Weight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch

Background: Gastric bypass and duodenal switch are currently performed bariatric surgical procedures. Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass.



Objective: To determine whether duodenal switch leads to greater weight loss and more favorable improvements in cardiovascular risk factors and quality of life than gastric bypass.



Design: Randomized, parallel-group trial. (ClinicalTrials.gov registration number: NCT00327912)



Setting: 2 academic medical centers (1 in Norway and 1 in Sweden).



Patients: 60 participants with a body mass index (BMI) between 50 and 60 kg/m2.



Intervention: Gastric bypass (n = 31) or duodenal switch (n = 29).



Measurements: The primary outcome was the change in BMI after 2 years. Secondary outcomes included anthropometric measures; concentrations of blood lipids, glucose, insulin, C-reactive protein, and vitamins; and health-related quality of life and adverse events.



Results: Fifty-eight of 60 participants (97%) completed the study. The mean reductions in BMI were 17.3 kg/m2 (95% CI, 15.7 to 19.0 kg/m2) after gastric bypass and 24.8 kg/m2 (CI, 23.0 to 26.5 kg/m2) after duodenal switch (mean between-group difference, 7.44 kg/m2 [CI, 5.24 to 9.64 kg/m2]; P < 0.001). Total cholesterol concentration decreased by 0.24 mmol/L (CI, ?0.03 to 0.50 mmol/L) (9.27 mg/dL [CI, ?1.16 to 19.3 mg/dL]) after gastric bypass and 1.07 mmol/L (CI, 0.79 to 1.35 mmol/L) (41.3 mg/dL [CI, 30.5 to 52.1 mg/dL]) after duodenal switch (mean between-group difference, 0.83 mmol/L [CI, 0.48 to 1.18 mmol/L]; 32.0 mg/dL [CI, 18.5 to 45.6 mg/dL]; P ≤ 0.001). Reductions in low-density lipoprotein cholesterol concentration, anthropometric measures, fat mass, and fat-free mass were also greater after duodenal switch (P ≤ 0.010 for each between-group comparison). Both groups had reductions in blood pressure and mean concentrations of glucose, insulin, and C-reactive protein, with no between-group differences. The duodenal switch group, but not the gastric bypass group, had reductions in concentrations of vitamin A and 25-hydroxyvitamin D. Most Short Form-36 Health Survey dimensional scores improved in both groups, with greater improvement in 1 of 8 domains (bodily pain) after gastric bypass. From surgery until 2 years, 10 participants (32%) had adverse events after gastric bypass and 18 (62%) after duodenal switch (P = 0.021). Adverse events related to malnutrition occurred only after duodenal switch.



Limitation: Clinical experience was greater with gastric bypass than with duodenal switch at the study centers.



Conclusion: Duodenal switch surgery was associated with greater weight loss, greater reductions of total and low-density lipoprotein cholesterol concentrations, and more adverse events. Improvements in other cardiovascular risk factors and quality of life were similar after both procedures.



Primary Funding Source: South-Eastern Norway Regional Health Authority.

The Only Way Is Essex: Gemma Collins loses almost four stone – want to see the sexy pictures?

Gemma Collins will be looking much more slim and svelte when she takes to our screens again later this month.




The buxom star of ITV2′s The Only Way Is Essex will be almost four stone lighter when she stars in the third series of the reality TV show, having undergone a strict health and fitness regime in recent months.







After swapping takeaways for salads, Gemma has stripped off for new! magazine and showed off her new size 14 body. Collins was a size 20 at her largest.



Gemma told the magazine: “I can’t wait to get down to Ann Summers! I’ve never felt sexier. As much as I said I was confident before, I really feel sexy now, not fake sexy. It was false confidence before.”



The blonde bombshell admitted that she had piled on the weight after being dumped by her boyfriend and starting to worry that she was never going to settle down, find love and start a family.



Collins explained that she was devastated when left single at the age of thirty, saying:





“I hit 30 and started to panic. I hadn’t found the love of my life – I just ballooned. I’d think, ‘No one loves me,’ and scoff another cake!



“It was scary. I thought, ‘Why the hell am I doing this to myself? I’m going to get fat and die.’



On what’s ahead for the future, Gemma mused:



“I want to meet someone new – I don’t want to date older men any more. I want a young, hot stallion.”

Primum Non Nocere

To do no harm has been a guiding tenet of medicine for millennia. In this context, bariatric surgery warrants serious consideration. Bariatric operations undoubtedly induce weight loss, but at what cost? Consideration of the balance between benefits and harms calls into question the overall utility of bariatric surgery and, most important, what the appropriate end points should be.




Weight loss is a good start. Bariatric procedures were devised to induce weight loss in patients who could not lose weight by modifying diet and exercise alone. The first operation was the ill-fated jejunoileal bypass, a procedure that caused substantial nutrient malabsorption resulting in weight loss. Because jejunoileal bypass was the first successful treatment for morbid obesity, clinicians embraced it until its substantial complication profile became evident (1): Years after surgery, bacterial overgrowth in the bypassed intestinal limb led to accumulated damage to the liver and cirrhosis. Roux-en-Y gastric bypass and biliopancreatic diversion procedures were devised to surgically induce weight loss and avoid the long-term complications associated with jejunoileal bypass.



We should have learned some important lessons from the jejunoileal bypass experience. First, operations should not be widely adopted until they have been studied in a controlled manner. In addition, procedures that induce intestinal malabsorption are unnatural and inherently dangerous. Extensive reviews of bariatric surgery have provided irrefutable evidence showing that bariatric surgery induces weight loss but also causes harm (2–4). Data on the effectiveness of these procedures

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