SOURCE: Jakobsen GS, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA 2018;319:291-301.

For most patients, managing obesity is a long-term endeavor. Recent proliferation of oral and parenteral anti-obesity agents has increased the number of pharmacologic treatments. Still, long-term weight reduction achieved with such treatments, in combination with lifestyle interventions, is modest (typically, 5-10% body weight decline). Additionally, pharmacologic treatments are not disease-modifying; that is, after medication cessation, weight regain occurs consistently and predictably.

Obesity surgery produces prompt and highly effective metabolic changes that favorably affect prevalent and incident diabetes and hypertension. But do these results last? To answer that question, Jakobsen et al reported on a 10-year follow-up of patients with obesity who were offered their choice of surgical or intensive medical treatment (n = 1,888) at a publicly funded tertiary care obesity center in Norway.

Outcomes differences between the groups were dramatic. Subjects who chose surgical treatment were twice as likely to go into hypertension remission, four times less likely to develop new onset hypertension, and four times more likely to experience remission of diabetes than medically treated subjects. Although surgical intervention was not without adverse effects, including a difficult-to-explain modest increased incidence of depression, metabolic benefits were consistent and enduring. The evidence of the advantages of bariatric surgery over medical management continues to accrue.