The lancet. Diabetes & endocrinology

Comparing three weight-loss surgeries for severe obesity: gastric bypass, adjustable band, and sleeve gastrectomy

Updated

Abstract

Among 1346 participants, 276 (68%) achieved at least 50% excess weight loss after Roux-en-Y gastric bypass.

  • Roux-en-Y gastric bypass resulted in a significantly higher proportion of participants achieving at least 50% excess weight loss compared to adjustable gastric banding (41% difference).
  • Participants who underwent sleeve gastrectomy achieved 15% more weight loss than those with adjustable gastric banding.
  • Quality of life scores were highest for Roux-en-Y gastric bypass (mean score of 0.72), followed by sleeve gastrectomy (0.68) and adjustable gastric banding (0.62).
  • The average number of adverse events reported per year was highest for Roux-en-Y gastric bypass (6.0) and lowest for adjustable gastric banding (4.6).
  • Roux-en-Y gastric bypass was identified as the most cost-effective procedure among the three surgical options.

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Funding

Competing interests

Declarations of interest JMB reports membership of the National Institute of Health and Care Research (NIHR) HTA Obesity Themed Call Board 2010, the HTA Surgery Themed Call Board 2012–13, the NIHR CTU Standing Advisory Committee 2012–20, the HTA Clinical Evaluation and Trials Committee 2009–13 and the NIHR Senior Investigator Panel (2021 to present), funding from the MRC Network of Hubs for Trials Methodology Research ConDuCT and ConDuCT II and NIHR Bristol Biomedical Research Centre. She also reports research grants from the NIHR (reference NIHR205174, NIHR152268, NIHR151274, NIHR127393, and NIHR130547) and Bristol and Weston Hospitals Charity and NIHR Research Capability Fund in the last 3 years. CAR reports membership of a Clinical Trials Unit funded by the NIHR (until 30 Sept 2023), membership of the NIHR Health Technology Assessment Funding Committee Policy Group (November 2016–November 2, 2021) and the Health Technology Assessment Commissioning Committee (August 2016–November 2021), and funding from the British Heart Foundation (until 2016). JLD reports membership of the NIHR HTA Commissioning Board (2006–12), NIHR Rapid Trials and Add-on Studies Board 2012, NIHR Senior Investigator panel (2009–2012), NIHR Health Services and Delivery Research Board, Deputy Chair (2010–11). BCR reports funding from the NIHR for expenses associated with his membership of the Health Technology Assessment Commissioning Board (January 2012–March 31, 2016), the Health Technology Assessment Efficient Study Designs Board (October–December, 2014), the Health Technology Assessment Interventional Procedures Committee B Methods Group and Systematic Reviews Programme Advisory Group (Systematic Reviews NIHR Cochrane Incentive Awards and Systematic Review Advisory Group). SW reports funding from the grant paid to her employer to cover her role in the trial, and panel membership of the US National Academies Genomics and Precision Medicine Round Table. JLT reports funding from the grant paid to her employer to cover her role in the trial and consultancy fees from University of Bristol, Bristol, UK (July 2022–June 2023). JMB, CAR, BCR, EAG, SP, and KBP report funding from the grant paid to their employer to cover their role in the trial. LC reports funding from the NIHR grant paid to her employer and membership of a Clinical Trials Unit funded by NIHR (until Sept 30, 2023). KBP reports funding paid to his employer from the Wellcome Trust (222051/Z/20/Z and to be assigned), Ineos Oxford Institute for AMR Research, Coalition for Epidemic Preparedness and Innovations, UK Health Security Agency, NIHR, Medical Research Foundation, Waltham Foundation, EU-H2020 IMI-2, and EU-H2020 in the last 3 years; and membership of the UK Advisory Committee on Antimicrobial Prescribing, Resistance, and Healthcare Associated Infections. RCA reports research funding from NovoNordisk Healthcare Organisation in the last 3 years, honoraria from NovoNordisk, AstraZeneca, and Eli Lilly for education talks on diet and exercise to health care professionals, and chairmanship of Diabetes UK Clinical Study Group 3: prevention, targets, and therapies for type 2 diabetes (until May 2021). RW reports payment for his role on the Advisory Board, College of Contemporary Health, London, UK. AA reports research funding from the NIHR (reference 17/11/49) during course of the study and honoraria from Medtronic for a lecture or presentation. PCL reports receipt of funding for expenses associated with attendance at trial-related investigator meetings and Directorship of Education, Association of Laparoscopic Surgeons of Great Britain and Ireland, and Honorary Secretary of the Grey Turner Surgical Society. JPB reports funding from the grant paid to his employer to cover his role in the trial and receipt of funding for expenses associated with attendance at trial-related meetings. He also reports grant funding from Oxford Medical Products in the last 3 years, membership of the Data Monitoring and Safety committee for the NIHR-funded EMBIO study, British Obesity and metabolic Surgery Society President (2023–25), Secretary (2021–23), Treasurer (2017–21), Obesity Empowerment Network Trustee, and treasurer (2019-present), and shares in Join Embla UK. SA reports Royalty for being Editor of the book Obesity, Bariatric and Metabolic Surgery—A Practical Guide from the sales and electronic downloads every year since its publication by Springer (August, 2015), Royalty for being Editor of 2nd edition of the book Obesity, Bariatric and Metabolic Surgery—A Practical Guide by Springer (2023), honoraria for invited for lectures or presentations at national and international meetings, and Directorship of Bariatric and Metabolic Surgery UK. JH reports honoraria for speaking at meetings and expert panel review into Meshes in hernia surgery from BD Bard and shares in Dr J C Hopkins. JMF reports being an employee of, and an equity holder in, Novartis Pharma. All other authors report no competing interests.
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