Other Studies Comparing Nonsurgical And Surgical Treatment

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While SOS has compared surgical treatment with treatment delivered by general practitioners at 480 primary heath care centres in Sweden (2), three other studies have compared surgical treatment with dietary treatment undertaken by more or less specialized obesity clinics (40-45).

Figure 35.14 Obesity-related psychosocial problems in everyday life by weight reduction during 2 years intervention in the SOS study. Indicated weight change classes obtained after pooling of 487 surgically treated patients and 487 obese controls followed for 2 years. The psychosocial problems were estimated with the validated OP instrument. High scores represent dysfunction. Groups with different letters are significantly different at 2-year follow-up (P < 0.05, Turkey's range test). From Karlsson et al. (39), with permission

Figure 35.14 Obesity-related psychosocial problems in everyday life by weight reduction during 2 years intervention in the SOS study. Indicated weight change classes obtained after pooling of 487 surgically treated patients and 487 obese controls followed for 2 years. The psychosocial problems were estimated with the validated OP instrument. High scores represent dysfunction. Groups with different letters are significantly different at 2-year follow-up (P < 0.05, Turkey's range test). From Karlsson et al. (39), with permission

Jejuno-ileal Bypass vs. Diet

In 'The Danish Obesity Project' (40,41) 202 patients were randomized in the proportions 2: 1 to jejunoileal bypass or diet treatment. Six patients never came to treatment. The remaining 130 surgically treated and 66 diet treated patients were followed for 2 to 3 years. After 2 years, the weight loss was 42.9 kg in the surgically treated group and 5.9 kg in the diet group. Quality of life as well as blood pressure were markedly improved in the surgical group. However, the surgical group had a large number of complications some of which were serious. As discussed below, jejuno-ileal bypass is no longer recommended due to serious side effects.

randomized to horizontal gastroplasty or very low calorie diet (VLCD) followed by traditional dieting. A 2-year (42) and 5-year (43) report appeared in the mid-1980s. Unfortunately, less than 50% of the patients had in fact been followed for 2 and 5 years, respectively, when the reports were written. At 2 years the weight loss was 30.6 kg in the gastroplasty group and 8.2 kg in the VLCD/diet group. Weight losses are not reported at 5 years. Instead, a 'cumulated success rate' defined as more than 10 kg maintained weight loss was given. This success rate was 16% in the patients operated with horizontal gastroplasty and 3% in the VLCD/diet group. Horizontal gastroplasties are no longer in use due to poor long-term results (1,44,45).

Horizontal Gasroplasty vs. VLCD Followed by Diet

In another early Danish study 60 patients were

Gastric Bypass vs. VLCD and Diet

In a prospective, non-randomized, non-matched study Martin et al. compared gastric bypass (GBP)

(n = 201) with VLCD followed by diet (n = 161) 46). After VLCD, the diet group was offered one counselling session per week for 18 months and then annual follow-ups. The follow-up ranged from 2 to 6 years. At 6 years the follow-up rate was 34.5% in the GBP group and 19.7% in the VLCD/diet group. In the GBP group BMI dropped from 49.3 kg/m2 to a minimum of 31.8 after 2 years. At 6 years BMI was 33.7 kg/m2. In the VLCD/diet group the corresponding figures were 41.2, 32.1 and 38.5. As compared to VLCD/diet treatment, GBP thus resulted in twice as large a BMI drop and in a much smaller relapse.

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