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Benefits of gastric bypass persist for 12 years

Benefits of gastric bypass persist for 12 years
From Reuters - September 20, 2017

(Reuters Health) - Twelve years after gastric-bypass weight-loss surgery, the benefits persist in most patients, leading to long-term weight loss, less diabetes, lower blood pressure and fewer cholesterol problems, according to a study of the technique that has had the longest follow-up so far.

This study further confirms the long-term durability of gastric bypass surgery, chief author Dr. Ted Adams of Intermountain Healthcare in Salt Lake City, Utah, told Reuters Health by phone.

You have an intervention that, 12 years down the road, is helping people maintain a 27 percent weight loss, said Dr. Jamy Ard, co-director of the Weight Management Center at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

Because some insurance plans dont pay for the surgery, we need to rethink what we will cover from an insurance standpoint, said Ard, who was not involved in the study.

On average, after 12 years, patients weighed 77 pounds (35 kg) less than they did before the surgery, Adams and colleagues report in the New England Journal of Medicine.

Half of those with type 2 diabetes at the time of surgery were free of it 12 years later.

All of the patients underwent Roux-en-Y gastric bypass, where surgeons close off all but an egg-size pouch of the stomach and then bypass part of the small intestine. Gastric bypass typically costs $20,000 to $30,000.

Researchers compared 387 patients who had surgery with 378 volunteers who decided against it, typically because insurance would not cover it, and 303 other adults with severe obesity. The team had previously reported benefits of the surgery at the 2- and 6-year marks.

The average starting weight was 295 pounds (134 kg). People who didnt undergo surgery typically lost just 6 pounds (2.9 kg).

Despite a wide variation in change in body weight across the sample, 360 of 387 patients (93 percent) in the surgery group maintained at least a 10 percent weight loss from baseline to year 12; 271 (70 percent) maintained at least a 20 percent weight loss; and 155 (40 percent) maintained at least a 30 percent weight loss, the researchers concluded. Only 4 of 387 patients (1 percent) in the surgery group had regained all their postsurgical weight loss.

While 26 percent of patients in the control groups had type 2 diabetes at the 12-year mark, the rate was a mere 3 percent with surgery.

Remission was more likely when a diabetic was not taking insulin, probably because those patients still had enough healthy pancreas cells left to produce insulin.

The more advanced the type 2 diabetes, the less the glycemic benefit from Roux-en-Y gastric bypass, the Adams team concluded.

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