Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity-Changes in Body Weight, Risk Factors and Comorbidities at 1 Year
Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity-Changes in Body Weight, Risk Factors and Comorbidities at 1 Year
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DOI：
10.1007/s11695-010-0131-1
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发表时间：
2011-07-01
期刊：
影响因子：
2.9
通讯作者：
Kulseng, Bard
中科院分区：
文献类型：
--
作者：
Martins, Catia;Strommen, Magnus;Kulseng, Bard
很少有研究关注病态肥胖患者的非手术替代方案。本研究旨在比较减肥手术和三种保守治疗后1年的体重减轻以及危险因素和合并症的变化。在减肥手术等候名单上的患者（BMI > 40或BMI > 35 kg/m2加上合并症），非随机分配到（A）减肥手术或三种保守治疗之一;（B）住院间歇治疗方案;（C）商业减肥营和（D）医院门诊计划。在基线和1年时评估体重、危险因素和合并症。在206名参与者中，179名完成了研究。所有治疗均导致体重显著减轻，但减肥手术（40 +/- 14 kg，31 +/- 9%）导致最大体重减轻（P < 0.0001）。B和C之间的体重减轻没有差异（22 +/- 13 kg，15 +/- 8% vs. 18 +/- 12 kg，13 +/- 8%），但与D相比，这些导致更大的体重减轻（7 +/- 10 kg，5 +/- 8%）。两组间总胆固醇或LDL胆固醇、三酰甘油或葡萄糖的变化无差异;然而，A组和C组HDL胆固醇的增加显著更大。A组和B组、C组和D组合并的合并症缓解率无差异（高血压除外，A组更好）。总之，尽管减肥手术与保守治疗相比，1年时体重减轻更大，但在病态肥胖患者中，生活方式干预也可实现临床显著体重减轻以及危险因素和合并症缓解率的类似改善。
Few studies have looked at non-surgical alternatives for morbid obese patients. This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments.Patients with morbid obesity (BMI > 40 or BMI > 35 kg/m(2) plus comorbidities) on waiting list for bariatric surgery, were non-randomly allocated to (A) bariatric surgery or to one of three conservative treatments; (B) residential intermittent program; (C) commercial weight loss camp and (D) hospital outpatient program. Body weight, risk factors and comorbidities were assessed at baseline and 1 year.Of 206 participants, 179 completed the study. All treatments resulted in significant weight loss, but bariatric surgery (40 +/- 14 kg, 31 +/- 9%) led to the largest weight loss (P < 0.0001). There were no differences in weight loss between B and C (22 +/- 13 kg, 15 +/- 8% vs. 18 +/- 12 kg, 13 +/- 8%), but these resulted in larger weight loss compared with D (7 +/- 10 kg, 5 +/- 8%). There were no differences in changes in total or LDL cholesterol, triacylglycerols or glucose between groups; however, the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B, C and D combined (except hypertension, which was better in group A).In conclusion, although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment, in patients with morbid obesity, clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions.