Bariatric Surgery: What’s the Evidence?
DOI: 10.3238/zfa.2019.0099-0102german translation / full article
QuestionThe epidemic of obesity is ever increasing worldwide. Family physicians are frequently asked by obese patients: “Should I have surgery to get rid of my excess weight?” Thus the question arises, what is current best evidence regarding benefits and risks of bariatric surgery. Answer There are only few randomized controlled trials without long-term follow up investigating the effectiveness and safety of bariatric surgery. While initial weight loss and positive effects on metabolic control and cardiovascular risk are well documented, there are only data from cohort studies regarding long-term effects on mortality and cardiovascular endpoints. These observational studies which probably overestimate beneficial effects reveal a number needed to treat of > 125 to prevent one death in 10 years, and a significant positive effect can only be seen more than 13 years after the operation. Long-term complication rate is high (at least 10–25 %), and cost savings may not be expected from bariatric surgery. The decision to have bariatric surgery should only be made in selected cases after thorough information of the patient regarding risks and benefits. Long-term randomized controlled trials are strongly recommended.