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N Engl J Med. 2017 Sep 21;377(12):1143-1155. doi: 10.1056/NEJMoa1700459.

Weight and Metabolic Outcomes 12 Years after Gastric Bypass.

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From Intermountain Live Well Center Salt Lake, Intermountain Healthcare (T.D.A.), the Division of Cardiovascular Genetics, Department of Internal Medicine (T.D.A., L.E.D., M.N.N., J.M.G., S.J.F., P.N.H., S.C.H.), Division of General Surgery, Department of Surgery (A.R.I.), and Division of Cardiovascular Medicine, Department of Internal Medicine (P.N.H.), University of Utah School of Medicine, the Department of Health, Kinesiology and Recreation, College of Health, University of Utah (J.K.), the Utah Foundation for Biomedical Research and Utah Lipid Center (E.A.B.), and Rocky Mountain Associated Physicians (R.M., S.C.S.), Salt Lake City, and the Department of Exercise Sciences, Brigham Young University, Provo (L.E.D.) - all in Utah; the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston (S.E.L.); Quality of Life Consulting, and the Department of Community and Family Medicine, Duke University Health System, Durham, NC (R.L.K.); Western Norway University of Applied Sciences, Department of Health Studies, and Førde Hospital Trust, Førde, and the Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg - all in Norway (R.L.K.); and the Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar (S.J.F., S.C.H.).



Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States.


A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia.


The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was -45.0 kg (95% confidence interval [CI], -47.2 to -42.9; mean percent change, -35.0) at 2 years, -36.3 kg (95% CI, -39.0 to -33.5; mean percent change, -28.0) at 6 years, and -35.0 kg (95% CI, -38.4 to -31.7; mean percent change, -26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was -2.9 kg (95% CI, -6.9 to 1.0; mean percent change, -2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, -3.5 to 3.5; mean percent change, -0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons).


This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

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