Sleeve gastrectomy more beneficial than intensive lifestyle modification in class 1 obesity

Patients with class 1 obesity may fare better with sleeve gastrectomy than intensive lifestyle modification, with a recent study showing that surgery facilitates greater weight loss and more effective diabetes prevention and remission with a caveat, according to a study. Sleeve gastrectomy is associated with a higher incidence of substance use disorder and self-harm.

The study included matched 3,648 patients (mean age 42.5 years, 90 percent women) with a mean body mass index (BMI) of 32.9 kg/m², among whom 1,216 underwent a sleeve gastrectomy and 2,432 went through an intensive lifestyle treatment.

One-year weight loss was significantly greater in the surgery group than in the lifestyle treatment group (22.9 vs 11.9 kg; mean difference, 10.7 kg, 95 percent confidence interval [CI], 10.0–11.5; p<0.001). Total weight decreased by 24.4 percent among patients who underwent surgery as opposed to only 12 percent among those who did intensive lifestyle modifications (p<0.001).

Furthermore, the surgery group had a lower risk of incident use of diabetes drugs over a median follow-up of 5.1 years (59.7 vs 100.4 events per 10,000 person-years; hazard ratio [HR], 0.60, 95 percent confidence interval [CI], 0.39–0.92; p=0.02) and were more likely to have diabetes drug remission at the year 2 time point (48.4 percent vs 22.0 percent; risk difference, 26.4 percent, 95 percent CI, 11.7–41.0; p<0.001).

However, compared with those in the lifestyle treatment group, patients who underwent surgery were at higher risk of substance use disorder (94 vs 50 events per 10,000 person-years; HR, 1.86, 95 percent CI, 1.30–2.67; p<0.001) and self-harm (45 vs 25 events per 10,000 person-years; HR, 1.81, 95 percent CI, 1.09–3.01; p=0.02).

There was no between-group difference in the incidence of major cardiovascular events (23.4 vs 24.8 events per 10,000 person-years; HR, 0.96, 95 percent CI, 0.49–1.91; p=0.92).

The present data suggest that sleeve gastrectomy may be an appropriate treatment option in selected patients with metabolic comorbidity and class 1 obesity.