Intended for healthcare professionals

Clinical Review State of the Art Review

Bariatric surgery for obesity and metabolic conditions in adults

BMJ 2014; 349 doi: (Published 27 August 2014) Cite this as: BMJ 2014;349:g3961
  1. David E Arterburn, associate investigator1,
  2. Anita P Courcoulas, professor of surgery2
  1. 1Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA
  2. 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  1. Correspondence to: D E Arterburn arterburn.d{at}


This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.


  • Contributors: Both authors planned, conducted, and prepared for publication all the review work described in this article; they both act as guarantors. Both authors also accept full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare: no support from any organization for the submitted work. DEA reports grants from the National Institutes of Health, grants and non-financial support from Informed Medical Decisions Foundation, grants from Department of Veterans Affairs, and grants from the Agency for Healthcare Research and Quality outside the submitted work. APC reports other funding from J&J Ethicon Scientific, personal fees from J&J Ethicon Scientific, grants from NIH-NIDDK, grants from Covidien, grants from EndoGastric Solutions, and grants from Nutrisystem outside the submitted work.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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