This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (763)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Obesity  • Quality of Care  • Evidence-Based Medicine  • Surgery  • Surgical Interventions  • Bariatric Surgery  • Gastrointestinal/ Upper Foregut  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review and Meta-analysis

Henry Buchwald, MD, PhD; Yoav Avidor, MD; Eugene Braunwald, MD; Michael D. Jensen, MD; Walter Pories, MD; Kyle Fahrbach, PhD; Karen Schoelles, MD

JAMA. 2004;292:1724-1737.

Context  About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.

Objective  To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).

Data Sources and Study Selection  Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.

Data Extraction  A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).

Data Synthesis  A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.

Conclusions  Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Author Affiliations: Department of Surgery, University of Minnesota, Minneapolis (Dr Buchwald); Ethicon Endo-Surgery Inc, a Johnson & Johnson company, Cincinnati, Ohio (Dr Avidor); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (Dr Braunwald); Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn (Dr Jensen); Department of Surgery, East Carolina University School of Medicine, Greenville, NC (Dr Pories); and MetaWorks Inc, Medford, Mass (Drs Fahrbach and Schoelles).

Corresponding Author: Henry Buchwald, MD, PhD, University of Minnesota, 420 Delaware St SE, MMC 290, Minneapolis, MN 55455 (buchw001{at}umn.edu).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTERS

Systematic Review of Bariatric Surgery
Jonathan R. Treadwell and Charles M. Turkelson
JAMA. 2005;293(14):1726.
EXTRACT | FULL TEXT  

Systematic Review of Bariatric Surgery
C. David Sjöström
JAMA. 2005;293(14):1726.
EXTRACT | FULL TEXT  

Systematic Review of Bariatric Surgery—Reply
Henry Buchwald, Yoav Avidor, Eugene Braunwald, Michael D. Jensen, Walter Pories, Kyle Fahrbach, and Karen Schoelles
JAMA. 2005;293(14):1726.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch
Aasheim et al.
Am. J. Clin. Nutr. 2009;90:15-22.
ABSTRACT | FULL TEXT  

Distal gastric bypass surgery for the treatment of hypothalamic obesity after childhood craniopharyngioma
Schultes et al.
Eur J Endocrinol 2009;161:201-206.
ABSTRACT | FULL TEXT  

Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus
Kirwan et al.
Am. J. Physiol. Endocrinol. Metab. 2009;297:E151-E156.
ABSTRACT | FULL TEXT  

Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis
Sturm et al.
Eur Heart J 2009;0:ehp211v1-ehp211.
ABSTRACT | FULL TEXT  

Hormonal and Metabolic Mechanisms of Diabetes Remission after Gastrointestinal Surgery
Thaler and Cummings
Endocrinology 2009;150:2518-2525.
ABSTRACT | FULL TEXT  

Bariatric surgery does not cure all type 2 diabetes
Jadoon et al.
BMJ Case Reports 2009;2009:bcr0820080755-bcr0820080755.
ABSTRACT | FULL TEXT  

Review: Bariatric surgery: to treat diabesity
Flatt et al.
British Journal of Diabetes & Vascular Disease 2009;9:103-107.
ABSTRACT  

Role of laparoscopic adjustable gastric banding in the treatment of obesity and related disorders
Singhal and Super
British Journal of Diabetes & Vascular Disease 2009;9:131-133.
ABSTRACT  

Health and Functioning Among Baby Boomers Approaching 60
Martin et al.
J Gerontol B Psychol Sci Soc Sci 2009;64B:369-377.
ABSTRACT | FULL TEXT  

Bariatric Surgery and Diabetes: Who Should Be Offered the Option of Remission?
Purnell and Flum
JAMA 2009;301:1593-1595.
FULL TEXT  

Anemia After Bariatric Surgery: More Than Just Iron Deficiency
von Drygalski and Andris
Nutr Clin Pract 2009;24:217-226.
ABSTRACT | FULL TEXT  

Weight Loss Surgery: Common Questions
Macias et al.
Diabetes Spectr. 2009;22:110-112.
FULL TEXT  

Results of Roux-en-Y Gastric Bypass in Morbidly Obese vs Superobese Patients: Similar Body Weight Loss, Correction of Comorbidities, and Improvement of Quality of Life
Suter et al.
Arch Surg 2009;144:312-318.
ABSTRACT | FULL TEXT  

Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients
Marcus et al.
Am. J. Psychiatry 2009;166:285-291.
FULL TEXT  

Pregnancy after bariatric surgery: no problem?
Gidiri and Greer
Obstet Med 2009;2:11-16.
ABSTRACT | FULL TEXT  

Impact of Different Bariatric Surgical Procedures on Insulin Action and {beta}-Cell Function in Type 2 Diabetes
Ferrannini and Mingrone
Diabetes Care 2009;32:514-520.
FULL TEXT  

Laparoscopic Sleeve Gastrectomy After Gastric Banding Removal: A Feasibility Study
Frezza et al.
SURG INNOV 2009;16:68-72.
ABSTRACT  

First-Phase Insulin Secretion Restoration and Differential Response to Glucose Load Depending on the Route of Administration in Type 2 Diabetic Subjects After Bariatric Surgery
Salinari et al.
Diabetes Care 2009;32:375-380.
ABSTRACT | FULL TEXT  

Human gut microbiota in obesity and after gastric bypass
Zhang et al.
Proc. Natl. Acad. Sci. USA 2009;106:2365-2370.
ABSTRACT | FULL TEXT  

Narrative Review: Effect of Bariatric Surgery on Type 2 Diabetes Mellitus
Vetter et al.
ANN INTERN MED 2009;150:94-103.
ABSTRACT | FULL TEXT  

Bariatric surgery - not to be taken lightly
Taheri et al.
JRSM 2009;102:2-3.
FULL TEXT  

REVIEW PAPER: Current Strategies in the Development of Anti-obesity Drugs and Their Safety Concerns
Elangbam
Vet Pathol 2009;46:10-24.
ABSTRACT | FULL TEXT  

Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
Inge et al.
Pediatrics 2009;123:214-222.
ABSTRACT | FULL TEXT  

The Metabolic Syndrome
Cornier et al.
Endocr. Rev. 2008;29:777-822.
ABSTRACT | FULL TEXT  

Mechanism for Improved Insulin Sensitivity after Gastric Bypass Surgery
Bikman et al.
J. Clin. Endocrinol. Metab. 2008;93:4656-4663.
ABSTRACT | FULL TEXT  

Recommended Nutritional Supplements for Bariatric Surgery Patients
Malone
The Annals of Pharmacotherapy 2008;42:1851-1858.
ABSTRACT | FULL TEXT  

Effects of Bariatric Surgery on Cardiovascular Function
Ashrafian et al.
Circulation 2008;118:2091-2102.
FULL TEXT  

Obesity and Inflammation: Lessons From Bariatric Surgery
Compher and Badellino
JPEN J Parenter Enteral Nutr 2008;32:645-647.
ABSTRACT | FULL TEXT  

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass: An Underrecognized Cause of Irreversible Renal Failure
Nasr et al.
CJASN 2008;3:1676-1683.
ABSTRACT | FULL TEXT  

Factors Associated With Weight Loss After Gastric Bypass
Campos et al.
Arch Surg 2008;143:877-884.
ABSTRACT | FULL TEXT  

Adjustable gastric banding plus conventional therapy improved glycaemic control in obese patients with type 2 diabetes
Padwal
Evid. Based Med. 2008;13:108-108.
FULL TEXT  

Obesity and the lung: 2 {middle dot} Obesity and sleep-disordered breathing
Crummy et al.
Thorax 2008;63:738-746.
ABSTRACT | FULL TEXT  

Bariatric surgery
Arterburn
BMJ 2008;337:a755-a755.
FULL TEXT  

Effect of Weight Loss by Gastric Bypass Surgery Versus Hypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes
Laferrere et al.
J. Clin. Endocrinol. Metab. 2008;93:2479-2485.
ABSTRACT | FULL TEXT  

Obesity and the lung: 1 {middle dot} Epidemiology
McClean et al.
Thorax 2008;63:649-654.
ABSTRACT | FULL TEXT  

Postoperative Hypoxemia in Morbidly Obese Patients With and Without Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery
Ahmad et al.
Anesth. Analg. 2008;107:138-143.
ABSTRACT | FULL TEXT  

Surgery for obesity in adults
DTB 2008;46:41-45.
ABSTRACT | FULL TEXT  

Pharmacotherapy for obesity in menopausal women
Samat et al.
Menopause Int 2008;14:57-62.
ABSTRACT | FULL TEXT  

Increased Colorectal Epithelial Cell Proliferation and Crypt Fission Associated with Obesity and Roux-en-Y Gastric Bypass
Sainsbury et al.
Cancer Epidemiol. Biomarkers Prev. 2008;17:1401-1410.
ABSTRACT | FULL TEXT  

Dietary Therapy for Obesity: An Emperor With No Clothes
Mark
Hypertension 2008;51:1426-1434.
FULL TEXT  

Is there a place for bariatric surgery in treating childhood obesity?
Shield et al.
Arch. Dis. Child. 2008;93:369-372.
FULL TEXT  

Happy Re-birthday: Weight Loss Surgery and the `New Me'
Throsby
Body Society 2008;14:117-133.
 

Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease
Lopez-Jimenez et al.
Chest 2008;133:793-804.
FULL TEXT  

Body Esteem Improves After Bariatric Surgery
Madan et al.
SURG INNOV 2008;15:32-37.
ABSTRACT  

Sleep Apnea and Hypertension: Interactions and Implications for Management
Kapa et al.
Hypertension 2008;51:605-608.
FULL TEXT  

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches
Schwartz et al.
Proc Am Thorac Soc 2008;5:185-192.
ABSTRACT | FULL TEXT  

Vitamin status in morbidly obese patients: a cross-sectional study
Aasheim et al.
Am. J. Clin. Nutr. 2008;87:362-369.
ABSTRACT | FULL TEXT  

Surgical treatment of obesity
Bult et al.
Eur J Endocrinol 2008;158:135-145.
ABSTRACT | FULL TEXT  

Is Type 2 Diabetes an Operable Intestinal Disease?: A provocative yet reasonable hypothesis
Rubino
Diabetes Care 2008;31:S290-S296.
ABSTRACT | FULL TEXT  

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes
Schernthaner and Morton
Diabetes Care 2008;31:S297-S302.
FULL TEXT  

Gastrointestinal Surgery as a Treatment for Diabetes
Cummings and Flum
JAMA 2008;299:341-343.
FULL TEXT  

Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association
American Diabetes Association
Diabetes Care 2008;31:S61-S78.
FULL TEXT  

Duodenal Jejunal Bypass Sleeve: A Totally Endoscopic Device for the Treatment of Morbid Obesity
Gersin et al.
SURG INNOV 2007;14:275-278.
ABSTRACT  

Insulin resistance and salt-sensitive hypertension in metabolic syndrome
Fujita
Nephrol Dial Transplant 2007;22:3102-3107.
FULL TEXT  

Pediatric Idiopathic Intracranial Hypertension: A Review
Mercille and Ospina
Pediatr. Rev. 2007;28:e77-e86.
FULL TEXT  

Spectrum and Risk Factors of Complications After Gastric Bypass
Campos et al.
Arch Surg 2007;142:969-975.
ABSTRACT | FULL TEXT  

When Policy Meets Statistics: The Very Real Effect That Questionable Statistical Analysis Has on Limiting Health Care Access for Bariatric Surgery
Livingston et al.
Arch Surg 2007;142:979-987.
ABSTRACT | FULL TEXT  

Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery
Still et al.
Arch Surg 2007;142:994-998.
ABSTRACT | FULL TEXT  

Gastric Bypass: Why Roux-en-Y? A Review of Experimental Data
Collins et al.
Arch Surg 2007;142:1000-1003.
ABSTRACT | FULL TEXT  

Characterization of weight loss and weight regain mechanisms after Roux-en-Y gastric bypass in rats
Guijarro et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2007;293:R1474-R1489.
ABSTRACT | FULL TEXT  

Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk
Parati et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2007;293:R1671-R1683.
ABSTRACT | FULL TEXT  

Evaluation and Management of Childhood and Adolescent Obesity
Singhal et al.
Mayo Clin Proc. 2007;82:1258-1264.
ABSTRACT | FULL TEXT  

Toward the Rational and Equitable Use of Bariatric Surgery
Flum et al.
JAMA 2007;298:1442-1444.
FULL TEXT  

Long-Term Mortality after Gastric Bypass Surgery
Adams et al.
NEJM 2007;357:753-761.
ABSTRACT | FULL TEXT  

One hundred pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up
Anderson et al.
Am. J. Clin. Nutr. 2007;86:301-307.
ABSTRACT | FULL TEXT  

Indirect Calorimetry: A Practical Guide for Clinicians
Haugen et al.
Nutr Clin Pract 2007;22:377-388.
ABSTRACT | FULL TEXT  

Diabetes, Weight Loss, and Sisyphus
Elasy
Clin. Diabetes 2007;25:81-82.
FULL TEXT  

Bariatric Surgery for Patients With Diabetes
Eckhauser et al.
Clin. Diabetes 2007;25:83-89.
ABSTRACT | FULL TEXT  

Management of Type 2 Diabetes After Bariatric Surgery
Dunn and Jagasia
Clin. Diabetes 2007;25:112-114.
FULL TEXT  

Gut Hormones, Obesity, Polycystic Ovarian Syndrome, Malignancy, and Lipodystrophy Syndromes
Bloomgarden
Diabetes Care 2007;30:1934-1939.
FULL TEXT  

Case Study: A Patient With Diabetes and Weight-Loss Surgery
Cummings
Diabetes Spectr. 2007;20:173-176.
FULL TEXT  

Prevalence And Trends In Obesity Among Aged And Disabled U.S. Medicare Beneficiaries, 1997-2002
Doshi et al.
Health Aff (Millwood) 2007;26:1111-1117.
ABSTRACT | FULL TEXT  

Incretin Levels and Effect Are Markedly Enhanced 1 Month After Roux-en-Y Gastric Bypass Surgery in Obese Patients With Type 2 Diabetes
Laferrere et al.
Diabetes Care 2007;30:1709-1716.
ABSTRACT | FULL TEXT  

Bariatric Surgery for Morbid Obesity
DeMaria
NEJM 2007;356:2176-2183.
FULL TEXT  

Neurologic complications of gastric bypass surgery for morbid obesity
Juhasz-Pocsine et al.
Neurology 2007;68:1843-1850.
ABSTRACT | FULL TEXT  

Malabsorption of Oral Antibiotics in Pregnancy after Gastric Bypass Surgery
Magee et al.
J Am Board Fam Med 2007;20:310-313.
ABSTRACT | FULL TEXT  

Acute Kidney Injury after Gastric Bypass Surgery
Thakar et al.
CJASN 2007;2:426-430.
ABSTRACT | FULL TEXT  

{beta}-Cell Function in Severely Obese Type 2 Diabetic Patients: Long-term effects of bariatric surgery
Camastra et al.
Diabetes Care 2007;30:1002-1004.
FULL TEXT  

Bariatric Surgery in Adolescents: Recent National Trends in Use and In-Hospital Outcome
Tsai et al.
Arch Pediatr Adolesc Med 2007;161:217-221.
ABSTRACT | FULL TEXT  

Nonalcoholic Fatty Liver Disease and Obesity
Saadeh
Nutr Clin Pract 2007;22:1-10.
ABSTRACT | FULL TEXT  

Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status
Kalarchian et al.
Am. J. Psychiatry 2007;164:328-334.
ABSTRACT | FULL TEXT  

Efficacy of Gastric Bypass in the Treatment of Obesity-Related Comorbidities
Peluso and Vanek
Nutr Clin Pract 2007;22:22-28.
ABSTRACT | FULL TEXT  

Nutrition and Gastrointestinal Complications of Bariatric Surgery
Shikora et al.
Nutr Clin Pract 2007;22:29-40.
ABSTRACT | FULL TEXT  

Effect of Massive Weight Loss on Inflammatory Adipocytokines and the Innate Immune System in Morbidly Obese Women
Manco et al.
J. Clin. Endocrinol. Metab. 2007;92:483-490.
ABSTRACT | FULL TEXT  

Public Health Response to the Obesity Epidemic: Too Soon or Too Late?
Byers and Sedjo
J. Nutr. 2007;137:488-492.
ABSTRACT | FULL TEXT  

Treatment of Obesity
Thompson et al.
Mayo Clin Proc. 2007;82:93-102.
ABSTRACT | FULL TEXT  

Surgery for morbid obesity
Bennett et al.
Postgrad. Med. J. 2007;83:8-15.
ABSTRACT | FULL TEXT  

Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association
American Diabetes Association
Diabetes Care 2007;30:S48-S65.
FULL TEXT  

Sympathetic Overactivity, Endothelial Dysfunction, Inflammation, and Metabolic Abnormalities Cluster in Grade III (World Health Organization) Obesity: Reversal through sustained weight loss obtained with laparoscopic adjustable gastric banding
Pontiroli et al.
Diabetes Care 2006;29:2735-2738.
FULL TEXT  

Improving patient safety by instructional systems design
Battles
Qual Saf Health Care 2006;15:i25-i29.
ABSTRACT | FULL TEXT  

New Techniques and Guidelines Point Way to Bariatric Surgery
DOC News 2006;3:4-4.
FULL TEXT  

Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status
Shah et al.
J. Clin. Endocrinol. Metab. 2006;91:4223-4231.
ABSTRACT | FULL TEXT  

Meta-analysis in Surgery: Methods and Limitations
Ng et al.
Arch Surg 2006;141:1125-1130.
ABSTRACT | FULL TEXT  

Case 31-2006 -- A 15-Year-Old Girl with Severe Obesity.
Hoppin et al.
NEJM 2006;355:1593-1602.
FULL TEXT  

Laparoscopic surgery was better than an intensive non-surgical intervention for weight loss in mild to moderate obesity
Padwal
Evid. Based Med. 2006;11:146-146.
FULL TEXT  

The Effectiveness of Screening for Obesity in Primary Care: Weighing the Evidence
Wilson and McAlpine
Med Care Res Rev 2006;63:570-598.
ABSTRACT  

Medication and nutrient administration considerations after bariatric surgery.
Miller and Smith
Am J Health Syst Pharm 2006;63:1852-1857.
ABSTRACT | FULL TEXT  

Assessment and Preparation of Patients for Bariatric Surgery
Collazo-Clavell et al.
Mayo Clin Proc. 2006;81:S11-S17.
ABSTRACT | FULL TEXT