Abstract
Introduction
The American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity (IFSO) have both stated that bariatric surgery (BS) should not be denied in Class I patients. However, lifestyle intervention (LI), such as diet plus gym programs, is still considered the preferred approach for subjects with a BMI ranging from 30 to 35 kg/m2. The aim of this study was to retrospectively compare results of LI and BS in patients in Class I obesity.
Methods
Retrospective analysis of prospective maintained databases of two centers for the “Interdisciplinary Treatment of Obesity” was performed. All patients in Class I obesity and follow-up >7 years were included in the study. Subjects were divided into two groups: BS group that included patients who had undergone surgery and LI group that included patients who underwent lifestyle intervention (LI). Percentage of excess body mass index loss (%EBMIL) and comorbidities remission were recorded.
Results
Seventy-six patients were included in the study. Fifty-six subjects were submitted to surgery (BS group); 20 subjects were treated with nonsurgical approach (LI group). In BS group, 34 underwent laparoscopic adjustable gastric band, 13 laparoscopic sleeve gastrectomy (LSG), and 9 laparoscopic Roux-en-Y gastric bypass. EWL% resulted significantly higher in BS group at 1, 3, 5, 7 and 10 years (p < 0.01).
Conclusion
Bariatric surgery is more effective than LI for patients in Class I obesity. Due to its versatility, low-risk profile and high-effectiveness LSG could be the standard intervention for these patients.
Similar content being viewed by others
References
Sjöström L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) 32(Suppl 7):S93–S97
Martins C, Strommen M, Stavne OA et al (2011) Bariatric surgery versus lifestyle intervention for morbid obesity—changes in bodyweight, risk factors and comorbidities at 1 year. Obes Surg 21(841–849):4
Hofso D, Nordstrand N, Johnson LK et al (2010) Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol 163(735–745):5
Anderson JW, Konz EC, Frederich RC, Wood CL (2001) Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 74(579–584):8
Sjostrom L, Lindroos AK, Peltonen M et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693
Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309(1):71–82
Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1994) Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 17(9):961–969
Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS (2008) Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg 207(6):928–934
Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K (2008) Interdisciplinary European guidelines on surgery for severe obesity]. Rozhl Chir 87(9):468–476
Foschi D, De Luca M, Sarro G, Bernante P, Zappa MA, Moroni R, Navarra G, Foletto M, Ceriani V, Piazza L, Di Lorenzo N (2016) LINEE GUIDA DI CHIRURGIA DELL’OBESITA’. SOCIETA’ ITALIANA DI CHIRURGIA DELL’OBESITA’ (SICOB)
ASMBS Clinical Issues Committee (2013) Bariatric surgery in class I obesity (body mass index 30-35 kg/m2). Surg Obes Relat Dis 9(1):e1–e10
Busetto L, Dixon J, De Luca M, Shikora S, Pories W, Angrisani L (2014) Bariatric surgery in class I obesity: a Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 24(4):487–519
American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62
National Institute for Health and Clinical excellence. Hypertension (CG127). http://www.nice.org.uk/guidance/cg127. 30 Oct 2013
Dixon JB, O’Brien PE, Playfair J et al (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 299:316–323
O’Brien PE, Dixon JB, Laurie C et al (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144:625–633
Schauer PR, Kashyap SR, Wolski K et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 26(366):1567–1576
Lee WJ, Chong K, Ser KH et al (2011) Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg 146:143–148
Li Q, Chen L, Yang Z et al (2012) Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index o 35 kg/m2. Diabetes Obes Metab 14:262–270
Angrisani L, Favretti F, Furbetta F et al (2004) Italian Group for Lap-Band System: results of multicenter study on patients with BMI r 35 kg/m2. Obes Surg 14:415–418
Cohen R, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE (2012) Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 35:1420–1428
Abbatini F, Capoccia D, Casella G, Coccia F, Leonetti F, Basso N (2012) Type 2 diabetes in obese patients with body mass index of 30–35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis 8:20–24
Scopinaro N, Adami GF, Papadia FS et al (2011) The effects of biliopancreatic diversion on type 2 diabetes mellitus in patients with mild obesity (BMI 30–35 kg/m2) and simple overweight (BMI 25–30 kg/m2): a prospective controlled study. Obes Surg 21:880–888
National Institutes of Health National Institutes of Health (1998) National Heart, Lung and Blood Institute: clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The Evidence Report
National Institute for Health and Clinical Excellence (2006) Obesity. Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE Guidelines 43:1–84
Avenell A, Brown TJ, McGee MA et al (2004) What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Diet 17:317–335
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all patients submitted to surgery and included in the study.
Rights and permissions
About this article
Cite this article
Vitiello, A., Angrisani, L., Santonicola, A. et al. Bariatric Surgery Versus Lifestyle Intervention in Class I Obesity: 7–10-Year Results of a Retrospective Study. World J Surg 43, 758–762 (2019). https://doi.org/10.1007/s00268-018-4847-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-018-4847-8