title: Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Factors associated with weight loss after gastric bypass. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult‐Onset Diabetes Mellitus Loss of 50% of excess weight using a very low energy diet improves insulin-stimulated glucose disposal and skeletal muscle insulin signalling in obese insulin-treated type 2 diabetic patients Early Results of Laparoscopic Biliopancreatic Diversion with Duodenal Switch: A Case Series of 40 Consecutive Patients A Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity: Outcomes, Quality of Life, and Costs Normalization of fasting hyperglycaemia by exogenous glucagon-like peptide 1 (7-36 amide) in Type 2 (non-insulin-dependent) diabetic patients Effect of Lap-Band®-Induced Weight Loss on Type 2 Diabetes Mellitus and Hypertension Sleeve Gastrectomy and Gastric Banding: Effects on Plasma Ghrelin Levels Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Improvement in comorbid illness after placement of the Swedish Adjustable Gastric Band. Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Perioperative safety in the longitudinal assessment of bariatric surgery. The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones
abstract: OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention BACKGROUND A very-low-energy diet ( VLED ) can result in substantial , rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity . Despite its growing popularity , a VLED in this setting has received little attention . OBJECTIVE The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED . DESIGN In a prospect i ve observational study , 32 subjects ( n = 19 men and 13 women ) with a mean ( + /-SD ) age of 47.5 + /- 8.3 y and a body mass index ( in kg/m(2 ) ) of 47.3 + /- 5.3 consumed a VLED for 12 wk . Primary outcomes included changes in liver volume ( LV ) and in visceral and subcutaneous adipose tissue ( VAT/SAT ) . Changes in body weight , anthropometric measures , and biochemical variables were also recorded , and compliance with , acceptability of , and side effects of treatment were assessed . Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2 , 4 , 8 , and 12 . RESULTS Mean ( + /-SD ) LV , VAT/SAT , and body weight decreased significantly ( P < 0.001 for all ) . The degree of LV reduction was directly related to the reduction in relative body weight ( r = 0.54 , P = 0.001 ) and initial LV ( r = 0.43 , P = 0.015 ) . Eighty percent of the reduction in LV occurred between weeks 0 and 2 ( P < 0.001 ) . Reductions in body weight and VAT were uniform over the 12-wk period . Attrition was 14 % . Acceptability was adequate but waned over time , and mild transitory side effects occurred . CONCLUSIONS Given the observed early reduction in LV and the progressive reduction in VAT , we suggest that the minimum duration for a preoperative VLED be 2 wk . Ideally , the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability BACKGROUND Gastric bypass ( GBP ) is the most common operation performed in the United States for morbid obesity . However , weight loss is poor in 10 % to 15 % of patients . We sought to determine the independent factors associated with poor weight loss after GBP . DESIGN Prospect i ve cohort study . We examined demographic , operative , and follow-up data by means of multivariate analysis . Variables investigated were age , sex , race , marital and insurance status , initial weight and body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) , comorbidities ( diabetes mellitus , hypertension , joint disease , sleep apnea , hyperlipidemia , and psychiatric disease ) , laparoscopic vs open surgery , gastric pouch area , gastrojejunostomy technique , and alimentary limb length . SETTING University tertiary referral center . PATIENTS All patients at our institution who underwent GBP from January 1 , 2003 , through July 30 , 2006 . MAIN OUTCOME MEASURES Weight loss at 12 months defined as poor ( < or = 40 % excess weight loss ) or good ( > 40 % excess weight loss ) . RESULTS Follow-up data at 12 months were available for 310 of the 361 patients ( 85.9 % ) undergoing GBP  during the study period . Mean preoperative BMI was 52 ( range , 36 - 108 ) . Mean BMI and excess weight loss at follow-up were 34 ( range , 17 - 74 ) and 60 % ( range , 8%-117 % ) , respectively . Thirty-eight patients ( 12.3 % ) had poor weight loss . Of the 4 variables associated with poor weight loss in the univariate analysis ( greater initial weight , diabetes , open approach , and larger pouch size ) , only diabetes ( odds ratio , 3.09 ; 95 % confidence interval , 1.35 - 7.09 [ P = .007 ] ) and larger pouch size ( odds ratio , 2.77;95 % confidence interval , 1.81 - 4.22 [ P < .001 ] ) remained after the multivariate analysis . CONCLUSIONS Gastric bypass results in substantial weight loss in most patients . Diabetes and larger pouch size are independently associated with poor weight loss after GBP OBJECTIVE To assess the cost-effectiveness of Roux-en-Y gastric bypass for treating  type 2 diabetes mellitus ( T2DM ) in the United States compared with st and ard medical management , using clinical data from a prospect i ve observational study conducted at an academic medical center . STUDY DESIGN Our study used a predictive health economic model ( the CORE Diabetes Model ) to project the long-term costs and clinical effectiveness of Roux-en-Y gastric bypass as a treatment for T2DM using the prospect i ve observational study as the basis for our clinical effectiveness assumptions . METHODS The CORE Diabetes Model used Monte Carlo simulation with tracker variables to estimate the lifetime costs and clinical outcomes of Roux-en-Y gastric bypass compared with st and ard medical management of obese T2DM patients . Sensitivity analyses were performed on key clinical assumptions , discount rates , and shorter time horizons . RESULTS The base-case scenario yielded an incremental cost-effectiveness ratio ( ICER ) of $ 21,973 per quality -adjusted life-year ( QALY ) gained . In sensitivity analyses , shortening the time horizon to 5 and 10 years and excluding the negative impact of increased body mass index on the patient 's quality of life had the greatest adverse impact on the ICERs ( ie , higher cost per QALY ) . CONCLUSIONS Under base-case assumptions , Roux-en-Y gastric bypass is cost-effective in the treatment of T2DM in the United States with an ICER below $ 50,000 per QALY gained . Sensitivity analyses indicated that bariatric surgery is not cost-effective over shorter time horizons , or if the negative quality -of-life impact of increased body mass index is ignored Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Aims /hypothesisBoth energy restriction ( ER ) per se and weight loss improve glucose metabolism in obese insulin-treated type 2 diabetic patients . Short-term ER decreases basal endogenous glucose production ( EGP ) but not glucose disposal . In contrast the blood glucose-lowering mechanism of long-term ER with substantial weight loss has not been fully eluci date d. The aim of this study was to investigate the effect of loss of 50 % of excess weight [ 50 % excess weight reduction ( EWR ) ] on EGP , whole-body insulin sensitivity and the disturbed myocellular insulin-signalling pathway in ten obese insulin-treated type 2 diabetic patients . Methods A euglycaemic – hyperinsulinaemic clamp with stable isotopes ( [6,6 - 2H2]glucose and [2H5]glycerol ) combined with skeletal muscle biopsies was performed during a very low energy diet ( VLED ; 1,883 kJ/day ) on day 2 and again after 50 % EWR . Oral blood glucose-lowering agents and insulin were discontinued 3 weeks prior to the VLED and at the start of the VLED , respectively . Results Loss of 50 % EWR ( 20.3 ± 2.2 kg from day 2 to day of 50 % EWR ) normalised basal EGP and improved insulin sensitivity , especially insulin-stimulated glucose disposal ( 18.8 ± 2.0 to 39.1 ± 2.8 μmol kg fat-free mass−1 min−1 , p = 0.001 ) . The latter was accompanied by improved insulin signalling at the level of the recently discovered protein kinase B/Akt substrates AS160 and PRAS40 along with a decrease in intramyocellular lipid ( IMCL ) content . Conclusions /interpretationConsiderable weight loss in obese , insulin-treated type 2 diabetic patients normalises basal EGP and improves insulin sensitivity result ing from an improvement in insulin signal transduction in skeletal muscle . The decrease in IMCL might contribute to this effect Background : Biliopancreatic diversion with duodenal switch ( BPD-DS ) is an operation which provides one of the greatest maintained weight losses of any bariatric procedure . We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity . Methods : A 150 - 200 ml sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum . The median length of the common channel was 100 cm . All patients were prospect ively followed up to 12 months . Results : 40 consecutive patients underwent laparoscopic BPD-DS as a primary procedure for morbid obesity . Median patient body mass index ( BMI ) was 60 kg/m2 ( range 42 - 85 kg/m2 ) . Mean age was 43 ± 1 years ( ± SEM ) , with 12 males and 28 females . One patient was converted to  open laparotomy ( 2.5 % ) . Median operative time was 210 ± 9 minutes ( range 110 - 360 minutes ) with a significant correlation between BMI and operative time ( p = 0.04 ) . Median length of stay was 4 days ( range 3- 210 days ) . There was one 30-day mortality ( 2.5 % ) . Major morbidities occurred in 6 patients ( 15 % ) , including 1 anastomotic leak ( 2.5 % ) , 1 venous thrombosis ( 2.5 % ) , 4 staple-line hemorrhages ( 10 % ) and 1 subphrenic abscess ( 2.5 % ) . Median follow-up at 6 months ( range 1 - 12 months ) result ed in 46 % ± 2 % excess weight loss ( EWL ) and at 9 months 58 % ± 3 % EWL . Conclusion : Laparoscopic BPD-DS is a complex , yet feasible , procedure result ing in effective weight loss with an acceptable morbidity . A BMI > 65 was associated with increased morbidity and mortality . A long-term study is needed to confirm efficacy and proper patient selection Background : Gastric bypass and adjustable gastric b and ing are the 2 most commonly performed bariatric procedures for the treatment of morbid obesity . The aim of this study was to compare the outcomes , quality of life , and costs of laparoscopic gastric bypass versus laparoscopic gastric b and ing . Study Design : Between 2002 and 2007 , 250 patients with a body mass index of 35 to 60 kg/m2 were r and omly assigned to gastric bypass or gastric b and ing . After exclusion , 111 patients underwent gastric bypass and 86 patients underwent gastric b and ing .  Outcome measures included demographic data , operative time , blood loss , length of hospital stay , morbidity , mortality , early and late reoperation rate , weight loss , changes in quality of life , and cost . Treatment failure was defined as losing less than 20 % of excess weight or conversion to another bariatric operation for failure of weight loss . Results : There were no deaths at 90 days in either group . The mean body mass index was higher in the gastric bypass group ( 47.5 vs. 45.5 kg/m2 , respectively , P < 0.01 ) while the mean age was higher in the gastric b and group ( 45 vs. 41 years , respectively , P < 0.01 ) . Compared with gastric b and ing , operative blood loss was higher and the mean operative time and length of stay were longer in the gastric bypass group . The 30-day complication rate was higher after gastric bypass ( 21.6 % vs. 7.0 % for gastric b and ) ; however , there were no life-threatening complications such as leaks or sepsis . The most frequent late complication in the gastric bypass group was stricture ( 14.3 % ) . The 1-year mortality was 0.9 % for the gastric bypass group and 0 % for the gastric b and group . The percent of excess weight loss at 4 years was higher in the gastric bypass group ( 68 ± 19 % vs. 45 ± 28 % , respectively , P < 0.05 ) . Treatment failure occurred in 16.7 % of the patients who underwent gastric b and ing and in 0 % of those who underwent gastric bypass , with male gender being a predictive factor for poor weight loss after gastric b and ing . At 1-year postsurgery , quality of life improved in both groups to that of US norms . The total cost was higher for gastric bypass as compared with gastric b and ing procedure ( $ 12,310 vs. $ 10,766 , respectively , P < 0.01 ) . Conclusions : Laparoscopic gastric bypass and gastric b and ing are both safe and effective approaches for the treatment of morbid obesity . Gastric bypass result ed in better weight loss at medium- and long-term follow-up but was associated with more perioperative and late complications and a higher 30-day readmission rate . There was a wide variation in weight loss after gastric b and ing with a small proportion of patients considered as treatment failure , and male gender was a predictive factor for poor weight loss Summary Glucagon-like peptide 1 ( GLP-1 ) ( 7 - 36 amide ) is a physiological incretin hormone that is released after nutrient intake from the lower gut and stimulates insulin secretion at elevated plasma glucose concentrations . Previous work has shown that even in Type 2 ( non-insulin-dependent ) diabetic patients GLP-1 ( 7 - 36 amide ) retains much of its insulinotropic action . However , it is not known whether the magnitude of this response is sufficient to normalize plasma glucose in Type 2 diabetic patients with poor metabolic control . Therefore , in 10 Type 2 diabetic patients with unsatisfactory metabolic control ( HbAlc 11.6±1.7 % ) on diet and sulphonylurea therapy ( in some patients supplemented by metformin or acarbose ) , 1.2 pmol ×kg−1 × min−1 GLP-1 ( 7 - 36 amide ) or placebo was infused intravenously in the fasting state ( plasma glucose 13.1±0.6 mmol/l ) . In all patients , insulin ( by 17.4±4.7 nmol ×1−1 × min ; p=0.0157 ) and C-peptide ( by 228.0±39.1 nmol × 1−1 × min ; p=0.0019 ) increased significantly over basal levels , glucagon was reduced ( by -1418±308 pmol ×1−1 × min ) and plasma glucose reached normal fasting concentrations ( 4.9±0.3 mmol/l ) within 4 h of GLP-1 ( 7 - 36 amide ) administration , but not with placebo . When normal fasting plasma glucose concentrations were reached insulin returned towards basal levels and plasma glucose concentrations remained stable despite the ongoing infusion of GLP-1 ( 7 - 36 amide ) . Therefore , exogenous GLP-1 ( 7 - 36 amide ) is an effective means of normalizing fasting plasma glucose concentrations in poorly-controlled Type 2 diabetic patients . The glucose-dependence of insulinotropic actions of GLP-1 ( 7 - 36 amide ) appears to be retained in such patients Background : Severe obesity is associated with type 2 diabetes and hypertension . Improvement in these comorbidities after surgically-induced weight loss has been documented , and laparoscopic adjustable gastric b and ing ( LAGB ) is an effective weight loss operation . Methods : Of 840 patients who underwent Lap-B and ® , data are available in 402 out of 413 patients whose surgery took place at ≥ 1 year ago . Preoperative and follow-up data were studied retrospectively to examine the effect of Lap-B and ® -induced weight loss on diabetes and hypertension . Results : Of 413 patients with at least 1 year postoperative follow-up , 53 ( 12.8 % ) were taking medications for type 2 diabetes preoperatively and 189 ( 45.7 % ) were on antihypertensive medications . 66 % ( n=35 ) of diabetic patients were also hypertensive . Resolution of diabetes was observed in 66 % at 1-year and 80 % at 2-year follow-up . HbA1c dropped from 7.25 % ( 5.6 - 11.0 , n=53 ) preoperatively to 5.58 % ( 5.0 - 6.2 , n=15 ) at 2 years after surgery . Hypertension resolved in 59.8 % and 74 % at 1 and 2 years , respectively . Percent excess weight loss ( % EWL ) was lower for diabetic patients than for our cohort population ( 39.2 % vs 41.2 % at 1 year , 46.7 % vs 54.2 % at 18 months , and 52.6 % vs 63.3 % at 2 years , respectively ) . Patients in whom diabetes was improved but not resolved had lower % EWL than did those whose diabetes went into remission ( 27.0 % at 1 year and 26.5 % at 2 years ) . Patients with the shortest duration of diabetes ( < 5 years ) and better weight loss after surgery achieved higher resolution rates . Conclusions : Dramatic improvement in – and frequent resolution of – diabetes and hypertension have been observed as a result of weight loss after Lap-B and ® surgery Background : Different changes of plasma ghrelin levels have been reported following gastric b and ing , Roux-en-Y gastric bypass , and biliopancreatic diversion . Methods : This prospect i ve study compares plasma ghrelin levels and weight loss following  laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic adjustable gastric b and ing ( LAGB ) in 20 patients . Results : Patients who underwent LSG ( n=10 ) showed a significant decrease of plasma ghrelin at day 1 compared to preoperative values ( 35.8 ± 12.3 fmol/ml vs 109.6 ± 32.6 fmol/ml , P=0.005 ) . Plasma ghrelin remained low and stable at 1 and 6 months postoperatively . In contrast , no change of plasma ghrelin at day 1 ( 71.8 ± 35.3 fmol/ml vs 73.7 ± 24.8 fmol/ml , P=0.441 ) was found in patients after LAGB ( n=10 )  . Increased plasma ghrelin levels compared with the preoperative levels at 1 ( 101.9 ± 30.3 fmol/ml vs 73.7 ± 24.8 fmol/ml , P=0.028 ) and 6 months ( 104.9 ± 51.1 fmol/ml vs 73.7 ± 24.8 fmol/ml , P=0.012 ) after surgery were observed . Mean excess weight loss was higher in the LSG group at 1 ( 30 ± 13 % vs 17 ± 7 % , P=0.005 ) and 6 months ( 61 ± 16 % vs 29 ± 11 % , P=0.001 ) compared with the LAGB group . Conclusions : As a consequence of resection of the gastric fundus , the predominant area of human ghrelin production , ghrelin is significantly reduced after LSG but not after LAGB . This reduction remains stable at follow-up 6 months postoperatively , which may contribute to the superior weight loss when compared with LAGB CONTEXT Obesity and diabetes are increasing in the United States . OBJECTIVE To estimate the prevalence of obesity and diabetes among US adults in 2001 . DESIGN , SETTING , AND PARTICIPANTS R and om-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001 . MAIN OUTCOME MEASURES Body mass index , based on self-reported weight and height and self-reported diabetes . RESULTS In 2001 the prevalence of obesity ( BMI > or = 30 ) was 20.9 % vs 19.8 % in 2000 , an increase of 5.6 % . The prevalence of diabetes increased to 7.9 % vs 7.3 % in 2000 , an increase of 8.2 % . The prevalence of BMI of 40 or higher in 2001 was 2.3 % . Overweight and obesity were significantly associated with diabetes , high blood pressure , high cholesterol , asthma , arthritis , and poor health status . Compared with adults with normal weight , adults with a BMI of 40 or higher had an odds ratio ( OR ) of 7.37 ( 95 % confidence interval [ CI ] , 6.39 - 8.50 ) for diagnosed diabetes , 6.38 ( 95 % CI , 5.67 - 7.17 ) for high blood pressure , 1.88 ( 95 % CI,1.67 - 2.13 ) for high cholesterol levels , 2.72 ( 95 % CI , 2.38 - 3.12 ) for asthma , 4.41 ( 95 % CI , 3.91 - 4.97 ) for arthritis , and 4.19 ( 95 % CI , 3.68 - 4.76 ) for fair or poor health . CONCLUSIONS Increases in obesity and diabetes among US adults continue in both sexes , all ages , all races , all educational levels , and all smoking levels . Obesity is strongly associated with several major health risk factors BACKGROUND Obesity and its related comorbid illnesses have become a national health priority . We report comorbidity and quality of life ( QoL ) data after  weight loss with gastric b and ing  using the Swedish Adjustable Gastric B and ( SAGB ) . METHODS Data were collected prospect ively for 838 consecutive morbidly obese patients who underwent laparoscopic adjustable gastric b and ing ( LAGB ) between January 2001 and July 2007 . Patients were followed-up by a multidisciplinary team consisting of a surgeon , physician , dietician , and exercise consultant , all of whom were involved in the evaluation of clinical outcomes . Continuous data were reported as mean + /- SD ; categorical data were reported as number and percentage . Patients served as their own controls . RESULTS Respective preoperative mean age , weight , and body mass index ( BMI ) were 44 years ( range 16 - 76 ) , 122 kg ( range 86 - 240 ) , and 44 kg/m2 ( range 35 - 86 ) , respectively . SAGB implantation was accomplished by the pars flaccida technique with no conversion to an open procedure . Mature follow-up data were available for 35 % of patients at 24 months and 21 % at 36 months . In the total cohort of 838 patients , BMI ( mean + /- SD ) decreased to 32 + /- 5 kg/m2 and 32 + /- 7 kg/m2 at 24 months and 36 months , respectively . Percentage excess weight loss ( % EWL ) ( mean + /- SD ) was 32 % + /- 14 % ( n = 506 ) , 47 % + /- 15 % ( n = 461 ) , 52 % + /- 16 % ( n = 291 ) , and 54 % + /- 23 % ( n = 175 ) at 6 , 12 , 24 , and 36 months , respectively ( P < .001 ) . There were 545 patients identified with comorbid illness at > 6-month follow-up . After a median follow-up of 13 months ( range 6 - 36 months ) , resolution and /or improvement of comorbidities was as follows : type 2 diabetes mellitus , 79 % ; metabolic syndrome , 78 % ; hypertension , 67 % ; dyslipidemia , 66 % ; gastroesophageal reflux , 66 % ; asthma , 57 % ; arthritis/joint pain , 70 % ; polycystic ovarian syndrome , 48 % ; and depression , 57 % . There was a significant improvement in QoL ( as measured by the Short Form-36 Health Survey [ SF-36 ] ) , bringing patients ' QoL to a level consistent with that of community norms in all 8 domain scores . Of 342 patients surveyed with the Beck Depression Inventory ( BDI-II ) , a statistically significant improvement in depressive mood was also observed ( P < .001 ) . CONCLUSION Weight loss achieved by use of the SAGB provides a dramatic reduction in many serious comorbid illnesses as well as improvement in the psychosocial wellbeing of morbidly obese patients OBJECTIVE Bariatric surgery reverses obesity-related comorbidities , including type 2 diabetes mellitus . Several studies have already described differences in anthropometrics and body composition in patients undergoing Roux-en-Y gastric bypass compared with laparoscopic adjustable gastric b and ing  , but the role of adipokines in the outcomes after the different types of surgery is not known . Differences in weight loss and reversal of insulin resistance exist between the 2 groups and correlate with changes in adipokines . METHODS Fifteen severely obese women ( mean body mass index [ BMI ] : 46.7 kg/m(2 ) ) underwent 2 types of laparoscopic weight loss surgery ( Roux-en-Y gastric bypass=10 , adjustable gastric b and ing=5 ) .  Weight , waist and hip circumference , body composition , plasma metabolic markers , and lipids were measured at set intervals during a 24-month period after surgery . RESULTS At 24 months , patients who underwent Roux-en-Y were overweight ( BMI 29.7 kg/m(2 ) ) , whereas patients who underwent gastric b and ing remained obese ( BMI 36.3 kg/m(2 ) ) . Patients who underwent Roux-en-Y lost significantly more fat mass than patients who underwent gastric b and ing ( mean difference 16.8 kg , P<.05 ) . Likewise , leptin levels were lower in the patients who underwent Roux-en-Y ( P=.003 ) , and levels correlated with weight loss , loss of fat mass , insulin levels , and Homeostasis Model of Assessment 2 . Adiponectin correlated with insulin levels and Homeostasis Model of Assessment 2 ( r=-0.653 , P=.04 and r=-0.674 , P=.032 , respectively ) in the patients who underwent Roux-en-Y at 24 months . CONCLUSION After 2 years , weight loss and normalization of metabolic parameters were less pronounced in patients who underwent gastric b and ing  compared with patients who underwent Roux-en-Y gastric bypass . Our findings require confirmation in a prospect i ve r and omized trial BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND To improve decision making in the treatment of extreme obesity , the risks of bariatric surgical procedures require further characterization . METHODS We performed a prospect i ve , multicenter , observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007 . A composite end point of 30-day major adverse outcomes ( including death ; venous thromboembolism ; percutaneous , endoscopic , or operative reintervention ; and failure to be discharged from the hospital ) was evaluated among patients undergoing first-time bariatric surgery .  RESULTS There were 4776 patients who had a first-time bariatric procedure ( mean age , 44.5 years ; 21.1 % men ; 10.9 % nonwhite ; median body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 46.5 ) . More than half had at least two coexisting conditions . A Roux-en-Y gastric bypass was performed in 3412 patients ( with 87.2 % of the procedures performed laparoscopically ) , and laparoscopic adjustable gastric b and ing was performed in 1198 patients ; 166 patients underwent other procedures and were not included in the analysis . The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing was 0.3 % ; a total of 4.3 % of patients had at least one major adverse outcome . A history of deep-vein thrombosis or pulmonary embolus , a diagnosis of obstructive sleep apnea , and impaired functional status were each independently associated with an increased risk of the composite end point . Extreme values of body-mass index were significantly associated with an increased risk of the composite end point , whereas age , sex , race , ethnic group , and other coexisting conditions were not . CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics . In helping patients make appropriate choices , short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese . ( Clinical Trials.gov number , NCT00433810 . Background We hypothesized that  laparoscopic adjustable gastric b and ing ( LAGB )  reduces weight and modulates ghrelin production , but largely spares gastrointestinal endocrine function . To examine this hypothesis , we determined plasma concentrations of appetite-control , insulinotropic , and digestive hormones in relation to LAGB . Methods Twenty-four patients undergoing LAGB were prospect ively enrolled .  Body mass index ( BMI ) was measured and blood sample s obtained at baseline and 6 and 12 months post-surgery . Plasma concentrations of leptin , acylated and total ghrelin , pancreatic polypeptide ( PP ) , insulin , glucose-dependent insulinotropic peptide ( GIP ) , active glucagon-like peptide-1 ( GLP-1 ) , gastrin , and pepsinogens I and II were measured using enzyme-linked immunoassays . Results Median percent excess weight loss ( % EWL ) over 12 months was 45.7 % with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery ( p < 0.001 ) . Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery ( p < 0.001 ) . In contrast , plasma levels of acylated and total ghrelin , PP , insulin , GIP , GLP-1 , gastrin , and pepsinogen I did not change in relation to surgery ( p > 0.05 ) . Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months . Conclusions LAGB yielded substantial % EWL and a proportional decrease in plasma leptin . Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss . Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term
target: Bariatric surgery leads to marked and long-lasting weight reduction .
  A large proportion of patients undergoing bariatric surgery have DM2 .
  Glycemic control improves in the months after laparoscopic adjustable gastric b and ing , but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery .
  Thus , both types of surgery are capable of improving or even curing DM2 , but the mechanisms may differ
background: OBJECTIVE To systematic ally review the literature pertaining to the reversal of  type 2 diabetes mellitus ( DM2 ) after Roux-en-Y gastric bypass and adjustable gastric b and ing .