Bariatric surgery versus lifestyle interventions for morbid obesity--changes in body weight, risk factors and comorbidities at 1 year.

摘要

BACKGROUND: Few studies have looked at non-surgical alternatives for morbid obese patients. This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments. METHODS: Patients with morbid obesity (BMI > 40 or BMI > 35 kg/m(2) plus comorbidities) on waiting list for bariatric surgery, were non-randomly allocated to (A) bariatric surgery or to one of three conservative treatments; (B) residential intermittent program; (C) commercial weight loss camp and (D) hospital outpatient program. Body weight, risk factors and comorbidities were assessed at baseline and 1 year. RESULTS: Of 206 participants, 179 completed the study. All treatments resulted in significant weight loss, but bariatric surgery (40 +/- 14 kg, 31 +/- 9%) led to the largest weight loss (P < 0.0001). There were no differences in weight loss between B and C (22 +/- 13 kg, 15 +/- 8% vs. 18 +/- 12 kg, 13 +/- 8%), but these resulted in larger weight loss compared with D (7 +/- 10 kg, 5 +/- 8%). There were no differences in changes in total or LDL cholesterol, triacylglycerols or glucose between groups; however, the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B, C and D combined (except hypertension, which was better in group A). CONCLUSION: In conclusion, although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment, in patients with morbid obesity, clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions.