The management of morbid obesity : bariatric surgery or lifestyle intervention?

Abstract

BACKGROUND: In Malta, obesity is a health problem where 22.3% of the population are obese, and thus an effective weight loss method is required. The research question posed was: In obese adults, how does bariatric surgery compared to lifestyle intervention affect weight loss and its maintenance? METHODS: Various databases were searched using several key words. Studies were included if they had an adult morbid obese population, compared bariatric surgery with lifestyle intervention programmes, and analysed weight loss and its maintenance as one of their outcomes. Studies were excluded if they were part or an extension of a study already included, studied children or adolescents, did not compare the two interventions simultaneously, and did not consider weight loss or its maintenance as one of their outcomes. Thirteen articles were extracted and critically appraised using the appropriate critical appraisal tool for the research design. The quality and reliability of the research designs were compared and discussed, followed by the analysis of ethical issues. RESULTS: Bariatric surgery resulted in significant more weight loss and maintenance when compared to lifestyle interventions programmes in adult morbid obese individuals. Weight regain occurred in both groups; however, it was more dominant in the lifestyle intervention group, concluding that bariatric surgery provides better weight maintenance as well. CONCLUSION: Consequently it is recommended that bariatric surgery becomes part of the local weight loss programme offered by the government to ensure effective weight loss management in the adult morbid obese individuals. Larger sample size studies, more randomised controlled trials, and longer follow ups are essential to sustain the outcome of results. Keywords: morbid obesity, adults, bariatric surgery, lifestyle intervention, weight loss, weight maintenance