterol increased by 18.9%, fasting blood glucose decreased by 25.4%, and LDL cholesterol decreased by 17.4%.

  • There were no significant improvements in HbA1C levels.

The study was limited because it looked at only 1 type of bariatric surgery and 75% of the patients who enrolled in the medical program dropped out.

However, it suggests that both treatments may be effective for the treatment of obesity, the researchers say.

"The problem is that after 6 months, people feel that they have been 'cured' by both procedures," Dr. Early commented. If patients followed a longer maintenance program, they might develop stronger skills and be more likely to continue or at least sustain weight loss, he speculated.

Obesity Week 2013: The Obesity Society Annual Scientific Meeting. Poster A-370-P, presented November 14, 2013.


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