PMID- 26694640 OWN - NLM STAT- MEDLINE DCOM- 20160325 LR - 20220318 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 12 IP - 12 DP - 2015 Dec TI - Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care. PG - e1001925 LID - 10.1371/journal.pmed.1001925 [doi] LID - e1001925 AB - BACKGROUND: Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. METHODS AND FINDINGS: This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83); hypertension, 0.35 (95% CI 0.27-0.45); angina, 0.59 (95% CI 0.40-0.87);MI, 0.28 (95% CI 0.10-0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI 2.65-11.99). No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66-1.43). The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes. CONCLUSIONS: Bariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese. FAU - Douglas, Ian J AU - Douglas IJ AD - Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. FAU - Bhaskaran, Krishnan AU - Bhaskaran K AD - Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. FAU - Batterham, Rachel L AU - Batterham RL AD - Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom. AD - University College London Hospitals Bariatric Centre for Weight Management and Metabolic Surgery, London, United Kingdom. AD - National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom. FAU - Smeeth, Liam AU - Smeeth L AD - Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. LA - eng GR - MR/K006584/1/MRC_/Medical Research Council/United Kingdom GR - 107731/Z/15/Z/WT_/Wellcome Trust/United Kingdom GR - 107731/Wellcome Trust/United Kingdom GR - 098504/Wellcome Trust/United Kingdom GR - G0802403/1/MRC_/Medical Research Council/United Kingdom GR - Wellcome Trust/United Kingdom GR - G0802403/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20151222 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM CIN - BMJ. 2015;351:h6917. PMID: 26705346 MH - Adult MH - *Bariatric Surgery/adverse effects/statistics & numerical data MH - *Body Mass Index MH - Comorbidity MH - Female MH - Humans MH - Male MH - Middle Aged MH - Obesity/*epidemiology/surgery MH - Retrospective Studies MH - *Treatment Outcome MH - United Kingdom/epidemiology MH - *Weight Loss PMC - PMC4687869 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: RLB has consulted for GlaxoSmithKline and received honoraria from Ethicon and Pfizer. EDAT- 2015/12/24 06:00 MHDA- 2016/03/26 06:00 PMCR- 2015/12/22 CRDT- 2015/12/24 06:00 PHST- 2015/06/08 00:00 [received] PHST- 2015/11/12 00:00 [accepted] PHST- 2015/12/24 06:00 [entrez] PHST- 2015/12/24 06:00 [pubmed] PHST- 2016/03/26 06:00 [medline] PHST- 2015/12/22 00:00 [pmc-release] AID - PMEDICINE-D-15-01712 [pii] AID - 10.1371/journal.pmed.1001925 [doi] PST - epublish SO - PLoS Med. 2015 Dec 22;12(12):e1001925. doi: 10.1371/journal.pmed.1001925. eCollection 2015 Dec.