The results of a literature review suggest that obesity surgery produces greater weight loss than conventional treatment for moderately obese patients as well as those with severe obesity. The best operation, however, remains unclear.

As reported in The Cochrane Library, Dr. Jill L. Colquitt and colleagues, from the University of Southampton, UK, searched various electronic databases and identified 26 studies that compared weight loss surgical procedures (also called bariatric surgery) with each other or with non-surgical treatments for obesity such as drugs, diets and exercise.

The studies included three randomized trials and three prospective studies that compared surgical with non-surgical treatments. The remaining 20 studies were trials that compared various types of bariatric operations.

Overall, the authors found that surgery provided greater weight loss for any degree of obesity compared with non-surgical treatments. Surgery was also associated with reductions in diabetes, hypertension, and other co-existing conditions. Improvements in health-related quality of life were noted after 2 years, but their long-term persistence was unclear.

The bariatric operations were not free from complications, including serious ones such as Pulmonary embolism and even postoperative death, the report indicates.

In the studies that compared different bariatric procedures, there was some evidence that gastric bypass provided greater weight loss than did vertical banded gastroplasty or adjustable gastric banding.

Isolated sleeve gastrectomy and banded gastric bypass both produced weight losses comparable to that seen with gastric bypass.

No statistically significant differences in weight loss or quality of life were seen between procedures performed using conventional open surgery and those using laparoscopic bariatric procedures.

Due to limited data, the authors were unable to reach firm conclusions regarding the relative safety of each bariatric operation.

While surgery produces greater weight loss than conventional obesity treatments, and exactly which procedure provides the best mix of effectiveness and safety is unclear, they note.

SOURCE: Cochrane Database System Review 2009.