The results from Gunn Signe Jakobsen‘s PhD thesis show that bariatric surgery can improve obesity-related comorbidities more, but is also associated with higher complication rates than specialized medical treatment.
- Earlier onset of obesity, but not obesity-related comorbidities, predicts obese patients who will choose surgery rather than conservative treatment.
- Patients using the cholesterol-lowering drug atorvastatin should be monitored closely for both therapeutic and adverse effects following bariatric surgery.
- Hypertension, diabetes and dyslipidemia improved more following bariatric surgery than medical obesity treatmeant, but rates of complication were higher.
Thesis: Bariatric surgery and specialized medical treatment for severe obesity Impact on cardiovascular risk factors and postsurgical pharmacokinetics of atorvastatin
Candidate: Gunn Signe Jakobsen
Time: May 4, 2018 at 13:15
Place: Oslo University Hospital, Rikshospitalet B: Seminar room 3
Link to university website (in Norwegian)
(1) Lower age, higher BMI, and onset of obesity before 12 years of age were the only significant predictors of surgery as treatment choice in morbidly obese patients. 249 patients who underwent bariatric surgery were compared to 256 patients treated conservatively. Gender and cardiovascular comorbidities such as dyslipidemia, hypertension and diabetes did not influence treatment choice.
(2) The uptake of atorvastatin increased the first weeks following bariatric surgery, but normalized during the next two years. The study enrolled only 20 patients, but the findings still indicate that patients using atorvastatin or similar drugs should be monitored closely for both therapeutic effects and adverse events the first years after bariatric surgery.
(3) Surgically treated patients were more likely to quit medication for hypertension, diabetes and dyslipidemia, compared to patients treated conservatively. However, the risk of undergoing at least one additional gastrointestinal surgical procedure, the risk of treatment with opioids and the risk of new-onset depression were increased in the surgical group.
1888 patients were included in this study, and they were followed for a median of 6.5 years.
(1) Jakobsen, G. S., Hofsø, D., Røislien, J., Sandbu, R., & Hjelmesæth, J. (2010). Morbidly obese patients—who undergoes bariatric surgery?. Obesity surgery, 20(8), 1142-1148.
(2) Jakobsen, G. S., Skottheim, I. B., Sandbu, R., Christensen, H., Røislien, J., Åsberg, A., & Hjelmesæth, J. (2013). Long-term effects of gastric bypass and duodenal switch on systemic exposure of atorvastatin. Surgical endoscopy, 27(6), 2094-2101.
(3) Jakobsen, G. S., Småstuen, M. C., Sandbu, R., Nordstrand, N., Hofsø, D., Lindberg, M., Hertel, J. K., & Hjelmesæth, J. (2018). Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities. Jama, 319(3), 291-301.