Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Evidence-based medicine reports on obesity surgery: a critique

International Journal of Obesity volume 29, pages 735–745 (2005)Cite this article

Abstract

OBJECTIVE:

To evaluate evidence in recent authoritative ‘Evidence-Based Medicine’ (EBM) reports on surgery for severe obesity.

METHODS:

Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, 1978–2004.

RESULTS:

EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the ‘learning curve’ of an avowed complex procedure.

CONCLUSION:

EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Special report: the relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. http://bcbs.com/tec/vol18/18_09.html.

  2. Newer techniques in bariatric surgery for morbid obesity. http://bcbs.com/tec/vol18/18_10.html.

  3. Hayes WS . Health outcomes after bariatric surgery. Winfred S Hayes Inc., Lansdale, PA, USA, HEAL 1302.24, 2004.

  4. Clegg A, Colquitt J, Sidhu M, Royle P, Walker A . Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord 2003; 27: 1167–1177.

    Article  CAS  PubMed  Google Scholar 

  5. Colquitt J, Clegg A, Sidhu M, Royle P . Surgery for morbid obesity. Cochrane Library 2003; 3: 1–58.

    Google Scholar 

  6. MacDonald Jr KG, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, Pories WJ . The gastric bypass operation reduces the progression and mortality of non-insulin dependent diabetes mellitus. J Gastrointest Surg 1997; 1: 213–220.

    Article  PubMed  Google Scholar 

  7. Flum DR, Dellinger EP . The impact of gastric bypass surgery on survival: a population-based analysis. J Am Coll Surg 2004; 199: 543–551.

    Article  PubMed  Google Scholar 

  8. Christou NV, Sampalis JS, Lieberman M, Look D, Auger S, McLean PA, MacLean LD . Surgery decreases long-term mortality in morbidly obese patients. Ann Surg 2004; 240: 416–424.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hell E, Miller KA, Moorehead MK, Norman S . Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg 2000; 10: 214–219.

    Article  CAS  PubMed  Google Scholar 

  10. Kral JG, Sjostrom LV, Sullivan MB . Assessment of quality of life before and after surgery for severe obesity. Am J Clin Nutr 1992; 55 (Suppl): 611S–614S.

    Article  CAS  PubMed  Google Scholar 

  11. Narbro K, Agren G, Jonasson E, Larsson B, Naslund I, Wedel H, Sjostrom L . Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study. Int J Obes Relat Metab Disord 1999; 23: 619–624.

    Article  CAS  PubMed  Google Scholar 

  12. Dymek MP, Le Grange D, Neven K, Alverdy J . Quality of life after gastric bypass surgery: a cross-sectional study. Obes Res 2002; 10: 1135–1142.

    Article  PubMed  Google Scholar 

  13. de Zwaan M, Lancaster KL, Mitchell JE, Howell LM, Monson N, Roerig JL, Crosby RD . Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg 2002; 12: 773–780.

    Article  PubMed  Google Scholar 

  14. Dixon JB, O'Brien PE . Changes in comorbidities and improvements in quality of life after LAP-BAND placement. Am J Surg 2002; 184: 51S–54S.

    Article  PubMed  Google Scholar 

  15. Karlsson J, Sjostrom L, Sullivan M . Swedish obese subjects (SOS)—an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab Disord 1998; 22: 113–126.

    Article  CAS  PubMed  Google Scholar 

  16. Choban PS, Onyejekwe J, Burge JC, Flancbaum L . A health status assessment of the impact of weight loss following Roux-en-Y gastric bypass for clinically severe obesity. J Am Coll Surg 1999; 188: 491–497.

    Article  CAS  PubMed  Google Scholar 

  17. Sjostrom CD, Peltonen M, Sjostrom L . Blood pressure and pulse pressure during long-term weight loss in the obese: the Swedish Obese Subjects (SOS) intervention study. Obes Res 2001; 9: 188–195.

    Article  CAS  PubMed  Google Scholar 

  18. Foley EF, Benotti PN, Borlase BC, Hollingshead J, Blackburn GL . Impact of gastric restrictive surgery on hypertension in the morbidly obese. Am J Surg 1992; 163: 294–297.

    Article  CAS  PubMed  Google Scholar 

  19. Carson JL, Ruddy ME, Duff AE, Holmes NJ, Cody RP, Brolin RE . The effect of gastric bypass surgery on hypertension in morbidly obese patients. Ann Int Med 1994; 154: 193–200.

    Article  CAS  Google Scholar 

  20. Alaud-din A, Meterissian S, Lisbona R, MacLean LD, Forse RA . Assessment of cardiac function in patients who were morbidly obese. Surgery 1990; 108: 809–818.

    CAS  PubMed  Google Scholar 

  21. Ben-Dov I, Grossman E, Stein A, Shachor D, Gaides M . Marked weight reduction lowers resting and exercise blood pressure in morbidly obese subjects. Am J Hypertens 2000; 13: 251–255.

    Article  CAS  PubMed  Google Scholar 

  22. Sjostrom CD, Lissner L, Wedel H, Sjostrom L . Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 1999; 7: 477–484.

    Article  CAS  PubMed  Google Scholar 

  23. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L . Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000; 36: 20–25.

    Article  CAS  PubMed  Google Scholar 

  24. Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, Alexandrides TK . Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery. Diabetes 2003; 52: 1098–1103.

    Article  CAS  PubMed  Google Scholar 

  25. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K . Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724–1757.

    Article  CAS  PubMed  Google Scholar 

  26. Alpert MA, Terry BE, Kelly DL . Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985; 55: 783–786.

    Article  CAS  PubMed  Google Scholar 

  27. Sugerman HJ, Baron PL, Fairman RP, Evans CR, Vetrovec GW . Hemodynamic dysfunction in obesity hypoventilation syndrome and the effects of treatment with surgically induced weight loss. Ann Surg 1988; 207: 604–613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Karason K, Wallentin I, Larsson B, Sjostrom L . Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ 1997; 315: 912–916.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Karason K, Wallentin I, Larsson B, Sjostrom L . Effects of obesity and weight loss on cardiac function and valvular performance. Obes Res 1998; 6: 422–429.

    Article  CAS  PubMed  Google Scholar 

  30. Kanoupakis E, Michaloudis D, Fraidakis O, Parthenakis F, Vardas P, Melissas J . Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg 2001; 11: 552–558.

    Article  CAS  PubMed  Google Scholar 

  31. Sugerman HJ, Fairman RP, Baron PL, Kwentus JA . Gastric surgery for respiratory insufficiency of obesity. Chest 1986; 90: 81–86.

    Article  CAS  PubMed  Google Scholar 

  32. Sugerman HJ, Fairman RP, Sood RK, Engle K, Wolfe L, Kellum JM . Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992; 55: 597S–601S.

    Article  CAS  PubMed  Google Scholar 

  33. Boone KA, Cullen JJ, Mason EE, Scott DH, Doherty C, Maher JW . Impact of vertical banded gastroplasty on respiratory insufficiency of severe obesity. Obes Surg 1996; 6: 454–458.

    Article  CAS  PubMed  Google Scholar 

  34. Charuzi I, Lavie P, Peiser J, Peled R . Bariatric surgery in morbidly obese sleep-apnea patients: short and long-term follow-up. Am J Clin Nutr 1992; 55: 594S–596S.

    Article  CAS  PubMed  Google Scholar 

  35. Rasheid S, Banasiak M, Gallagher SF, Lipska A, Kaba S, Ventimiglia D, Anderson WM, Murr MM . Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg 2003; 13: 58–61.

    Article  PubMed  Google Scholar 

  36. Macgregor A, Greenberg RA . Effect of surgically induced weight loss on asthma in the morbidly obese. Obes Surg 1993; 3: 15–21.

    Article  CAS  PubMed  Google Scholar 

  37. Dixon JB, Chapman L, O'Brien P . Marked improvement in asthma after Lap-Band® surgery for morbid obesity. Obes Surg 1999; 9: 385–389.

    Article  CAS  PubMed  Google Scholar 

  38. Luyckx FH, Scheen AJ, Desaive C, Dewe W, Gielen JE, Lefebvre PJ . Effects of gastroplasty on body weight and related biological abnormalities in morbid obesity. Diabetes Metab 1998; 24: 355–361.

    CAS  PubMed  Google Scholar 

  39. Gleysteen JJ . Results of surgery: long-term effects on hyperlipidemia. Am J Clin Nutr 1992; 55: 591S–593S.

    Article  CAS  PubMed  Google Scholar 

  40. Buffington CK, Cowan Jr GS, Smith H . Significant changes in the lipid–lipoprotein status of premenopausal morbidly obese females following gastric bypass surgery. Obes Surg 1994; 4: 328–335.

    Article  CAS  PubMed  Google Scholar 

  41. Wolf AM, Beisiegel U, Kornter B, Kuhlmann HW . Does gastric restriction surgery reduce the risks of metabolic diseases? Obes Surg 1998; 8: 9–13.

    Article  CAS  PubMed  Google Scholar 

  42. Busseto L, Pisent C, Rinaldi D, Longhin PL, Segato G, De Marchi F, Foletto M, Favretti F, Lise M, Enzi G . Variation in lipid levels in morbidly obese patients operated with Lap-Band® adjustable gastric banding system: effects of different levels of weight loss. Obes Surg 2000; 10: 569–577.

    Article  Google Scholar 

  43. Brolin RE, Bradley LJ, Wilson AC, Cody RP . Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity. J Gastrointest Surg 2000; 4: 464–469.

    Article  CAS  PubMed  Google Scholar 

  44. Kellum J, Kuemmerle J, O'Darisio T, Rayford P, Martin D, Engle K, Wolf L, Sugerman H . Gastrointestinal hormone (GIH) responses to meals before and after gastric bypass and vertical banded gastroplasty. Ann Surg 1990; 211: 763–767.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Pories WJ, MacDonald KG, Morgan EJ, Sinha MK, Dohm GL, Swanson MS, Barakat HA, Khazanie PG, Leggett-Frazier N, Long SD . Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 1992; 55: 582S–585S.

    Article  CAS  PubMed  Google Scholar 

  46. Neve HJ, Soulsby CT, Whiteley GS, Kincey J, Taylor TV . Resolution of diabetes following vertical gastroplasty in morbidly obese patients. Obes Surg 1993; 3: 75–78.

    Article  CAS  PubMed  Google Scholar 

  47. Castagneto M, De Gaetano A, Mingrone G, Tacchino R, Nanni G, Capristo E, Benedetti G, Tataranni PA, Greco AV . Normalization of insulin sensitivity in obese patients after stable weight reduction with biliopancreatic diversion. Obes Surg 1994; 4: 161–168.

    Article  CAS  PubMed  Google Scholar 

  48. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM, Dohm L . Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339–350.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Hickey MS, Pories WJ, MacDonald Jr KG, Cory KA, Dohm GL, Swanson MS, Israel RG, Barakat HA, Considine RV, Caro JF, Houmard JA . A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg 1998; 227: 637–643.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Dixon JB, O'Brien PE . Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002; 25: 397–398.

    Article  Google Scholar 

  51. Schauer PR, Burguera B, Ikramuddin S, Cottan D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D . Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238: 467–484.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sugerman HJ, Wolfe LG, Sica DA, Clore JN . Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 2003; 237: 751–756.

    PubMed  PubMed Central  Google Scholar 

  53. Dolan K, Bryant R, Fielding G . Treating diabetes in the morbidly obese by laparoscopic gastric banding. Obes Surg 2003; 13: 439–443.

    Article  PubMed  Google Scholar 

  54. Ranlov I, Hardt F . Regression of liver steatosis following gastroplasty or gastric bypass for morbid obesity. Digestion 1990; 47: 208–214.

    Article  CAS  PubMed  Google Scholar 

  55. Silverman EM, Sapala JA, Appelman HD . Regression of hepatic steatosis in morbidly obese persons after gastric bypass. Am J Clin Pathol 1995; 104: 23–31.

    Article  CAS  PubMed  Google Scholar 

  56. Kral JG, Thung SN, Biron S, Hould FS, Lebel S, Marceau S, Simard S, Marceau P . Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery 2004; 135: 48–58.

    Article  PubMed  Google Scholar 

  57. Luyckx FH, Desaive C, Thiry A, Dewe W, Scheen AJ, Gielen JE, Lefebvre PJ . Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord 1998; 22: 222–226.

    Article  CAS  PubMed  Google Scholar 

  58. Richards DS, Miller DK, Goodman GN . Pregnancy after gastric bypass for morbid obesity. J Reprod Med 1987; 32: 172–175.

    CAS  PubMed  Google Scholar 

  59. Bilenka B, Ben-Shlomo I, Cozacov C, Gold CH, Zohar S . Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand 1995; 74: 42–44.

    Article  CAS  PubMed  Google Scholar 

  60. Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Simard S, Kral JG . Outcome of pregnancies after obesity surgery. In: Guy-Grand B, Ailhaud G (eds) Progress in Obesity Research, Vol. 8 John Libbey and Co.: London; 1999. pp 795–802.

    Google Scholar 

  61. Dixon JB, Dixon ME, O'Brien PE . Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obes Surg 2001; 11: 59–65.

    Article  CAS  PubMed  Google Scholar 

  62. Deitel M, To TB, Stone E, Sutherland DJ, Wilk EJ . Sex hormonal changes accompanying loss of massive excess weight. Gastroenterol Clin N Am 1987; 16: 511–515.

    Article  CAS  Google Scholar 

  63. Bastounis EA, Karayiannakis AJ, Syrigos K, Zbar A, Makri GG, Alexio D . Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res 1998; 30: 43–47.

    Article  CAS  PubMed  Google Scholar 

  64. Dixon JB, O'Brien PE . Neck circumference a good predictor of raises insulin and free androgen index in obese premenopausal women: changes with weight loss. Clin Endocrinol 2002; 57: 769–778.

    Article  CAS  Google Scholar 

  65. Smith SC, Edwards CB, Goodman GN . Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg 1997; 7: 479–484.

    Article  CAS  PubMed  Google Scholar 

  66. Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P . Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2002; 16: 1027–1031.

    Article  CAS  PubMed  Google Scholar 

  67. Sugerman HJ, Kellum JM, DeMaria EJ . Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg 2001; 234: 41–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Winiarsky R, Barth P, Lotke P . Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998; 80: 1770–1774.

    Article  CAS  PubMed  Google Scholar 

  69. Parvizi J, Trousadale RT, Sarr MG . Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthroplasty 2000; 15: 1003–1008.

    Article  CAS  PubMed  Google Scholar 

  70. Peltonen M, Lindroos AK, Torgerson JS . Musculoskeletal pain in the obese: a comparison with the general population and long-term changes after conventional and surgical obesity treatment. Pain 2003; 104: 549–557.

    Article  PubMed  Google Scholar 

  71. Melissas J, Volakakis E, Hadjipavlou A . Low-back pain in morbidly obese patients and the effect of weight loss following surgery. Obes Surg 2003; 13: 389–393.

    Article  PubMed  Google Scholar 

  72. Bump RC, Sugerman HJ, Fantl JA, McClish DK . Obesity and lower urinary tract function in women: effects of surgically induced weight loss. Am J Obstet Gynecol 1992; 167: 392–397.

    Article  CAS  PubMed  Google Scholar 

  73. Sugerman HJ, Felton WL, Sismanis A, Salvant JB, Kellum JM . Effects of surgically induced weight loss on pseudotumor cerebri in morbid obesity. Neurology 1995; 45: 1655–1659.

    Article  CAS  PubMed  Google Scholar 

  74. Sugerman HJ, Felton III WL, Sismanis A, Kellum JM, DeMaria EJ, Sugerman EL . Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg 1999; 21: 682–685.

    Google Scholar 

  75. Andersen T, Backer OG, Stokholm KH, Quaade F . Randomized trial of diet and gastroplasty compared with diet alone in morbid obesity. N Engl J Med 1984; 310: 352–356.

    Article  CAS  PubMed  Google Scholar 

  76. Andersen T, Stokholm KH, Backer OG, Quaade F . Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity. Int J Obes Relat Metab Disord 1988; 12: 277–284.

    CAS  Google Scholar 

  77. Kral JG . Gastroplasty and diet in morbid obesity. N Eng J Med 1984; 310: 1743 (letter).

    Google Scholar 

  78. Westling A, Gustavsson S . Laparoscopic vs. open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001; 11: 284–292.

    Article  CAS  PubMed  Google Scholar 

  79. Wittgrove AC, Clark GW . Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 5–60 month follow-up. Obes Surg 2000; 10: 233–239.

    Article  CAS  PubMed  Google Scholar 

  80. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J . Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000; 232: 515–529.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Higa KD, Ho T, Boone KB . Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Technol 2001; 11: 377–382.

    Article  CAS  Google Scholar 

  82. DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG . Results of 281 consecutive Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235: 640–647.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM . Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life and costs. Ann Surg 2001; 234: 279–291.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Schauer PR, Ikramuddin S, Hamad G, Gourash W . The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 2003; 17: 212–215.

    Article  CAS  PubMed  Google Scholar 

  85. Naslund I, Wickbom G, Christoffersson E, Agren G . A prospective randomized comparison of gastric bypass and gastroplasty. Complications and early results. Acta Chir Scand 1986; 152: 681–689.

    CAS  PubMed  Google Scholar 

  86. Sugerman HJ, Starkey JV, Birkenhauer R . A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg 1987; 205: 613–624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Hall JC, Watts JM, O'Brien PE, Dunstan RE, Walsh JF, Slavotinek AH, Elmslie RG . Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990; 211: 419–427.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. MacLean LD, Rhode BM, Sampalis J, Forse RA . Results of the surgical treatment of obesity. Am J Surg 1993; 165: 155–162.

    Article  CAS  PubMed  Google Scholar 

  89. Howard L, Malone M, Michalek A, Carter J, Alger S, Van Woert J . Gastric bypass and vertical banded gastroplasty: a prospective randomized comparison and 5-year follow-up. Obes Surg 1995; 5: 55–60.

    Article  CAS  PubMed  Google Scholar 

  90. Yale CE . Gastric surgery for morbid obesity. Complications and long-term weight control. Arch Surg 1989; 124: 941–946.

    Article  CAS  PubMed  Google Scholar 

  91. Brolin RL, Robertson LB, Kenler HA, Cody RP . Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg 1994; 220: 782–790.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Capella JF, Capella RF . The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg 1996; 171: 74–79.

    Article  CAS  PubMed  Google Scholar 

  93. Buchwald H, Menchaca HJ, Menchaca YM, Michalek VN . Surgically induced weight loss: gastric bypass versus gastroplasty. Prob Gen Surg 2000; 17: 23–28.

    Google Scholar 

  94. Sjostrom L, Larsson B, Backman L, Bengtsson C, Bouchard C, Dahlgren S, Hallgren P, Jonsson E, Karlsson J, Lapidus L, Lindroos A-K, Lindstedt S, Lissner L, Narbro H, Naslund I, Olbe Z, Sullivan M, Sylvan A, Nedel H, Agren G . Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state. Int J Obes Relat Metab Disord 1992; 16: 465–479.

    CAS  PubMed  Google Scholar 

  95. Sugerman HJ, Kellum JM, Engle KM, Wolfe L, Starkey JV, Birkenhauer R, Fletcher P, Sawyer MJ . Gastric bypass for the treatment of morbid obesity. Am J Clin Nutr 1992; 55: 560S–566S.

    Article  CAS  PubMed  Google Scholar 

  96. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 1992; 55: 615S–619S.

  97. Fielding GA, Rhodes M, Nathanson LK . Laparoscopic gastric banding for morbid obesity. Surgical outcome in 355 cases. Surg Endosc 1999; 13: 550–554.

    Article  CAS  PubMed  Google Scholar 

  98. Angrisani L, Alkilani M, Basso N, Belvederesi N, Campanile F, Capizzi FD, D'Atri C, Di Cosmo L, Doldi SB, Favretti F, Forestieri P, Furbetta F, Giacomelli F, Giardiello C, Iuppa A, Lesti G, Lucchese M, Puglisi F, Scipioni L, Toppino M, Turicchia GU, Veneziani A, Docimo C, Borrelli V, Lorenzo M, Italian Collaborative Study Group for the Lap-Band System. Laparoscopic Italian experience with the Lap-Band. Obes Surg 2001; 11: 307–310.

    Article  CAS  PubMed  Google Scholar 

  99. O'Brien PE, Dixon JB, Brown W . The laparoscopic adjustable gastric band (Lap-Band®): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg 2002; 12: 652–660.

    Article  PubMed  Google Scholar 

  100. Belachew M, Belva PH, Desaive C . Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002; 12: 564–589.

    Article  CAS  PubMed  Google Scholar 

  101. Scopinaro N, Gianetta E, Adami GF, Friedman D, Traverso E, Marinari GM, Cuneo S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V . Biliopancreatic diversion for obesity at eighteen years. Surgery 1996; 119: 261–268.

    Article  CAS  PubMed  Google Scholar 

  102. Hess DS, Hess DW . Biliopancreatic diversion with a duodenal switch. Obes Surg 1998; 8: 267–282.

    Article  CAS  PubMed  Google Scholar 

  103. Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S . Biliopancreatic diversion with duodenal switch. World J Surg 1998; 22: 947–954.

    Article  CAS  PubMed  Google Scholar 

  104. Brolin RE, LaMarca LB, Kenler HA, Cody RP . Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6: 195–203.

    Article  PubMed  Google Scholar 

  105. Brolin RE, Kenler HA, Gorman JH, Cody RP . Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 1992; 215: 387–395.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Steinbrook R . Surgery for severe obesity. N Eng J Med 2004; 350: 1075–1079.

    Article  CAS  Google Scholar 

  107. Fredenheim M . Hospitals pressured by soaring demand for obesity surgery. New York Times, August 29, 2003.

  108. Ault A . Federal panel gives high marks to joint replacement surgery. New York Times, December 16, 2003.

  109. Rand CS, Macgregor AM . Morbidly obese patients' perceptions of social discrimination before and after surgery for obesity. South Med J 1990; 83: 1390–1395.

    Article  CAS  PubMed  Google Scholar 

  110. Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C . Weight bias among health professionals specializing in obesity. Obes Res 2003; 11: 1033–1039.

    Article  PubMed  Google Scholar 

  111. Skidmore S . Blue Cross will stop covering weight-loss surgeries. The Florida Times-Union, Thursday, February 12, 2004.

  112. Lieberman MD, Kilburn H, Lindsey M, Brennan MF . Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995; 222: 638–645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  113. Liu JH, Zingmond D, Etzioni DA, O'Connell JB, Maggard MA, Livingston EH, Liu CD, Ko CY . Characterizing the performance and outcomes of obesity surgery in California. Ann Surg 2003; 69: 823–828.

    Google Scholar 

  114. Courcoulas A, Schuchert M, Gatti G, Luketich J . The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery 2003; 134: 613–621.

    Article  PubMed  Google Scholar 

  115. Guidelines for granting privileges in bariatric surgery. http://www.asbs.org/html/guidelines.html.

  116. Bariatric Surgery Centers of Excellence. American Society for Bariatric Surgery. http://www.asbs.org/html/excellence.html.

  117. Hu X, Wright JG, McLeod RS, Lossing A, Walters BC . Observational studies as alternatives to randomized clinical trials in surgical clinical research. Surgery 1996; 119: 473–475.

    Article  CAS  PubMed  Google Scholar 

  118. Benson K, Hartz AJ . A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000; 342: 1878–1886.

    Article  CAS  PubMed  Google Scholar 

  119. Concato J, Shah N, Horwitz RI . Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887–1892.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Steinbrook R . Peer review and federal regulations. N Engl J Med 2004; 350: 103–104.

    Article  CAS  PubMed  Google Scholar 

  121. Östman J, Britton M, Jonsson E . Treating and Preventing Obesity. An Evidence Based Review. WILEY-VCH verlag GmbH & Co KgaA: Weinhem; 2004.

    Book  Google Scholar 

  122. EPC: Southern California-RAND Evidence-based Practice Center. Pharmacological and Surgical Treatment of Obesity. July, 2004, www.ahcpr.gov/clinic/tp/obesphtp.htm.

  123. Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO . Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 1999; 13: 10–13.

    Article  CAS  PubMed  Google Scholar 

  124. van Gemert WG, Adang EMM, Kop M, Vos G, Greve JWM, Soeters PB . A prospective cost-effectiveness analysis of vertical banded gastroplasty for the treatment of morbid obesity. Obes Surg 1999; 9: 484–491.

    Article  CAS  PubMed  Google Scholar 

  125. Agren G, Narbro K, Naslund I, Sjostrom L, Peltonen M . Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int J Obes Relat Metab Disord 2002; 26: 184–192.

    Article  CAS  PubMed  Google Scholar 

  126. Narbro K, Agren G, Jonsson E, Naslund I, Sjostrom L, Peltonen M, Swedish Obese Subjects Intervention Study. Pharmaceutical costs in obese individuals: comparison with randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Intern Med 2002; 162: 2061–2069.

    Article  PubMed  Google Scholar 

  127. Agren G, Narbro K, Jonsson E, Naslund I, Sjostrom L, Peltonen M . Cost of in-patient care over 7 years among surgically and conventionally treated obese patients. Obes Res 2002; 10: 1276–1283.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Virginia Commonwealth University, Richmond, VA, USA

    H J Sugerman

  2. SUNY Downstate Medical Center, Brooklyn, NY, USA

    J G Kral

Authors
  1. H J Sugerman
    View author publications

    Search author on:PubMed Google Scholar

  2. J G Kral
    View author publications

    Search author on:PubMed Google Scholar

Corresponding authors

Correspondence to H J Sugerman or J G Kral.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sugerman, H., Kral, J. Evidence-based medicine reports on obesity surgery: a critique. Int J Obes 29, 735–745 (2005). https://doi.org/10.1038/sj.ijo.0802930

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802930

Keywords

This article is cited by

Search

Advanced search

Quick links