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      Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients :

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          Abstract

          This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients. Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown. We used an observational 2-cohort study. The treatment cohort (n = 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n = 5746) included age- and gender-matched severely obese patients who had not undergone weight-reduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception. The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P < 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%. This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.

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          Annual deaths attributable to obesity in the United States.

          Obesity is a major health problem in the United States, but the number of obesity-attributable deaths has not been rigorously estimated. To estimate the number of deaths, annually, attributable to obesity among US adults. Data from 5 prospective cohort studies (the Alameda Community Health Study, the Framingham Heart Study, the Tecumseh Community Health Study, the American Cancer Society Cancer Prevention Study I, and the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published study (the Nurses' Health Study) in conjunction with 1991 national statistics on body mass index distributions, population size, and overall deaths. Adults, 18 years or older in 1991, classified by body mass index (kg/m2) as overweight (25-30), obese (30-35), and severely obese (>35). Relative hazard ratio (HR) of death for obese or overweight persons. The estimated number of annual deaths attributable to obesity varied with the cohort used to calculate the HRs, but findings were consistent overall. More than 80% of the estimated obesity-attributable deaths occurred among individuals with a body mass index of more than 30 kg/m2. When HRs were estimated for all eligible subjects from all 6 studies, the mean estimate of deaths attributable to obesity in the United States was 280184 (range, 236111-341153). Hazard ratios also were calculated from data for nonsmokers or never-smokers only. When these HRs were applied to the entire population (assuming the HR applied to all individuals), the mean estimate for obesity-attributable death was 324 940 (range, 262541-383410). The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.
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            Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up.

            The authors have performed the laparoscopic gastric bypass since 1993 and perform about one-half of bariatric cases laparoscopically. Since our initial report, several groups throughout the world have preformed the gastric bypass laparoscopically, with various modifications. Prospectively, we followed and recorded the results of our laparoscopic patients. A detailed pre- and post-operative analysis of the patient's co-morbidities is performed as well as complete weight and laboratory data evaluation. With > 80% follow-up, we found an excess weight loss of about 80% by the first year. This degree of loss is well sustained. Over 95% of the significant pre-operative co-morbidities are controlled. The laparoscopic gastric bypass has been refined over 5 years of use. Though we have not changed the basic operation as we originally described, others have modified the various anastomotic techniques. The weight loss results are very good to excellent, with patients now out to "long-term" follow-up. Resolution of the co-morbidities is documented. The operation has an adequate track record to show effectiveness, and training programs should be established to maximize safety.
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              Recommendations for reporting weight loss.

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                Author and article information

                Journal
                Annals of Surgery
                Annals of Surgery
                Ovid Technologies (Wolters Kluwer Health)
                0003-4932
                2004
                September 2004
                : 240
                : 3
                : 416-424
                Article
                10.1097/01.sla.0000137343.63376.19
                1356432
                15319713
                a1023f7f-785a-4e9f-9e63-62a194ed8838
                © 2004
                History

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