A decade-long study led by the University of Bristol and supported by the National Institute for Health and Care Research has confirmed that gastric bypass surgery is the most clinically and cost-effective treatment for people living with severe obesity.
The By-Band-Sleeve trial, the largest of its kind, involved 1,346 patients, with Musgrove Park Hospital contributing the highest number of participants (247). The study compared three types of bariatric surgery: Roux-en-Y gastric bypass (Bypass), adjustable gastric banding (Band), and sleeve gastrectomy (Sleeve).
After three years, the study found:
- 68% of Bypass patients achieved at least 50% excess weight loss
- Compared to 41% for Sleeve and 25% for Band
- Average weight loss was 26.5kg (over 4 stone), with some losing up to 98kg (over 15 stone)
Nicki Salter, Somerset NHS FT’s research team leader for bariatrics, weight management and endocrinology, said:
“For the first time we now have the concrete evidence to tell patients considering bariatric surgery which operation is best out of the three procedures compared.
“This is not only around weight loss and cost effectiveness, but also in terms of quality of life, which perhaps is the most important factor.”
Bypass also led to greater reductions in comorbidities such as high blood pressure and diabetes, and was found to be the most cost-effective option when factoring in quality of life and long-term healthcare costs.
Professor of Surgery at the University of Bristol, Jane Blazeby, also commented:
“Based on the trial findings, we recommend patients electing to have bariatric and metabolic surgery are advised to have Bypass. Sleeve should be a secondary option when Bypass is not possible. Our evidence does not support Band as standard treatment for people living with severe obesity.
“The hard work undertaken by all the study participants, surgeons, nurses and dietitians means we now have reliable information to inform NHS practice.
“The next challenge is for surgical teams to work with researchers and physicians to conduct a new study that compares surgery to weight loss drugs to create evidence to understand how they compare surgery in terms of weight loss, quality of life and costs.”
Musgrove Park Hospital was the lead centre and the first hospital to host the trial. The study was spearheaded locally by Professor Rob Andrews, diabetes consultant and principal investigator, and Professor Richard Welbourn, consultant bariatric surgeon and overall lead surgeon.
The findings support current national guidelines recommending surgery for severe obesity and provide robust evidence to guide future NHS treatment pathways.
Image credit: iStock
