Surgery for morbid obesity i.e. bariatric surgery, is now well established worldwide, and not only in the United States, although it prevails in this country because of a large population of obese people. Let us remind you that surgery is dedicated to patients with a Body Mass Index (BMI) above 40 kg/m2, or above 35 kg/m2 if there are related comorbidities.

Surgery does, however, remain under scrutiny, and its cost-efficiency ratio has been questioned. As a matter of fact, we know that weight-loss improves the comorbid conditions, and that surgery is an effective way to obtain a sustained weight-loss (albeit with significant mortality and post-operative morbidity rates). Yet this is not enough to demonstrate the efficiency of surgery compared with other treatments for morbid obesity.

A complex and broad comparative study was initiated in 1991 in Sweden on a population of more than 1000 obese people, who were voluntarily put on a register. One section of this cohort was operated on (using various procedures: gastric banding, gastric stapling, gastric bypass - if you want to know more about these procedures, please refer to chapter 'digestive surgery'). Another section of people followed conventional treatments.

The illnesses and various complications in each group of patients were compared over the years. Although comprehensive results are not yet available, very interesting partial results have been published in international reviews. 692 patients were included and 483 (70%) were followed up for 8 years. No significant weight changes occurred in the obese control group (non treated) over 8 years, whereas bariatric surgery resulted in a maintained weight-loss of 20,1 kg after 8 years. This weight reduction had a dramatic effect on the incidence of diabetes, although hypertension was not cured over this period. Short-term improvements have also been reported regarding cardiac and pulmonary functions (sleep apnoea for example), and health problems linked to blood lipids.
Thanks to this study, it has been established that operated patients had significantly fewer days of sickness than in the control group (except during the first year after initiation of treatment, which can be explained by the aftermath of the operation and its possible complications).

Although additional studies are requested (particularly regarding quality of life in the long term), it can be said that surgery as a treatment for morbid obesity has a favourable outcome. As usual, the most important issue is the impact of the «operative risk » issue, immediately after surgery as well as in the long term, which any patient is likely to face in order to improve his future health.