This Article Full Text Full Text (PDF) All Versions of this Article: 91/11/4223    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shah, M. Articles by Garg, A. Search for Related Content PubMed PubMed Citation Articles by Shah, M. Articles by Garg, A. Related Collections Metabolism Obesity

Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status

Division of Nutrition and Metabolic Diseases (M.S., V.S., A.G.), Department of Internal Medicine (V.S., A.G.), and Center for Human Nutrition (M.S., V.S., A.G.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-9052; and Department of Kinesiology (M.S.), Texas Christian University, Fort Worth, Texas 76129

Address all correspondence and requests for reprints to: Abhimanyu Garg, M.D., Professor and Chief, Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9052. E-mail: abhimanyu.garg{at}utsouthwestern.edu.

Context: The number of patients who undergo Roux-en-Y gastric bypass (RYGB) and gastric banding (GB) surgeries has increased dramatically over the past decade, yet the long-term impact of these surgeries on body weight, comorbidities, and nutritional status remains unclear, as do the mechanisms of weight regain.

Evidence Acquisition: The articles were found via PubMed searches. To review the impact of bariatric surgery on weight maintenance and comorbidities, only articles with a postoperative follow-up of 3 yr or longer were included. The articles on nutritional status had a follow-up of 12 months or longer.

Conclusions: RYGB and GB surgeries lead to substantial weight loss in individuals with morbid obesity. However, significant weight regain occurs over the long term, and according to the only well-designed prospective controlled study, the improvement in comorbidities associated with weight loss mitigates in the long term on weight regain. There is some evidence from a retrospective study that RYGB surgery is associated with a modest decrease in long-term mortality. These results remain to be substantiated by well-designed, long-term, randomized and prospective controlled studies. The mechanisms that lead to weight regain need to be further examined and may include increase in energy intake due to enlargement of stoma and adaptive changes in the levels of gut and adipocyte hormones such as ghrelin and leptin, which regulate energy intake; decrease in physical activity; changes in energy expenditure; and other factors. In addition to weight regain, RYGB surgery is associated with frequent incidence of iron, vitamin B12, folate, calcium, and vitamin D deficiency, which requires regular supplementation and monitoring.

This article has been cited by other articles:

				A. V. Mayorov, N. Amara, J. Y. Chang, J. A. Moss, M. S. Hixon, D. I. Ruiz, M. M. Meijler, E. P. Zorrilla, and K. D. Janda Catalytic antibody degradation of ghrelin increases whole-body metabolic rate and reduces refeeding in fasting mice PNAS, November 11, 2008; 105(45): 17487 - 17492. [Abstract] [Full Text] [PDF]

				J. Fleischer, E. M. Stein, M. Bessler, M. D. Badia, N. Restuccia, L. Olivero-Rivera, D. J. McMahon, and S. J. Silverberg The Decline in Hip Bone Density after Gastric Bypass Surgery Is Associated with Extent of Weight Loss J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3735 - 3740. [Abstract] [Full Text] [PDF]

				M. Riedl, G. Vila, C. Maier, A. Handisurya, S. Shakeri-Manesch, G. Prager, O. Wagner, A. Kautzky-Willer, B. Ludvik, M. Clodi, et al. Plasma Osteopontin Increases After Bariatric Surgery and Correlates with Markers of Bone Turnover But Not with Insulin Resistance J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2307 - 2312. [Abstract] [Full Text] [PDF]

				J P H Shield, E Crowne, and J Morgan Is there a place for bariatric surgery in treating childhood obesity? Arch. Dis. Child., May 1, 2008; 93(5): 369 - 372. [Full Text] [PDF]

				S. F. Clark Iron Deficiency Anemia Nutr Clin Pract, April 1, 2008; 23(2): 128 - 141. [Abstract] [Full Text] [PDF]