Do We Have to Leave Obesity Treatment to the Surgeons?

摘要

The comparison of the largest bariatric surgery study (Swedish Obese Subjects, SOS) with almost 4 000 surgical and conservatively treated patients and its conservative counterpart, the Look-AHEAD study (Action for Help in Diabetes) with more than 5 000 obese patients (aver-age BMI 36 kg/m(2)) with type 2 diabetes showed that although both studies resulted in improved cardiovascular risk factors (bodyweight, HbA1c, HDL/LDL, blood pressure, sleep apnoe syndrome) only the SOS study and subsequent obesity surgery studies could verify their primary outcome hypothesis (significant reduction of the incidence of both cardiovascular deaths, non-fatal infarctions and strokes and hospitalization angina). Furthermore the SOS study could demonstrate a decreased mortality compared to the Look-AHEAD study. Despite a high psychological co-morbidity of obesity surgery patients the majority of studies also with follow-ups of more than 5 years demonstrates an improvement in mental functioning and quality of life. In contrast, there seems to be an increased risk for suicide about 3-4 years after the surgical intervention. Thus, while the majority of obesity surgery patients seems to benefit both physically and mentally, there is a minority that risks to take at least psychologically serious damage.