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Which Obesity Treatment is Best?

The Journal of the American Medical Association (JAMA) has released 4 new studies comparing the effects of various surgical and non-surgical weight loss treatments among patients with obesity.
Two of the 4 studies compared patient outcomes following various types of bariatric surgery—including laparoscopic banding, gastric bypass, or laparoscopic sleeve gastrectomy—with nonsurgical, medical obesity treatment and usual care.
The first study (N=8385, baseline median body mass index [BMI] 46 kg/m2) found that bariatric surgery was associated with a lower risk of all-cause mortality vs non-surgical treatment.1 The second study (N=1888, baseline BMI 44.2 kg/m2) found that bariatric surgery was associated with a decreased risk for obesity-related comorbidities but an increased risk for complications.2
The remaining 2 studies, the SLEEVEPASS Randomized Clinical Trial and the SM-BOSS Randomized Clinical Trial, specifically assessed the effects of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) on weight loss in patients with obesity.
The authors of the SLEEVEPASS trial (N=240) found that LSG was not equivalent to LRYGB in regard to percentage excess weight loss at 5 years,3 whereas the authors of the SM-BOSS trial (N=217, mean BMI 43.9 kg/m2) found no significant differences in excess BMI loss between both procedures.4

REFERENCE:
Reges O, Greenland P, Dicker D, et al. Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA. 2018;319(3):279-290. 
Jakobsen GS, Småstuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA. 2018;319(3):291-201. 
Salminem P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241-254. 
Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255-265. 

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