Landmark research recommends gastric bypass for people with severe obesity undergoing surgery.
The study found that gastric bypass is the most clinically and cost-effective form of interventional surgery for people living with severe obesity.
The new University of Bristol-led trial, funded by the National Institute for Health and Care Research (NIHR), is published in The Lancet Diabetes & Endocrinology.
UK national guidelines recommend considering surgery for individuals living with severe obesity.
When the trial started, bypass and band were commonly performed in the UK and worldwide. A third operation, sleeve, began to be performed more often during the first two years of the trial and was then included.
Researchers found bypass to be most clinically effective for patients and to provide the best value for money for the NHS three years after surgery.
Patients were recruited from 12 UK hospitals between 2013 and 2019.
Jane Blazeby, Professor of Surgery at the University of Bristol, led the trial. She said: ‘Based on the trial findings, we recommend that patients electing to have bariatric and metabolic surgery are advised to have a bypass. Sleeve should be a secondary option when bypass is not possible. Our evidence does not support band as a standard treatment for people living with severe obesity.’
She added: ‘The hard work undertaken by all the study participants, surgeons, nurses and dieticians means we now have reliable information to inform NHS practice. The next challenge is for surgical teams to work with researchers and physicians to conduct a new study that compares surgery to weight-loss drugs to create evidence to understand how surgery compares in terms of weight loss, quality of life and costs.’
The study found that 68% (276) of participants randomised to bypass achieved at least 50% excess weight loss after three years, compared to 25% (97) for band and 41% (141) for sleeve.
On average, trial participants lost 26.5kg (just over four stone). Some people lost as much as 98kg (over 15 stone). There were a few that gained weight (<10%).
Bypass led to a greater reduction in comorbidities, such as high blood pressure and diabetes. Using a standard UK cost threshold applied by NICE, it was found to be the most cost-effective option when considering patients’ quality of life.
While the bypass was initially more expensive, it led to improved quality of life and reduced healthcare costs after three years compared to the other two surgeries.
Based on this evidence, researchers recommend that patients electing to have metabolic and bariatric surgery have a bypass.
A sleeve should be offered where contraindicated or unfeasible. They add that this evidence does not support band surgery as the standard treatment for severe obesity.
Researchers emphasised the importance of comparing surgery with obesity management medications (OMMs) to inform patients, surgeons, and the NHS.
