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Bariatric Surgery for Patients with Overweight/Obesity. A Comprehensive Grading Methodology and Network Metanalysis of Randomized Controlled Trials on Weight Loss Outcomes and Adverse Events

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Abstract

This study aims to compare different types of metabolic bariatric surgery (MBS) with lifestyle intervention/medical therapy (LSI/MT) for the treatment of overweight/obesity. The present and network meta-analysis (NMA) includes randomized trials. MBS was associated with a reduction of BMI, body weight, and percent weight loss, when compared to LSI/MT, and also with a significant reduction of HbA1c and a higher remission of diabetes. Meta-regression analyses revealed that BMI, a higher proportion of women, and a longer duration of trial were associated with greater effects of MBS. The NMA showed that all surgical procedures included (except greater curvature plication) were associated with a reduction of BMI. MBS is an effective option for the treatment of obesity. The choice of BMI thresholds for eligibility for surgery of patients with different complications should be performed making an evaluation of risks and benefits in each BMI category.

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Authors and Affiliations

  1. Dipartimento di Chirurgia Generale e Metabolica, Azienda ULSS5 Polesana, Ospedale di Rovigo, 45010, Rovigo, Italia

    Maurizio De Luca & Monica Zese

  2. Azienda Ospedaliero Universitaria Careggi e Università di Firenze, 50134, Firenze, Italia

    Giovanni Antonio Silverii, Benedetta Ragghianti, Giulia Bandini, Edoardo Mannucci & Matteo Monami

  3. Dipartimento di Scienze Biochimiche Avanzate, Università Degli Studi Di Napoli “Federico II”, 80138, Napoli, Italia

    Pietro Forestieri, Mario Musella & Giovanna Berardi

  4. ASST Fatebenefratelli-Sacco, 20157, Milano, Italia

    Marco Antonio Zappa

  5. Policlinico Universitario “G. Martino” Messina, 98124, Messina, Italia

    Giuseppe Navarra

  6. Ospedale San Giuseppe, 20100, Milano, Italia

    Diego Foschi

  7. UOC Chirurgia Generale e Bariatrica, Istituto Clinico Alta Specialità’ San Gaudenzio – Novara, Gruppo Policlinico di Monza, 28100, Novara, Italia

    Giuliano Sarro

  8. Università degli Studi di Salerno A.O.U. San Giovanni di Dio e Ruggi D’Aragona Ospedale G. Fucito, 84131, Salerno, Italia

    Vincenzo Pilone

  9. Asl 3, Pistoia, 51100, Pistoia, Italia

    Enrico Facchiano

  10. Policlinico Universitario di Padova, 35128, Padova, Italia

    Mirto Foletto

  11. Policlinico San Marco, Bergamo, 24046, Bergamo, Italia

    Stefano Olmi

  12. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, 00168, Italia

    Marco Raffelli

  13. Azienda Ospedaliero-Universitaria Pisana, 56126, Pisa, Italia

    Rosario Bellini

  14. Dipartimento di Chirurgia Bariatrica e Metabolica—Ospedale San Carlo di Nancy, Università di Roma Tor Vergata, Roma e Maria Cecilia Hospital, Cotignola, 00165, (Ravenna), Italia

    Paolo Gentileschi

  15. Distretto 41 – UOMI, ASL NAPOLI2 nord, 80027, Napoli, Italia

    Maria Rosaria Cerbone

  16. SC Diabetologia Dietologia e Nutrizione Clinica, Azienda Ospedaliera Santa Maria di Terni, 05100, Terni, Italia

    Ilenia Grandone

  17. Università Degli Studi Di Roma Tor Vergata, 00133, Roma, Italia

    Nicola Di Lorenzo

  18. Ospedale Santa Maria Nuova—Chirurgia Generale e Bariatrica – Azienda Sanitaria Toscana Centro, 50122, Firenze, Italia

    Marcello Lucchese

  19. UOC Chirurgia Generale e d’Urgenza, Arnas Garibaldi, 95123, Catania, Italia

    Luigi Piazza

  20. Dipartimento di Chirurgia, Università La Sapienza, AOU Policlinico Umberto I, 00161, Roma, Italia

    Giovanni Casella

  21. AORN A. Cardarelli Napoli, UO Chirurgia Bariatrica e Metabolica, 80131, Napoli, Italia

    Emilio Manno

  22. Chirurgia Endocrina e Metabolica, Ospedale G.B.Morgagni, 47121, Forlì, Italia

    Alberto Zaccaroni

  23. Dipartimento Chirurgico del Presidio Ospedaliero Gorizia-Monfalcone, ASS2 Isontina, 34170, Gorizia, Italia

    Alessandro Balani

Authors
  1. Maurizio De Luca
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  2. Monica Zese
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  3. Giovanni Antonio Silverii
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  23. Marcello Lucchese
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  29. Edoardo Mannucci
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  30. Matteo Monami
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Contributions

Matteo Monami and Edoardo Mannucci were involved in each of the following points: (1) design, (2) data collection, (3) analysis, (4) writing the manuscript. Maurizio De Luca, Monica Zese, Giovanni Antonio Silverii, Benedetta Ragghianti, Giulia Bandini, Pietro Forestieri, Marco Antonio Zappa, Giuseppe Navarra, Diego Foschi, Mario Musella, Giuliano Sarro, Vincenzo Pilone, Enrico Facchiano, Mirto Foletto, Stefano Olmi, Marco Raffelli, Rosario Bellini, Paolo Gentileschi, Maria Rosaria Cerbone, Ilenia Grandone, Giovanna Berardi, Nicola Di Lorenzo, Marcello Lucchese, Luigi Piazza, Giovanni Casella, Emilio Manno, Alberto Zaccaroni, Alessandro Balani were involved in each of the following points: (1) data collection, (2) manuscript revision. All the authors approved the final version of this manuscript. Dr. Matteo Monami is the person who takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

Corresponding author

Correspondence to Monica Zese.

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Competing Interests

Matteo Monami has received speaking fees from Astra Zeneca, Bristol Myers Squibb, Boehringer-Ingelheim, Eli-Lilly, Merck, Novo Nordisk, Sanofi, and Novartis and research grants from Bristol Myers Squibb. Edoardo Mannucci has received consultancy fees from Merck and Novartis speaking fees from Astra Zeneca, Bristol Myers Squibb, Boehringer-Ingelheim, Eli-Lilly, Merck, Novo Nordisk, Sanofi, and Novartis and research grants from Merck, Novartis, and Takeda. Maurizio De Luca, Monica Zese, Giovanni Antonio Silverii, Benedetta Ragghianti, Giulia Bandini, Pietro Forestieri, Marco Antonio Zappa, Giuseppe Navarra, Diego Foschi, Mario Musella, Giuliano Sarro, Vincenzo Pilone, Enrico Facchiano, Mirto Foletto, Stefano Olmi, Marco Raffelli, Rosario Bellini, Paolo Gentileschi, Maria Rosaria Cerbone, Ilenia Grandone, Giovanna Berardi, Nicola Di Lorenzo, Marcello Lucchese, Luigi Piazza, Giovanni Casella, Emilio Manno, Alberto Zaccaroni, Alessandro Balani has no conflicts of interest to declare.

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De Luca, M., Zese, M., Silverii, G.A. et al. Bariatric Surgery for Patients with Overweight/Obesity. A Comprehensive Grading Methodology and Network Metanalysis of Randomized Controlled Trials on Weight Loss Outcomes and Adverse Events. OBES SURG 33, 4147–4158 (2023). https://doi.org/10.1007/s11695-023-06909-4

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