Providing Comprehensive Care for Patients with Obesity

Help Patients Compare Bariatric Surgery Outcomes, Implement Lifestyle Changes

June 8, 2022

Obesity and Bariatric Surgery
Findings from a Patient-Centered Outcomes Research Institute (PCORI)-funded study comparing types of weight loss surgery include helpful takeaways for all PAs who treat patients with obesity, especially those who might be considering bariatric surgery as part of their long-term obesity management plan. PCORI’s Evidence Update for Clinicians summarizes these study findings and compares the outcomes of two surgery types.

Not all patients with obesity are able to lose weight through diet and exercise alone. Bariatric surgery can help patients lose weight and improve problems related to obesity, like diabetes. To help patients and clinicians determine if weight loss surgery is a viable option – and if so, which type best aligns with the patient’s goals and safety – this study compared the outcomes of the two most common types of surgery: Roux-en-Y gastric bypass (gastric bypass) and sleeve gastrectomy (sleeve).

Choosing a Type of Surgery
Notably, professional organizations do not recommend one specific type of bariatric surgery, but instead advise that clinicians and patients discuss and decide together based on the patient’s health, weight loss goals, and safety. Overall, the study found that both types of surgery resulted in weight loss and clinically comparable Type 2 Diabetes remission rates for the majority of patients. Additionally, many patients noted increased mobility and improvements in chronic health problems or in their mood, depression, or anxiety.

Ultimately, the study found that gastric bypass resulted in more favorable post-surgery outcomes. When measuring total weight loss, patients who received gastric bypass had better results: Five years post-surgery, patients who had gastric bypass lost 26% of their total weight compared to patients who had sleeve, who lost 19% of their total weight.

Gastric bypass also had a greater positive impact on patients with Type 2 Diabetes. When measuring diabetes remission rates, the study found that diabetes returned in 42% of people who had sleeve compared to 33% of people who had gastric bypass. Additionally, the risk of glycemic relapse was 25% lower for patients who had gastric bypass compared with patients who had sleeve. Both surgeries were overall beneficial for patients with Type 2 Diabetes, as approximately 85% of patients no longer needed to take medicine for Type 2 Diabetes at some point in the five years following either surgery.

While gastric bypass led to greater total weight loss and diabetes remission rates, it was also slightly riskier. This surgery type was associated with a higher rate of adverse outcomes, where patients needed additional abdominal surgeries or rehospitalization after undergoing gastric bypass. In the five years after surgery, patients who had gastric bypass had a 12% chance of needing another surgery, compared to 9% of patients who had sleeve. In the study, death following weight loss surgery happened in less than 1% of all patients, with no difference in risk of death between the two surgery types.

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Bariatric Surgery as a Weight Loss Tool
Many PAs, especially those practicing in primary care, diagnose and treat patients with obesity. Comprehensive care plans for post-bariatric surgery patients rely on the same long-term weight loss strategies and lifestyle modifications PAs would recommend to patients with obesity to achieve prolonged weight control.

Most patients in the study experienced some weight gain after their initial post-surgery weight loss. Educating patients on making changes in diet and exercise can help prevent significant weight gain following surgery, just as these same strategies can be used to treat obesity. Furthermore, some patients should be prepared to seek lifelong follow-up care from a surgeon or bariatrician.

Patients in the study faced other mental and social challenges more specific to receiving weight loss surgery. For example, some patients experienced negative reactions from friends and family who viewed their surgery as a “shortcut” to weight loss. Participating in therapy or a patient support group are potential strategies PAs could recommend to patients to cope with these interpersonal challenges.

PAs in primary care or other settings who are working with patients considering weight loss surgery should be prepared to discuss these common questions:

  • What are the benefits of weight loss surgery? What are the harms?
  • Which type of weight loss surgery is best for me?
  • What other changes and challenges should I expect, and what kinds of support are available to me?

See the Evidence Update for Patients to read more about weight loss surgery considerations from a patient perspective.

This content was developed in a collaboration between the Patient-Centered Outcomes Research Institute (PCORI) and AAPA, to share the Evidence Update and research findings with the PA audience. PCORI’s Evidence Updates are freely accessible to all.

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