In one 2-year report on 767 surgically treated patients and 712 obese controls, the weight loss was 28 ± 15 kg (means ± SD) and 0.5 ± 8.9 kg, respectively (4). The percentage reductions after gastric bypass, VBG and banding were 33 + 10, 23 + 10 and 21 + 12%, respectively. Similar 2-year changes in body weight were recently reported for 1210 surgically treated and 1099 control subjects of SOS (5).
The energy intake before and during weight loss was studied by means of a validated dietary questionnaire (6,7) in 365 patient operated with VBG or banding and in 34 patients operated with gastric
bypass (8). Although the weight loss was 38.6 kg in the gastric bypass group but only 26.7 kg in the combined VBG and banding group, the energy intake before and after surgery did not differ between the groups (Figure 35.4). It has been shown that gastric bypass is associated with increased energy expenditure (9), perhaps due to an increased secretion of glucagon-like peptide 1 (GLP-1) (10,11).
In another report, 346 surgically treated patients and 346 controls were followed for 8 years (12). At 8 years, 251 surgically treated patients (73%) and 232 controls (67%) had completed the study. All dead individuals are included among non-completers since mortality figures are not yet released from the safety monitoring committee of SOS. Weight changes of completers in the four groups are shown in Figure 35.5. As in the 2-year report, there was no significant weight change in the control group while the surgically treated groups reached minimum weights after one year. As expected, gastric bypass was more efficient than VBG and banding. Between the end of year 1 and the end of year 8, a slow relapse was seen in all of the surgically treated groups. However, as compared to inclusion, the surgically induced weight loss was still 20.1 ± 15.7 kg (16.5%) after 8 years, while the controls had increased their body weight 0.7 + 12.0 kg. The difference in the 8-year body weight change between the two groups was highly significant (P < 0.001).
Figure 35.5 illustrates also that conventional, non-pharmacological treatment of severe obesity is of little benefit when undertaken by non-specialized treatment units. This implies personal tragedies for millions of obese persons not having access to specialized treatment and immense consequences from a public health point of view.
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