SOURCE: Adams TD, Davidson LE, Litwin SE, et al. N Engl J Med 2017;377:1143-1155.

While often viewed as a last-resort treatment of obesity, bariatric surgery actually is the only intervention demonstrated to improve obesity-related mortality. Strict criteria for payment by insurers and costs that are inaccessible to most of the uninsured have restricted the population who could benefit from bariatric surgery.

Adams et al enhanced the somewhat sparse literature on long-term outcomes with bariatric surgery. Their 12-year prospective follow-up of patients with severe obesity included a bypass surgery group (n = 418), a group intended for surgery (n = 417) but who ultimately did not undergo surgery (e.g., for lack of insurance coverage), and a matched group of severely obese patients not seeking surgical treatment. Favorable impact was sustained over the 12-year observation period. Overall weight loss at 12 years was 35 kg (bariatric surgery) vs. 2.9 kg (intended surgery) and 0 kg (no surgery). For diabetics at the time of bariatric surgery, diabetes remained in remission for more than half of patients at 12 years. The likelihood of new-onset diabetes over 12 years of follow-up among those not diabetic at baseline was reduced by > 90%. The benefits of bariatric surgery are substantial, prompt, and enduring.