Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

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: JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort - XML Representation

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    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Citation 104116</b></p><a name="104116"> </a><a name="hc104116"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">version: 19; Last updated: 2025-03-27 17:50:20+0000</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-journal-article-citation.html">JournalArticleCitation</a></p></div><p><b>ArtifactPublicationStatus</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-status-type active}">Active</span></p><p><b>url</b>: <a href="Citation-104116.html">Citation JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort</a></p><p><b>identifier</b>: FEvIR Object Identifier/104116, <code>https://pubmed.ncbi.nlm.nih.gov</code>/29340680, <a href="http://terminology.hl7.org/6.5.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt 

This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: 

Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.

This OID may also be used in CD.codeSystem.">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.44.15.38</p><p><b>version</b>: 1.0.0-ballot2</p><p><b>title</b>: JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort</p><p><b>status</b>: Active</p><p><b>date</b>: 2022-09-06 14:07:55+0000</p><p><b>author</b>: Brian S. Alper: , Computable Publishing®: MEDLINE-to-FEvIR Converter: , Joanne Dehnbostel: </p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href="http://www.hl7.org/Special/committees/dss">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: </p><div><p>This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.</p>
</div><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td><a href="http://hl7.org/fhir/R5/codesystem-citation-classification-type.html#citation-classification-type-fevir-platform-use">Citation Classification Type fevir-platform-use</a>: FEvIR Platform Use</td><td><span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier project-specific}">Project Specific</span></td></tr></table><p><b>jurisdiction</b>: <span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">World</span></p><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>
</div><p><b>approvalDate</b>: 2018-01-26</p><p><b>lastReviewDate</b>: 2022-03-30</p><h3>Summaries</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Style</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://hl7.org/fhir/citation-summary-style comppub}">Computable Publishing</span></td><td><div><p>Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities [Journal Article]. Contributors: Jakobsen GS, Småstuen MC, Sandbu R, Nordstrand N, Hofsø D, Lindberg M, Hertel JK, Hjelmesæth J. In: JAMA, PMID 29340680. Published January 16, 2018. Available at: https://pubmed.ncbi.nlm.nih.gov/29340680/.</p>
</div></td></tr></table><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/citation-classification-type citation-source}">Citation Source</span></p><p><b>classifier</b>: <span title="Codes:">MEDLINE</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/citation-classification-type medline-owner}">MEDLINE Citation Owner</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#owner_value NLM}">National Library of Medicine, Index Section</span></p></blockquote><p><b>currentState</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type medline-medline}">Medline Citation Status of MEDLINE</span>, <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-publication-status-ppublish}">PubMed PublicationStatus of ppublish</span></p><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-entrez}">PubMed Pubstatus of Entrez</span></p><p><b>period</b>: ?? --&gt; 2018-01-18 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-pubmed}">PubMed Pubstatus of PubMed</span></p><p><b>period</b>: ?? --&gt; 2018-01-18 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-medline}">PubMed Pubstatus of Medline</span></p><p><b>period</b>: ?? --&gt; 2018-01-27 06:00:00+0000</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: <code>https://pubmed.ncbi.nlm.nih.gov</code>/29340680, pii/2669729, <code>https://doi.org</code>/10.1001/jama.2017.21055, <code>https://www.ncbi.nlm.nih.gov/pmc/</code>/PMC5833560</p><h3>Titles</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://hl7.org/fhir/title-type primary}">Primary title</span></td><td><div><p>Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities.</p>
</div></td></tr></table><h3>Abstracts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://hl7.org/fhir/cited-artifact-abstract-type primary-human-use}">Primary human use</span></td><td><div><p><strong>Importance:</strong> The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain.
<strong>Objective:</strong> To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment.
<strong>Design, Setting, and Participants:</strong> Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included).
<strong>Exposures:</strong> Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs.
<strong>Main Outcomes and Measures:</strong> Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database.
<strong>Results:</strong> Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4]). Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]). The proportion of patients with low ferritin levels was significantly greater in the surgical group (26% vs 12%, P &lt; .001).
<strong>Conclusions and Relevance:</strong> Among patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatment was associated with a clinically important increased risk for complications, as well as lower risks of obesity-related comorbidities. The risk for complications should be considered in the decision-making process.</p>
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</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Am J Psychiatry. 2007 Feb;164(2):328-34; quiz 374</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D016420}">Comment</span></p><p><b>citation</b>: </p><div><p>JAMA. 2018 Jan 16;319(3):238-240</p>
</div></blockquote><blockquote><p><b>publicationForm</b></p><blockquote><p><b>publishedIn</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/published-in-type D020492}">Periodical</span></p><p><b>identifier</b>: Electronic ISSN Type/1538-3598, ISOAbbreviation/JAMA, ISSN Linking/0098-7484, Medline Title Abbreviation/JAMA, NLM Unique ID/7501160</p><p><b>title</b>: JAMA</p><p><b>publisherLocation</b>: United States</p></blockquote><p><b>citedMedium</b>: <span title="Codes:">internet</span></p><p><b>volume</b>: 319</p><p><b>issue</b>: 3</p><p><b>articleDate</b>: 2018-01-16</p><p><b>pageString</b>: 291-301</p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/artifact-url-classifier abstract}">Abstract</span></p><p><b>url</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/29340680/">https://pubmed.ncbi.nlm.nih.gov/29340680/</a></p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/artifact-url-classifier doi-based}">DOI Based</span></p><p><b>url</b>: <a href="https://doi.org/10.1001/jama.2017.21055">https://doi.org/10.1001/jama.2017.21055</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type publishing-model}">Publishing Model</span></p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier Print}">Print</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type chemical}">Chemical</span></p><p><b>classifier</b>: <span title="Codes:{https://www.cas.org/support/documentation/chemical-substances 9007-73-2}, {https://www.nlm.nih.gov/mesh D005293}">Ferritins</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type publication-type}">Publication type</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D003160}">Comparative Study</span>, <span title="Codes:{https://www.nlm.nih.gov/mesh D016428}">Journal Article</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type citation-subset}">Citation subset</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#citationsubset IM}">IM</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">MeSH heading</span></p><p><b>artifactAssessment</b>: <a href="#hc104116/meshHeading0">ArtifactAssessment: artifact[x] = this resource</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type knowledge-artifact-type}">Knowledge Artifact Type</span></p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>artifactAssessment</b>: Classifier added by Computable Publishing LLC</p></blockquote><blockquote><p><b>contributorship</b></p><p><b>complete</b>: true</p><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor0">Jakobsen GS</a></p><p><b>forenameInitials</b>: GS</p><p><b>affiliation</b>: Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor1">Småstuen MC</a></p><p><b>forenameInitials</b>: MC</p><p><b>affiliation</b>: Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor2">Sandbu R</a></p><p><b>forenameInitials</b>: R</p><p><b>affiliation</b>: </p><ul><li>Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</li><li>Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway.</li></ul></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor3">Nordstrand N</a></p><p><b>forenameInitials</b>: N</p><p><b>affiliation</b>: Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor4">Hofsø D</a></p><p><b>forenameInitials</b>: D</p><p><b>affiliation</b>: Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor5">Lindberg M</a></p><p><b>forenameInitials</b>: M</p><p><b>affiliation</b>: Department of Laboratory Medicine, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor6">Hertel JK</a></p><p><b>forenameInitials</b>: JK</p><p><b>affiliation</b>: Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href="#hc104116/contributor7">Hjelmesæth J</a></p><p><b>forenameInitials</b>: J</p><p><b>affiliation</b>: </p><ul><li>Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.</li><li>Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.</li></ul></blockquote></blockquote></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor0</b></p><a name="104116/contributor0"> </a><a name="hc104116/contributor0"> </a><p><b>name</b>: Gunn Signe Jakobsen </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor1</b></p><a name="104116/contributor1"> </a><a name="hc104116/contributor1"> </a><p><b>name</b>: Milada Cvancarova Småstuen </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor2</b></p><a name="104116/contributor2"> </a><a name="hc104116/contributor2"> </a><p><b>name</b>: Rune Sandbu </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor3</b></p><a name="104116/contributor3"> </a><a name="hc104116/contributor3"> </a><p><b>name</b>: Njord Nordstrand </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor4</b></p><a name="104116/contributor4"> </a><a name="hc104116/contributor4"> </a><p><b>name</b>: Dag Hofsø </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor5</b></p><a name="104116/contributor5"> </a><a name="hc104116/contributor5"> </a><p><b>name</b>: Morten Lindberg </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor6</b></p><a name="104116/contributor6"> </a><a name="hc104116/contributor6"> </a><p><b>name</b>: Jens Kristoffer Hertel </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Practitioner #contributor7</b></p><a name="104116/contributor7"> </a><a name="hc104116/contributor7"> </a><p><b>name</b>: Jøran Hjelmesæth </p></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: ArtifactAssessment #meshHeading0</b></p><a name="104116/meshHeading0"> </a><a name="hc104116/meshHeading0"> </a><p><b>artifact</b>: <a href="#hc104116">Citation JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort</a></p><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D000328}">Adult</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">qualifier</span></td><td><span title="Codes:">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D050110}">Bariatric Surgery</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title="Codes:">qualifier</span></p><p><b>classifier</b>: <span title="Codes:">is Major 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none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">qualifier</span></td><td><span title="Codes:">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D015331}">Cohort Studies</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">qualifier</span></td><td><span title="Codes:">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type 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topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title="Codes:">qualifier</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh Q000150}">complications</span></p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">is Major topic</span></td><td><span title="Codes:{http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl C49487}">No</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D003924}">Diabetes Mellitus, Type 2</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span 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true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">qualifier</span></td><td><span title="Codes:">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D005293}">Ferritins</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title="Codes:">qualifier</span></p><p><b>classifier</b>: <span title="Codes:">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title="Codes:">qualifier</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh Q000097}">blood</span></p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">is Major topic</span></td><td><span title="Codes:{http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl C49487}">No</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/mesh D006801}">Humans</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:">qualifier</span></td><td><span title="Codes:">is not a major 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**Objective:** To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment.
**Design, Setting, and Participants:** Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included).
**Exposures:** Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs.
**Main Outcomes and Measures:** Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database.
**Results:** Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4]). Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]). The proportion of patients with low ferritin levels was significantly greater in the surgical group (26% vs 12%, P &amp;lt; .001).
**Conclusions and Relevance:** Among patients with severe obesity followed up for a median of 6.5 years, bariatric surgery compared with medical treatment was associated with a clinically important increased risk for complications, as well as lower risks of obesity-related comorbidities. The risk for complications should be considered in the decision-making process."/>
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