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Review: sparse high quality evidence supports surgery for obesity

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 Q How effective and safe are surgical treatments for obesity?


Embedded ImageData sources:

Medline and EMBASE/Excerpta Medica (to July 2003), and existing systematic reviews.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs), controlled clinical trials, cohort studies, and case series that evaluated surgical treatment of obesity.

Embedded ImageOutcomes:

weight loss, mortality, complication rates, and control of major obesity related comorbid conditions.


147 studies met the inclusion criteria: 89 reported weight loss results (mean age 38 y, 75% women, baseline body mass index 47 kg/m2), 134 reported mortality rates, and 128 reported complications rates. The analysis focused on the most common currently performed surgical procedures: Roux-en-Y gastric bypass (RYGB) (including open and laparoscopic), vertical banded gastroplasty (VBG), adjustable gastric banding, and biliopancreatic diversion (including duodenal switch).

Weight loss. 3 RCTs compared surgery with no surgery. 2 older RCTs favoured surgery: 1 RCT from 1984 showed greater weight loss at 24 months with horizontal gastroplasty plus diet than with diet alone (31 v 8 kg); 1 RCT from 1979 comparing jejunoileal bypass with medical treatment showed a 37 kg difference favouring surgery at 24 months. 1 RCT available only in abstract form that compared surgery with medical therapy (very low calorie diet, pharmacotherapy, and …

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  • For correspondence: Dr M A Maggard, University of California, Los Angeles, Los Angeles, CA, USA.

  • Source of funding: Agency for Healthcare Research and Quality.