Surgical and Nonsurgical Interventions for Obesity in Service of Preserving Cognitive Function

The purposes of this article are to highlight what is currently known about the mechanisms of obesity-related cognitive impairment and weight loss-related cognitive improvement, and to discuss the benefits and drawbacks of available treatments.

The article is based on a live debate, presenting the main advantages and disadvantages of exercise interventions and bariatric surgery as related to cognitive functioning. The live debate took place during a 1-day conference, Diabetes, Obesity and the Brain, sponsored by the American Psychosomatic Society in October 2013.

Although it is well established that bariatric surgery tends to lead to greater weight loss, better glycemic control, and cognitive improvement (effect sizes ranging between 0.61 and 0.78) during the first 1 to 2 years postintervention compared with nonsurgical treatments, medical complications are possible, and follow-up data beyond 5 years are limited. In contrast, nonsurgical therapies have been extensively studied in a variety of clinical settings and have proved that they can sustain positive health outcomes up to 10 years later, but their cognitive benefits tend to be more modest (effect sizes ranging from 0.18 to 0.69) and long-term regimen compliance, especially in obese individuals, is uncertain.

Rather than focusing on debating whether surgical or no-surgical interventions for obesity are better, additional research is needed to identify the most efficient and practical combination of approaches to ensure sustained positive health outcomes for the largest number of patients possible.