Bariatric issues: research on the long term benefits and risks of bariatric surgery, JAMA article

The JAMA Network, a set of 10 online journals published by JAMA, published “Long-term Risks and Benefits of Bariatric Surgery: A Research Challenge” on 10-1-14.

To summarize very briefly, the article strikes me as having a VERY conservative tone. It begins with, “Bariatric surgery results in lasting weight loss and is recognized as improving metabolic aspects of obesity, for which long-term outcomes remain poorly defined. Many important research questions remain unanswered, contributing to limited use of bariatric surgery for both weight loss and metabolic conditions.” I think that this understates the research in support of the benefits of bariatric surgery and is a very cautious statement about the emerging research about long term outcomes, which has, I think, emerging results better than ‘poorly defined.”

The authors are, I believe, accurate when stating that for some medical professionals and overweight patients there are concerns about bariatric surgery that cause them to hold off on what could be potentially helpful, or even life-saving, treatment.

The article goes on to discuss technical aspects of the research challenges for studying the long term benefits and risk of bariatric surgery, which are considerable. The authors note that a particularly challenging factor is the fact that there is a wide range of responses to bariatric surgery. In other words, overall there may be significant outcomes for patients who have had bariatric surgery as a group, but at the individual level there is a wide range of responses in regard to weight loss and and the status of theiir comorbid conditions, including mental health conditions. The author’s also note that the current research does not tell us much about predictors of good our bad outcomes for both weight loss and comorbid conditions.

The authors conclude, “High-quality evidence shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments and are more effective at inducing initial type 2 diabetes mellitus remission in obese patients.” They end with the most common refrain for most research reports: “more research is needed.”

Overall, this article provides a very basic, but somewhat cautious, summary of the status of current research about bariatric surgery.

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