FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 351:2683-2693 December 23, 2004 Number 26 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Solomon, C. G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.

Methods The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years.

Results After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable.

Conclusions As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.

Source Information

From the Departments of Body Composition and Metabolism (L.S., A.-K.L., B.C., K.N., M.S.) and Anesthesiology (B.L., C.D.S.), Sahlgrenska University Hospital, Göteborg, Nordic University of Public Health (H.W.), Göteborg; the Medical Department, Norra Älvsborgs Läns Hospital, Trollhättan (J.T.); and Börjegatan 10B, Uppsala (S.D.) — all in Sweden; the Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (M.P.); and Pennington Biomedical Research Center, Louisiana State University, Baton Rouge (C.B.).

Address reprint requests to Dr. Lars Sjöström at SOS Secretariat, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

Full Text of this Article

Related Letters:

Long-Term Outcome of Bariatric Surgery
Vlassov V. V., Sjöström L.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:1495-1496, Apr 7, 2005. Correspondence

This article has been cited by other articles:

• Bassuk, S. S., Manson, J. E. (2008). Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2: 191-213 [Abstract]  
• Gasteyger, C., Suter, M., Gaillard, R. C, Giusti, V. (2008). Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am. J. Clin. Nutr. 87: 1128-1133 [Abstract] [Full Text]  
• Shield, J P H, Crowne, E, Morgan, J (2008). Is there a place for bariatric surgery in treating childhood obesity?. Arch. Dis. Child. 93: 369-372 [Full Text]  
• Abel, E. D., Litwin, S. E., Sweeney, G. (2008). Cardiac Remodeling in Obesity. Physiol. Rev. 88: 389-419 [Abstract] [Full Text]  
• Horvath, K., Jeitler, K., Siering, U., Stich, A. K., Skipka, G., Gratzer, T. W., Siebenhofer, A. (2008). Long-term Effects of Weight-Reducing Interventions in Hypertensive Patients: Systematic Review and Meta-analysis. Arch Intern Med 168: 571-580 [Abstract] [Full Text]  
• The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consens, (2008). Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod 23: 462-477 [Abstract] [Full Text]  
• Mokhlesi, B., Kryger, M. H., Grunstein, R. R. (2008). Assessment and Management of Patients with Obesity Hypoventilation Syndrome. Proc Am Thorac Soc 5: 218-225 [Abstract] [Full Text]  
• Bult, M. J F, van Dalen, T., Muller, A. F (2008). Surgical treatment of obesity. Eur J Endocrinol 158: 135-145 [Abstract] [Full Text]  
• Hainer, V., Toplak, H., Mitrakou, A. (2008). Treatment Modalities of Obesity: What fits whom?. Diabetes Care 31: S269-S277 [Abstract] [Full Text]  
• Schernthaner, G., Morton, J. M. (2008). Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes. Diabetes Care 31: S297-S302 [Full Text]  
• Dixon, J. B., O'Brien, P. E., Playfair, J., Chapman, L., Schachter, L. M., Skinner, S., Proietto, J., Bailey, M., Anderson, M. (2008). Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial. JAMA 299: 316-323 [Abstract] [Full Text]  
• Cummings, D. E., Flum, D. R. (2008). Gastrointestinal Surgery as a Treatment for Diabetes. JAMA 299: 341-343 [Full Text]  
• American Diabetes Association, (2008). Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association. Diabetes Care 31: S61-S78 [Full Text]  
• van der Woude, D., Beedupalli, J., Beale, M., Sjostrom, L., Lystig, T., Carlsson, L. (2007). Bariatric surgery and mortality.. NEJM 357: 2633-2633 [Full Text]  
• Omalu, B. I., Ives, D. G., Buhari, A. M., Lindner, J. L., Schauer, P. R., Wecht, C. H., Kuller, L. H. (2007). Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004. Arch Surg 142: 923-928 [Abstract] [Full Text]  
• Campos, G. M., Ciovica, R., Rogers, S. J., Posselt, A. M., Vittinghoff, E., Takata, M., Cello, J. P. (2007). Spectrum and Risk Factors of Complications After Gastric Bypass. Arch Surg 142: 969-975 [Abstract] [Full Text]  
• Guijarro, A., Suzuki, S., Chen, C., Kirchner, H., Middleton, F. A., Nadtochiy, S., Brookes, P. S., Niijima, A., Inui, A., Meguid, M. M. (2007). Characterization of weight loss and weight regain mechanisms after Roux-en-Y gastric bypass in rats. Am. J. Physiol. Regul. Integr. Comp. Physiol. 293: R1474-R1489 [Abstract] [Full Text]  
• Sjostrom, L., Narbro, K., Sjostrom, C. D., Karason, K., Larsson, B., Wedel, H., Lystig, T., Sullivan, M., Bouchard, C., Carlsson, B., Bengtsson, C., Dahlgren, S., Gummesson, A., Jacobson, P., Karlsson, J., Lindroos, A.-K., Lonroth, H., Naslund, I., Olbers, T., Stenlof, K., Torgerson, J., Agren, G., Carlsson, L. M.S., the Swedish Obese Subjects Study, (2007). Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. NEJM 357: 741-752 [Abstract] [Full Text]  
• Adams, T. D., Gress, R. E., Smith, S. C., Halverson, R. C., Simper, S. C., Rosamond, W. D., LaMonte, M. J., Stroup, A. M., Hunt, S. C. (2007). Long-Term Mortality after Gastric Bypass Surgery. NEJM 357: 753-761 [Abstract] [Full Text]  
• Bray, G. A. (2007). The Missing Link -- Lose Weight, Live Longer. NEJM 357: 818-820 [Full Text]  
• Eckhauser, A. W., Richards, W. O., Fowler, M. J. (2007). Bariatric Surgery for Patients With Diabetes. Clin. Diabetes 25: 83-89 [Abstract] [Full Text]  
• Dunn, J. P., Jagasia, S. M. (2007). Management of Type 2 Diabetes After Bariatric Surgery. Clin. Diabetes 25: 112-114 [Full Text]  
• Bloomgarden, Z. T. (2007). Gut Hormones, Obesity, Polycystic Ovarian Syndrome, Malignancy, and Lipodystrophy Syndromes. Diabetes Care 30: 1934-1939 [Full Text]  
• Cummings, S. (2007). Case Study: A Patient With Diabetes and Weight-Loss Surgery. Diabetes Spectr. 20: 173-176 [Full Text]  
• Bello, A. K., de Zeeuw, D., Nahas, M. E., Brantsma, A. H., Bakker, S. J. L., de Jong, P. E., Gansevoort, R. T. (2007). Impact of weight change on albuminuria in the general population. Nephrol Dial Transplant 22: 1619-1627 [Abstract] [Full Text]  
• Bray, G. A., Greenway, F. L. (2007). Pharmacological Treatment of the Overweight Patient. Pharmacol. Rev. 59: 151-184 [Full Text]  
• Rosenstock, J., Hollander, P., Gadde, K. M., Sun, X., Strauss, R., Leung, A., for the OBD-202 Study Group, (2007). A Randomized, Double-Blind, Placebo-Controlled, Multicenter Study to Assess the Efficacy and Safety of Topiramate Controlled Release in the Treatment of Obese Type 2 Diabetic Patients. Diabetes Care 30: 1480-1486 [Abstract] [Full Text]  
• DeMaria, E. J. (2007). Bariatric Surgery for Morbid Obesity. NEJM 356: 2176-2183 [Full Text]  
• Fantuzzi, G., Mazzone, T. (2007). Adipose Tissue and Atherosclerosis: Exploring the Connection. Arterioscler. Thromb. Vasc. Bio. 27: 996-1003 [Abstract] [Full Text]  
• Thakar, C. V., Kharat, V., Blanck, S., Leonard, A. C. (2007). Acute Kidney Injury after Gastric Bypass Surgery. CJASN 2: 426-430 [Abstract] [Full Text]  
• Wahba, I. M., Mak, R. H. (2007). Obesity and Obesity-Initiated Metabolic Syndrome: Mechanistic Links to Chronic Kidney Disease. CJASN 2: 550-562 [Abstract] [Full Text]  
• Lau, D. C.W., Douketis, J. D., Morrison, K. M., Hramiak, I. M., Sharma, A. M., Ur, E., for members of the Obesity Canada Clinical Practic, (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ 176: S1-S13 [Full Text]  
• Lau, D. C.W., Douketis, J. D., Morrison, K. M., Hramiak, I. M., Sharma, A. M., Ur, E., pour les membres du Groupe d'experts d'Obesite Can, (2007). Lignes directrices canadiennes de 2006 sur la prise en charge et la prevention de l'obesite chez les adultes et les enfants [sommaire]. CMAJ 176: SF1-SF14 [Full Text]  
• McDonald, S. D. (2007). Management and prevention of obesity in adults and children. CMAJ 176: 1109-1110 [Full Text]  
• Franz, M. J. (2007). The Evidence Is In: Lifestyle Interventions Can Prevent Diabetes. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 1: 113-121 [Abstract]  
• Rusch, M. D., Andris, D. (2007). Maladaptive Eating Patterns After Weight-Loss Surgery. Nutr Clin Pract 22: 41-49 [Abstract] [Full Text]  
• Abrahamson, M. J. (2007). A 74-Year-Old Woman With Diabetes. JAMA 297: 196-204 [Abstract] [Full Text]  
• Jacobson, P., Torgerson, J. S., Sjostrom, L., Bouchard, C. (2007). Spouse Resemblance in Body Mass Index: Effects on Adult Obesity Prevalence in the Offspring Generation. Am J Epidemiol 165: 101-108 [Abstract] [Full Text]  
• American Diabetes Association, (2007). Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association. Diabetes Care 30: S48-S65 [Full Text]  
• Heine, R J, Diamant, M, Mbanya, J-C, Nathan, D M (2006). Management of hyperglycaemia in type 2 diabetes: the end of recurrent failure?. BMJ 333: 1200-1204 [Full Text]  
• Pope, G. D., Finlayson, S. R.G., Kemp, J. A., Birkmeyer, J. D. (2006). Life Expectancy Benefits of Gastric Bypass Surgery. SURG INNOV 13: 265-273 [Abstract]  
• Hooning, M. J., Dorresteijn, L. D.A., Aleman, B. M.P., Kappelle, A. C., Klijn, J. G.M., Boogerd, W., van Leeuwen, F. E. (2006). Decreased Risk of Stroke Among 10-Year Survivors of Breast Cancer. JCO 24: 5388-5394 [Abstract] [Full Text]  
• Pontiroli, A. E., Pizzocri, P., Paroni, R., Folli, F. (2006). 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. Diabetes Care 29: 2735-2738 [Full Text]  
• Naslund, E., Kral, J. G. (2006). Impact of Gastric Bypass Surgery on Gut Hormones and Glucose Homeostasis in Type 2 Diabetes. Diabetes 55: S92-S97 [Abstract] [Full Text]  
• (2006). New Techniques and Guidelines Point Way to Bariatric Surgery. DOC News 3: 4-4 [Full Text]  
• Carver, C. (2006). Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes. The Diabetes Educator 32: 910-917 [Abstract] [Full Text]  
• Lidfeldt, J., Samsioe, G., Agardh, C.-D. (2006). Obese women and the relation between cardiovascular risk profile and hormone therapy, glucose tolerance, and psychosocial conditions.. Diabetes Care 29: 2477-2482 [Abstract] [Full Text]  
• Shah, M., Simha, V., Garg, A. (2006). Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status. J. Clin. Endocrinol. Metab. 91: 4223-4231 [Abstract] [Full Text]  
• Kral, J. G (2006). ABC of obesity. Management: Part III--surgery.. BMJ 333: 900-903 [Full Text]  
• American Diabetes Association, (2006). Nutrition Recommendations and Interventions for Diabetes-2006: A position statement of the American Diabetes Association.. Diabetes Care 29: 2140-2157 [Full Text]  
• Christ-Crain, M., Stoeckli, R., Ernst, A., Morgenthaler, N. G., Bilz, S., Korbonits, M., Struck, J., Bergmann, A., Muller, B., Keller, U. (2006). Effect of Gastric Bypass and Gastric Banding on Proneurotensin Levels in Morbidly Obese Patients. J. Clin. Endocrinol. Metab. 91: 3544-3547 [Abstract] [Full Text]  
• Malnick, S.D.H., Knobler, H. (2006). The medical complications of obesity. QJM 99: 565-579 [Full Text]  
• Gosman, G. G., Katcher, H. I., Legro, R. S. (2006). Obesity and the role of gut and adipose hormones in female reproduction. Hum Reprod Update 12: 585-601 [Abstract] [Full Text]  
• Pasquali, R., Gambineri, A. (2006). Insulin-sensitizing agents in polycystic ovary syndrome.. Eur J Endocrinol 154: 763-775 [Abstract] [Full Text]  
• O'Brien, P. E., Dixon, J. B., Laurie, C., Skinner, S., Proietto, J., McNeil, J., Strauss, B., Marks, S., Schachter, L., Chapman, L., Anderson, M. (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 [Abstract] [Full Text]  
• Wadden, T. A., Tsai, A. G. (2006). Bariatric Surgery: Crossing a Body Mass Index Threshold. ANN INTERN MED 144: 689-691 [Full Text]  
• Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., Eckel, R. H. (2006). Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss.. Arterioscler. Thromb. Vasc. Bio. 26: 968-976 [Abstract] [Full Text]  
• Morinigo, R., Moize, V., Musri, M., Lacy, A. M., Navarro, S., Marin, J. L., Delgado, S., Casamitjana, R., Vidal, J. (2006). Glucagon-Like Peptide-1, Peptide YY, Hunger, and Satiety after Gastric Bypass Surgery in Morbidly Obese Subjects. J. Clin. Endocrinol. Metab. 91: 1735-1740 [Abstract] [Full Text]  
• Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., Eckel, R. H. (2006). Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 113: 898-918 [Abstract] [Full Text]  
• Escobar-Morreale, H. F., Botella-Carretero, J. I., Alvarez-Blasco, F., Sancho, J., San Millan, J. L. (2005). The Polycystic Ovary Syndrome Associated with Morbid Obesity May Resolve after Weight Loss Induced by Bariatric Surgery. J. Clin. Endocrinol. Metab. 90: 6364-6369 [Abstract] [Full Text]  
• Holt, R. I. G. (2005). Obesity - an epidemic of the twenty-first century: an update for psychiatrists. J Psychopharmacol 19: 6-15 [Abstract]  
• Ryan, D. (2005). Risks and benefits of weight loss: challenges to obesity research. Eur Heart J Suppl 7: L27-L31 [Abstract] [Full Text]  
• Finer, N. (2005). Does pharmacologically induced weight loss improve cardiovascular outcome? Impact of anti-obesity agents on cardiovascular risk factors. Eur Heart J Suppl 7: L32-L38 [Abstract] [Full Text]  
• James, W. P. T. (2005). The SCOUT study: risk-benefit profile of sibutramine in overweight high-risk cardiovascular patients. Eur Heart J Suppl 7: L44-L48 [Abstract] [Full Text]  
• Flum, D. R., Salem, L., Broeckel Elrod, J. A., Dellinger, E. P., Cheadle, A., Chan, L. (2005). Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures. JAMA 294: 1903-1908 [Abstract] [Full Text]  
• Zingmond, D. S., McGory, M. L., Ko, C. Y. (2005). Hospitalization Before and After Gastric Bypass Surgery. JAMA 294: 1918-1924 [Abstract] [Full Text]  
• Courcoulas, A. P., Flum, D. R. (2005). Filling the Gaps in Bariatric Surgical Research. JAMA 294: 1957-1960 [Full Text]  
• Wolfe, B. M., Morton, J. M. (2005). Weighing In on Bariatric Surgery: Procedure Use, Readmission Rates, and Mortality. JAMA 294: 1960-1963 [Full Text]  
• Engeli, S., Bohnke, J., Feldpausch, M., Gorzelniak, K., Janke, J., Batkai, S., Pacher, P., Harvey-White, J., Luft, F. C., Sharma, A. M., Jordan, J. (2005). Activation of the Peripheral Endocannabinoid System in Human Obesity. Diabetes 54: 2838-2843 [Abstract] [Full Text]  
• Janssen, B., Hohenadel, D., Brinkkoetter, P., Peters, V., Rind, N., Fischer, C., Rychlik, I., Cerna, M., Romzova, M., de Heer, E., Baelde, H., Bakker, S. J.L., Zirie, M., Rondeau, E., Mathieson, P., Saleem, M. A., Meyer, J., Koppel, H., Sauerhoefer, S., Bartram, C. R., Nawroth, P., Hammes, H.-P., Yard, B. A., Zschocke, J., van der Woude, F. J. (2005). Carnosine as a Protective Factor in Diabetic Nephropathy: Association With a Leucine Repeat of the Carnosinase Gene CNDP1. Diabetes 54: 2320-2327 [Abstract] [Full Text]  
• Cummings, D. E. (2005). Gastric Bypass and Nesidioblastosis -- Too Much of a Good Thing for Islets?. NEJM 353: 300-302 [Full Text]  
• Vlassov, V. V., Sjostrom, L. (2005). Long-Term Outcome of Bariatric Surgery. NEJM 352: 1495-1496 [Full Text]  
• Snow, V., Barry, P., Fitterman, N., Qaseem, A., Weiss, K., for the Clinical Efficacy Assessment Subcommittee, (2005). Pharmacologic and Surgical Management of Obesity in Primary Care: A Clinical Practice Guideline from the American College of Physicians. ANN INTERN MED 142: 525-531 [Abstract] [Full Text]  
• Maggard, M. A., Shugarman, L. R., Suttorp, M., Maglione, M., Sugerman, H. J., Livingston, E. H., Nguyen, N. T., Li, Z., Mojica, W. A., Hilton, L., Rhodes, S., Morton, S. C., Shekelle, P. G. (2005). Meta-Analysis: Surgical Treatment of Obesity. ANN INTERN MED 142: 547-559 [Abstract] [Full Text]  
• Padwal, R. S., Lewanczuk, R. Z. (2005). Trends in bariatric surgery in Canada, 1993-2003. CMAJ 172: 735-735 [Full Text]  
• Tarantino, D. P., Smith, D. B. (2005). Bariatric Surgery: Assessing Opportunities for Value Innovation. SURG INNOV 12: 91-99 [Abstract]  
• (2005). Long-Term Outcomes After Bariatric Surgery. Journal Watch Cardiology 2005: 4-4 [Full Text]  
• (2005). Endocrinology & Metabolism News February 2005. J. Clin. Endocrinol. Metab. 90: 16a-16a [Full Text]  
• (2005). 10-Year Follow-Up After Bariatric Surgery. JWatch General 2005: 3-3 [Full Text]  
• Solomon, C. G., Dluhy, R. G. (2004). Bariatric Surgery -- Quick Fix or Long-Term Solution?. NEJM 351: 2751-2753 [Full Text]