Beyond 5 years, the sustained effectiveness of bariatric surgery: the idiopathic intracranial hypertension weight trial

<h3>Question</h3> What is the effectiveness of bariatric surgery beyond 5 years in people living with Idiopathic Intracranial Hypertension (IIH)? <h3>Methods</h3> The IIH Weight Trial enrolled women with active IIH and a body mass index (BMI) ≥35kg/m² between March 1, 2014, and May 25, 2017, for randomization to either bariatric surgery or community weight management. The 60-month outcomes included lumbar puncture opening pressure and anthropometric measures. <h3>Results</h3> Twenty-nine participants were included, with 16 receiving surgery during follow up, of which 12 had the intervention within first 12 months. Participants who had surgery lost significantly more weight from baseline as compared to those in the diet arm, mean change (SD) -20.9kg (19.1) versus +4.9kg (18.1), p=0.0009, and had a greater reduction in pressure, -12.2cmCSF (8.0) v. - 3.8cmCSF (8.0), p=0.0195. The initial significant improvements seen in those who had surgery within first 12 months were maintained at 60 months, -18.7kg (13.0) and -12.5cmCSF (8.5), p=0.0020 and p=0.0026 respectively. Furthermore, a delay to bariatric surgery (&lt;12m v &gt;24m) did not significantly affect outcomes. <h3>Conclusions</h3> Bariatric surgery delivers sustained weight loss and reduction in intracranial pressure in women with IIH and BMI ≥35kg/m² where previous weight management lifestyle interventions had failed.