Planning Framework for Weight Management in Primary Care

medical management, and 22.0� 19.7 kg (16.3� 13.5%) for surgery (p<0.001). The proportion of subjects who achieved at least 10% weight loss was 9% for wait-listed,17% for medically managed, and 63% for surgery (p<0.001). Within the surgery group, weight reductions were 7.0� 9.7 kg (5.8� 7.9%) with banding, 21.4� 16.0 kg (16.4� 11.6%) with sleeve gastrectomy, and 36.6� 19.5 kg (26.1� 12.2%) with gastric bypass (p<0.001). Rates of hypertension, diabetes, and dyslipidemia decreased to a significantly greater degree with surgery than medical management (p<0.001) and stayed the same or increased in wait-listed subjects. Interpretation: Population-based medical and surgical bariatric care was clinically effective. Mean two-year weight losses and reductions in cardiovascular comorbidities were far greater with surgery, particularly gastric bypass, compared to medical treatment. Waitlisted patients exposed to “usual care” experienced modest weight loss and accrued cardiovascular comorbidities over the twoyear period. (Trial registration: Clinicaltrials.gov NCT00850356)