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Evidence Base of Weight Loss Surgery

In Appendix 2 and 3 you find the results of a very important literature review that shows clearly the guidelines for weight loss surgery and their levels of evidence ( Surg Endoscopy May 2009 )

In Appendix 1 you find the levels of evidence

Level 1 : Highest evidence
Level 2 : Medium evidence
Level 3 : Poor evidence

The Highlights

Weight loss surgery is the MOST effective treatment ….( level 1 )
Individuals with a BMI of 30-35 kg/m2 may benefit from laparoscopic bariatric surgery ( level 1 )
Laparoscopic RGB ( gastric bypass ) is similar in efficacy to open RGB ( level 1 )
Laparoscopic sleeve gastrectomy ( LSG ) is validated as providing effective weight loss and resolution of comorbidities for as long as 3-5 years ( level 2 )
Other well-selected patients may benefit from laparoscopic bariatric surgery by experienced surgeons

patients with a BMI exceeding 60 ( level 2 )
patients older than 60 years ( level 2 )

Laparoscopic AGB ( adjustable gastric band ) is effective in all BMI subgroups, with durable weight loss and control of comorbidities past 5 years ( level 1 )
Intermediate -term weight loss after laparoscopic AGB ( gastric banding ) may be less than after laparoscopic RGB ( gastric bypass ) ( level 1 )

Conclusions

Weight loss surgery is the most effective treatment, careful patient selection and procedure selection is highly important , but all the different procedures will result in durable weight loss.