A Weill Cornell Medicine-Qatar (WCM-Q) researcher has helped to demonstrate that gastric bypass operations lead to maintenance of weight loss as well as remission and prevention of type 2 diabetes, high blood pressure and high cholesterol 12 years after the surgery.
Dr Steven Hunt, professor of genetic medicine, played a key role in a long-term research project that found that patients who underwent a type of gastric bypass operation called ‘Roux-en-Y’ had lost an average of 35kg of body weight 12 years after surgery.
Furthermore, 51% of patients who had type 2 diabetes at the time of surgery no longer had the disease 12 years after their gastric bypass procedure. Patients who had the surgery also had higher rates of remission and prevention of hypertension (high blood pressure) and dyslipidemia (high cholesterol) than those who did not have the surgery.
In a Roux-en-Y gastric bypass, a surgeon staples off a section of the upper stomach to form a small pouch about the size of an egg. This section is then attached to a part of the small intestine called the Roux limb, forming a Y-shape and bypassing the majority of the stomach. This severely limits the amount of food the patient can eat, which aids weight loss.
The observational study, entitled ‘Weight and Metabolic Outcomes 12 Years after Gastric Bypass’, has now been published in The New England Journal of Medicine, one of the world’s foremost medical journals.
The research, which drew upon the expertise of researchers at WCM-Q and a number of institutions in the US, analysed data collected over a 12-year period from 1,156 patients with severe obesity who visited a bariatric surgical centre at Rocky Mountain Associated Physicians or the University of Utah in Salt Lake City, Utah. Researchers compared the outcomes of patients in three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass surgery; 417 patients who sought but did not undergo surgery, mainly for insurance reasons; and 321 patients who did not seek surgery.
The results of the study provide strong evidence for the efficacy of Roux-en-Y surgery for long-term weight loss and prevention and remission of type 2 diabetes, hypertension and dyslipidemia. Those who underwent surgery also showed lower incidence of mortality and cancer than those who did not.
Dr Hunt said: “This is really the only long-term controlled study of Roux-en-Y gastric bypass outcomes and the results are encouraging. A lot of people are keeping a lot of weight off and new-onset type 2 diabetes was almost done away with. For those who did have type 2 diabetes at the start of the study, most went into remission, particularly if they had not yet started diabetes medication. Even those with type 2 diabetes who were already on medication went into remission, though they were at greater risk of the diabetes coming back. However, even when the diabetes came back, in many cases they were free of the disease for six to 12 years, which means they are more likely to have delayed onset of typical diabetes complications like neuropathy, impaired vision and amputations, which would be a very good outcome.
“In a larger Utah study of gastric bypass surgery, total mortality was significantly reduced. Incidence and mortality of cancer was also reduced, especially in obesity-related cancers.”
However, patients who have Roux-en-Y gastric bypass surgery are less able to absorb nutrients like calcium and vitamin D, and experience higher incidence of depression, death by accidental poisoning (thought to be caused by substance abuse) and death by suicide than those who did not have the procedure.
Dr Hunt added: “While patients who have the surgery generally report improved mobility, health and health-related quality of life, they often still have psychosocial difficulties. Some surgeons are starting to address this by doing more preoperative evaluation of psycho-social factors, giving more counselling and being more proactive in the prescription of drug therapies for mental health issues.”
Other institutions involved in the research along with WCM-Q included the University of Utah, Brigham Young University, Duke University Health System and Intermountain Healthcare in Utah, among others.
The study was supported by funds from WCM-Q’s Biomedical Research Programme and grants from the US National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and the US National Center for Research Resources.
Dr Khaled Machaca, associate dean of Research at WCM-Q, said: “The impact of this long term follow-up study cannot be overestimated as it validates beyond doubt the beneficial effect of the Roux-en-Y surgery in terms of sustained weight loss. This affects the attitudes of both physicians and patients alike toward the approach as they consider potential ways to manage both obesity or diabetes. This significance of the study is reflected by its publication in The New England Journal of Medicine, the premier journal of clinical and translational medicine. Dr Hunt’s contributions attest to the calibre and impact that research conducted by WCM-Q faculty can have internationally.”

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