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Am Fam Physician. 2004;69(4):978-979

Severe obesity is associated with multiple comorbidities (such as hypertension and diabetes) that can decrease life expectancy. Gastric bypass (GBP) surgery for severe obesity can positively affect hypertension and diabetes. Sugerman and associates performed a retrospective review of patients who had diabetes or hypertension and underwent GBP.

Of the 1,025 patients who had GBP, 15 percent had diabetes, and 51 percent had hypertension. One to 2 years postoperatively, patients reported an average significant weight loss of 50 kg (110 lb). Hypertension and diabetes resolved in 69 percent and 83 percent, respectively. There was significant improvement in many other obesity comorbidities, including sleep apnea, gastroesophageal reflux symptoms, and venous stasis disease.

One half of patients were followed five to seven years postoperatively. Average weight loss was higher at five to seven years than at one to two years. Resolution rates for hypertension and diabetes were similar. Thirty-seven percent of patients were followed for 10 to 12 years postoperatively. Of the 37 percent, all patients maintained their weight loss.

The authors conclude that there is a significant improvement in diabetes, hypertension, and other obesity comorbidities in severely obese patients after GBP. Current pharmacologic therapy for obesity is associated with a 10 percent weight loss that is probably inadequate to control diabetes and hypertension in many of these severely obese patients. The observation that many severely obese patients had either hypertension or diabetes alone hints that insulin resistance and hypertension can simply coexist in severely obese patients without a specific, unifying causal relationship.

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