Adults with severe obesity may benefit more from Roux-en-Y gastric bypass and sleeve gastrectomy than from adjustable gastric banding, according to new research published on March 31 in The Lancet Diabetes & Endocrinology.  The findings come from a large, pragmatic randomized controlled trial led by Dr. Sanjay Agrawal of Homerton University Hospital, London.

Conducted across 12 hospitals in the United Kingdom, the study involved 1,346 adult participants who met the national criteria for metabolic and bariatric surgery.  Initially comparing Roux-en-Y gastric bypass and adjustable gastric banding, the study later incorporated sleeve gastrectomy when the procedure gained broader clinical availability in the UK.

 The results showed that 68% of patients who underwent gastric bypass achieved at least 50% excess weight loss, compared to 25% in the gastric banding group and 41% in the sleeve gastrectomy group. Quality of life, assessed through the EuroQol 5-Dimension utility scale, also favored gastric bypass (0.72), followed by sleeve gastrectomy (0.68) and gastric banding (0.62).  While adverse events were reported across all groups — totaling 1,651 incidents — the rate of occurrence was 6.0 per year for gastric bypass, 4.6 for gastric banding, and 5.7 for sleeve gastrectomy.

Importantly, only one of the 11 recorded deaths during the three-year study period was linked to surgery, occurring in the gastric banding group.  In addition to superior clinical outcomes, gastric bypass emerged as the most cost-effective option, making it a potentially preferred choice in the UK’s public health system. 

“Future research to understand longer-term outcomes and to compare metabolic and bariatric surgery with obesity management medications is needed to guide evidence-based practice in this rapidly evolving field,” the study authors emphasized.  With obesity rates continuing to climb globally, the study’s insights provide valuable direction for clinicians, policymakers, and patients navigating the complex landscape of surgical weight loss options.