UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Medical outcomes following bariatric surgery

Authors
Dana Telem, MD
Alexander J Greenstein, MD, MPH
Bruce Wolfe, MD
Section Editor
Daniel Jones, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Short-term outcomes are defined as events that occur within two years following a bariatric operative procedure. This topic reviews short-term outcomes, including sustained weight loss, medical comorbidities, psychosocial difficulties, and health care expenditure, following the three most commonly performed bariatric operations: Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), and Adjustable Gastric Band (AGB).

Obesity is a worldwide epidemic, affecting children, adolescents, and adults [1-5]. For example, the 2010 National Health and Examination Survey conducted by the Centers for Disease Control and Prevention demonstrated that 33.8 percent of adults in the United States and Canada are classified as obese [6-8]. Bariatric surgery remains the only effective sustained weight loss option for morbidly obese patients, and the performance of bariatric surgical procedures has significantly increased in the last 10 years [9,10].

The American Society for Metabolic and Bariatric Surgery (ASMBS) estimated that in 2008 alone, 220,000 people in the United States underwent a weight loss operation [10]. In addition to achieving weight loss, bariatric procedures result in marked improvement or resolution of many obesity-related health problems, such as type II diabetes. However, the recent guidelines published by the American Heart Association (AHA), American College of Cardiology (ACC), and The Obesity Society (TOS) indicate that there is insufficient evidence at present to recommend bariatric or metabolic surgical procedures as primary treatment for type 2 diabetes independent of body mass index criteria [11,12]. (See "Bariatric operations for management of obesity: Indications and preoperative preparation".)

Additional topics on bariatric surgery are discussed separately, including:

(See "Bariatric operations for management of obesity: Indications and preoperative preparation".)

                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Jun 16 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Global prevalence of adult obesity - Country rankings 2010. Source: International Obesity Taskforce, International Association for the Study of Obesity www.allcountries.org/ranks/global_prevalence_of_adult_obesity.html (Accessed on October 21, 2013).
  2. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. www.cdc.gov/obesity/data/trends.html (Accessed on January 28, 2010).
  3. Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138:24.
  4. Vlad I. Obesity costs UK economy 2bn pounds sterling a year. BMJ 2003; 327:1308.
  5. Duda RB, Darko R, Adanu RMK, et al. Prevalence of Obesity in an Urban West African Population: Results of the Women’s Health Study of Accra. African J Health Sciences 2007; 14:154.
  6. McGuire S. Shields M., Carroll M.D., Ogden C.L. adult obesity prevalence in Canada and the United States. NCHS data brief no. 56, Hyattsville, MD: National Center for Health Statistics, 2011. Adv Nutr 2011; 2:368.
  7. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288:1723.
  8. Balsiger BM, Murr MM, Poggio JL, Sarr MG. Bariatric surgery. Surgery for weight control in patients with morbid obesity. Med Clin North Am 2000; 84:477.
  9. Patterson EJ, Urbach DR, Swanström LL. A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg 2003; 196:379.
  10. Nguyen NT, Masoomi H, Magno CP, et al. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg 2011; 213:261.
  11. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9:159.
  12. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2014; 63:2985.
  13. Metropolitan Life Tables for women and men. www.halls.md/ideal-weight/met.htm (Accessed on August 29, 2013).
  14. BMI classification. World Health Organization. apps.who.int/bmi/index.jsp?introPage=intro_3.html (Accessed on August 29, 2013).
  15. Mehaffey JH, LaPar DJ, Clement KC, et al. 10-Year Outcomes After Roux-en-Y Gastric Bypass. Ann Surg 2016; 264:121.
  16. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724.
  17. Ballantyne GH. Measuring outcomes following bariatric surgery: weight loss parameters, improvement in co-morbid conditions, change in quality of life and patient satisfaction. Obes Surg 2003; 13:954.
  18. Delin CR, Watts JM. Success in Surgical Intervention for Morbid Obesity: Is Weight Loss Enough? Obes Surg 1995; 5:189.
  19. Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 2013; 258:690.
  20. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310:2416.
  21. Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA Surg 2014; 149:707.
  22. Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care 2008; 31 Suppl 2:S290.
  23. Rhee NA, Vilsbøll T, Knop FK. Current evidence for a role of GLP-1 in Roux-en-Y gastric bypass-induced remission of type 2 diabetes. Diabetes Obes Metab 2012; 14:291.
  24. Osto E, Doytcheva P, Corteville C, et al. Rapid and body weight-independent improvement of endothelial and high-density lipoprotein function after Roux-en-Y gastric bypass: role of glucagon-like peptide-1. Circulation 2015; 131:871.
  25. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012; 366:1567.
  26. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014; 370:2002.
  27. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009; 32:193.
  28. American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care 2011; 34 Suppl 1:S11.
  29. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012; 366:1577.
  30. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386:964.
  31. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309:2240.
  32. Courcoulas AP, Belle SH, Neiberg RH, et al. Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial. JAMA Surg 2015; 150:931.
  33. Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010; 251:399.
  34. Kenngott HG, Clemens G, Gondan M, et al. DiaSurg 2 trial--surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial--DRKS00004550. Trials 2013; 14:183.
  35. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011; 254:410.
  36. Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008; 299:316.
  37. Ahn SM, Pomp A, Rubino F. Metabolic surgery for type 2 diabetes. Ann N Y Acad Sci 2010; 1212:E37.
  38. Müller-Stich BP, Fischer L, Kenngott HG, et al. Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization--results of a prospective cohort study (DiaSurg 1 study). Ann Surg 2013; 258:760.
  39. Zhang N, Maffei A, Cerabona T, et al. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy? Surg Endosc 2013; 27:1273.
  40. Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA 1987; 257:2176.
  41. Joshi AV, Day D, Lubowski TJ, Ambegaonkar A. Relationship between obesity and cardiovascular risk factors: findings from a multi-state screening project in the United States. Curr Med Res Opin 2005; 21:1755.
  42. Nguyen NT, Varela E, Sabio A, et al. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg 2006; 203:24.
  43. Jamal M, Wegner R, Heitshusen D, et al. Resolution of hyperlipidemia follows surgical weight loss in patients undergoing Roux-en-Y gastric bypass surgery: a 6-year analysis of data. Surg Obes Relat Dis 2011; 7:473.
  44. Brolin RE, Kenler HA, Wilson AC, et al. Serum lipids after gastric bypass surgery for morbid obesity. Int J Obes 1990; 14:939.
  45. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003; 289:2230.
  46. Redline S, Budhiraja R, Kapur V, et al. The scoring of respiratory events in sleep: reliability and validity. J Clin Sleep Med 2007; 3:169.
  47. Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 2009; 122:535.
  48. Dixon JB, Schachter LM, O'Brien PE, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA 2012; 308:1142.
  49. Newman AB, Foster G, Givelber R, et al. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 2005; 165:2408.
  50. Sarkhosh K, Switzer NJ, El-Hadi M, et al. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg 2013; 23:414.
  51. Herbella FA, Sweet MP, Tedesco P, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg 2007; 11:286.
  52. Ayazi S, Hagen JA, Chan LS, et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 2009; 13:1440.
  53. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005; 143:199.
  54. Minimally Invasive Bariatric Surgery, Schauer P, Schirmer B, Brethauer S (Eds), Springer Science Business Media, 2007.
  55. Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity: a prospective study based on the Montreal Consensus. Ann Surg 2010; 251:244.
  56. de Jong JR, Besselink MG, van Ramshorst B, et al. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review. Obes Rev 2010; 11:297.
  57. Howard DD, Caban AM, Cendan JC, Ben-David K. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 2011; 7:709.
  58. Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2011; 7:569.
  59. Omana JJ, Nguyen SQ, Herron D, Kini S. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc 2010; 24:2513.
  60. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 2010; 20:357.
  61. Petersen WV, Meile T, Küper MA, et al. Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity. Obes Surg 2012; 22:360.
  62. Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc 2013; 27:1260.
  63. Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis 2011; 7:510.
  64. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012; 8:8.
  65. DuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease . A national analysis. JAMA Surg 2014; 149:328.
  66. King WC, Chen JY, Belle SH, et al. Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity. JAMA 2016; 315:1362.
  67. Vrbikova J, Hainer V. Obesity and polycystic ovary syndrome. Obes Facts 2009; 2:26.
  68. Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005; 1:77.
  69. Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab 2005; 90:6364.
  70. Legro RS, Dodson WC, Gnatuk CL, et al. Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab 2012; 97:4540.
  71. Shah DK, Ginsburg ES. Bariatric surgery and fertility. Curr Opin Obstet Gynecol 2010; 22:248.
  72. Nelson SM, Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol 2007; 19:384.
  73. Musella M, Milone M, Bellini M, et al. Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis 2012; 8:445.
  74. Shekelle PG, Newberry S, Maglione M, et al. Bariatric surgery in women of reproductive age: special concerns for pregnancy. Evid Rep Technol Assess (Full Rep) 2008; :1.
  75. Sheiner E, Edri A, Balaban E, et al. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol 2011; 204:50.e1.
  76. Du Plessis SS, Cabler S, McAlister DA, et al. The effect of obesity on sperm disorders and male infertility. Nat Rev Urol 2010; 7:153.
  77. Reis LO, Dias FG. Male fertility, obesity, and bariatric surgery. Reprod Sci 2012; 19:778.
  78. Sermondade N, Massin N, Boitrelle F, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Reprod Biomed Online 2012; 24:206.
  79. Lazaros L, Hatzi E, Markoula S, et al. Dramatic reduction in sperm parameters following bariatric surgery: report of two cases. Andrologia 2012; 44:428.
  80. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 2009; 182:S2.
  81. Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis 2009; 5:524.
  82. Whitcomb EL, Lukacz ES, Lawrence JM, et al. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:289.
  83. Subak LL, King WC, Belle SH, et al. Urinary Incontinence Before and After Bariatric Surgery. JAMA Intern Med 2015; 175:1378.
  84. Raghavendra RS, Kini D. Benign, premalignant, and malignant lesions encountered in bariatric surgery. JSLS 2012; 16:360.
  85. Basen-Engquist K, Chang M. Obesity and cancer risk: recent review and evidence. Curr Oncol Rep 2011; 13:71.
  86. Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut 2013; 62:933.
  87. Argenta PA, Kassing M, Truskinovsky AM, Svendsen CA. Bariatric surgery and endometrial pathology in asymptomatic morbidly obese women: a prospective, pilot study. BJOG 2013; 120:795.
  88. Hafeez S, Ahmed MH. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance? J Obes 2013; 2013:839275.
  89. Day CP. Non-alcoholic fatty liver disease: current concepts and management strategies. Clin Med (Lond) 2006; 6:19.
  90. Karcz WK, Krawczykowski D, Kuesters S, et al. Influence of Sleeve Gastrectomy on NASH and Type 2 Diabetes Mellitus. J Obes 2011; 2011:765473.
  91. Furuya CK Jr, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol 2007; 22:510.
  92. Dixon JB, Bhathal PS, O'Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg 2006; 16:1278.
  93. Dixon JB, Bhathal PS, Hughes NR, O'Brien PE. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatology 2004; 39:1647.
  94. Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg 2012; 22:1016.
  95. Clark JM, Alkhuraishi AR, Solga SF, et al. Roux-en-Y gastric bypass improves liver histology in patients with non-alcoholic fatty liver disease. Obes Res 2005; 13:1180.
  96. de Almeida SR, Rocha PR, Sanches MD, et al. Roux-en-Y gastric bypass improves the nonalcoholic steatohepatitis (NASH) of morbid obesity. Obes Surg 2006; 16:270.
  97. Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery 2004; 135:48.
  98. Barker KB, Palekar NA, Bowers SP, et al. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol 2006; 101:368.
  99. Stratopoulos C, Papakonstantinou A, Terzis I, et al. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg 2005; 15:1154.
  100. Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg 2005; 242:610.
  101. Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev 2010; :CD007340.
  102. Dixon JB, Dixon ME, O'Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003; 163:2058.
  103. Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis. JAMA 2016; 315:150.
  104. van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg 2006; 16:787.
  105. Mamplekou E, Komesidou V, Bissias Ch, et al. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. Obes Surg 2005; 15:1177.
  106. Green AE, Dymek-Valentine M, Pytluk S, et al. Psychosocial outcome of gastric bypass surgery for patients with and without binge eating. Obes Surg 2004; 14:975.
  107. Papageorgiou GM, Papakonstantinou A, Mamplekou E, et al. Pre- and postoperative psychological characteristics in morbidly obese patients. Obes Surg 2002; 12:534.
  108. van Hout GC, van Oudheusden I, van Heck GL. Psychological profile of the morbidly obese. Obes Surg 2004; 14:579.
  109. Guisado JA, Vaz FJ. Personality profiles of the morbidly obese after vertical banded gastroplasty. Obes Surg 2003; 13:394.
  110. Buddeberg-Fischer B, Klaghofer R, Sigrist S, Buddeberg C. Impact of psychosocial stress and symptoms on indication for bariatric surgery and outcome in morbidly obese patients. Obes Surg 2004; 14:361.
  111. Morseth MS, Hanvold SE, Rø Ø, et al. Self-Reported Eating Disorder Symptoms Before and After Gastric Bypass and Duodenal Switch for Super Obesity--a 5-Year Follow-Up Study. Obes Surg 2016; 26:588.
  112. Dixon JB, Eaton LL, Vincent V, Michaelson R. LAP-BAND for BMI 30-40: 5-year health outcomes from the multicenter pivotal study. Int J Obes (Lond) 2016; 40:291.
  113. Kalarchian MA, King WC, Devlin MJ, et al. Psychiatric Disorders and Weight Change in a Prospective Study of Bariatric Surgery Patients: A 3-Year Follow-Up. Psychosom Med 2016; 78:373.
  114. Sarwer DB, Wadden TA, Moore RH, et al. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis 2010; 6:608.
  115. Hrabosky JI, Masheb RM, White MA, et al. A prospective study of body dissatisfaction and concerns in extremely obese gastric bypass patients: 6- and 12-month postoperative outcomes. Obes Surg 2006; 16:1615.
  116. Dixon JB, Dixon ME, O'Brien PE. Body image: appearance orientation and evaluation in the severely obese. Changes with weight loss. Obes Surg 2002; 12:65.
  117. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357:753.
  118. Bhatti JA, Nathens AB, Thiruchelvam D, et al. Self-harm Emergencies After Bariatric Surgery: A Population-Based Cohort Study. JAMA Surg 2016; 151:226.
  119. Mathus-Vliegen EM, de Weerd S, de Wit LT. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss. Surgery 2004; 135:489.
  120. Weiner JP, Goodwin SM, Chang HY, et al. Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg 2013; 148:555.
  121. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009; 13:1.
  122. Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care 2008; 14:589.
  123. Finkelstein EA, Allaire BT, Burgess SM, Hale BC. Financial implications of coverage for laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2011; 7:295.
  124. Neovius M, Narbro K, Keating C, et al. Health care use during 20 years following bariatric surgery. JAMA 2012; 308:1132.
  125. Maciejewski ML, Livingston EH, Smith VA, et al. Health expenditures among high-risk patients after gastric bypass and matched controls. Arch Surg 2012; 147:633.