OBJECTIVE Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life. RESEARCH DESIGN AND METHODS The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers. RESULTS There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups. CONCLUSIONS The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.

中文翻译：

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在前瞻性对照瑞典肥胖受试者研究中，肥胖手术对早期和成人肥胖的影响

目的减肥手术是一种有效的肥胖治疗方法，但对于成年肥胖和成年肥胖的成年人，结局是否不同尚不清楚。我们调查了20岁以下肥胖状况如何影响减肥手术后生命的结局。研究设计和方法瑞典肥胖受试者研究是一项前瞻性匹配研究，在25个外科部门和480个初级卫生保健中心进行。1987年至2001年之间招募了年龄在37至60岁且BMI≥34 kg / m2（男性）或≥38kg / m2（女性）的参与者。2,007名参与者接受了减肥手术和2,040例常规护理。使用20岁时自我报告的体重将患者分为BMI正常（<25 kg / m2），超重（BMI 25-29.9 kg / m2）或肥胖（BMI≥30 kg / m2）的亚组。体重，能量摄入，在过去的10年中检查了2型糖尿病的患病情况，并使用健康记录中的数据确定了长达26年的心血管和微血管疾病的发生率。结果减肥手术后的亚组之间，体重减轻之间的差异很小，但具有统计学意义（交互作用P = 0.032），其中20岁以上肥胖者的体重减轻幅度最大。减肥手术增加了2型糖尿病的缓解率（在20岁时BMI正常，超重或肥胖的亚组的几率分别为4.51、4.90和5.58；相互作用P = 0.951），降低了2型糖尿病的发生率（几率0.15，分别为0.13和0.15；相互作用P = 0.972），并降低了20岁时与肥胖状况无关的微血管并发症（相互作用P = 0.650）。在这些亚组中，减肥手术与心血管疾病之间的关联相似（交互作用P = 0.674）。在亚组中，手术并发症相似。结论成人减肥手术的治疗益处相似，无论20岁时肥胖状况如何。