***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obesity is associated with increased morbidity rates and pharmaceutical costs . To what extent various medication costs are affected by intentional weight loss is unknown . METHODS A cross-sectional comparison of the use of prescribed pharmaceuticals was conducted in 1286 obese individuals in the Swedish Obese Subjects ( SOS ) intervention study and 958 r and omly selected reference individuals .  Medication changes for 6 years after bariatric surgery were evaluated in 510 surgically and 455 conventionally treated SOS patients . RESULTS Compared with the reference group , obese individuals were more often taking diabetes mellitus , cardiovascular disease , nonsteroidal anti-inflammatory and pain , and asthma medications ( risk ratios ranging from 2.3 - 9.2 ) . Average annual costs for all medications were 1400 Swedish kronor ( SEK ) ( US $ 140 ) in obese individuals and 800 SEK ( US $ 80 ) in the reference population ( P<.001 ) . Average yearly medication costs during follow-up were 1849 ( US $ 185 ) in surgically treated patients ( weight change -16 % ) and 1905 SEK ( US $ 190 ) in weight-stable conventionally treated patients ( P = .87 ) . The surgical group had lower costs for diabetes mellitus ( difference : -94 SEK/y ( -US $ 9 ] ) and cardiovascular disease medications ( difference : -186 SEK/y ( -US $ 19 ] ) but higher costs for gastrointestinal tract disorder ( difference : + 135 SEK/y [ US $ 13 ] ) and anemia and vitamin deficiency medications ( difference : + 50 SEK/y [ US $ 5 ] ) . CONCLUSIONS Use and cost of medications are markedly increased in obese vs reference population s. Surgical obesity treatment lowers diabetes mellitus and cardiovascular disease medication costs but increases other medication costs , result ing in similar total costs for surgically and conventionally treated obese individuals for 6 years BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery . This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases . Obstructive sleep apnea ( OSA ) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery . The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent . A retrospective review of our prospect ively collected data base was performed . All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study . The  overall incidence of sleep apnea in our patients was 78 per cent ( 227 of 290 ) . All 227 were diagnosed by formal sleep study . There were 63 ( 22 % ) males and 227 ( 78 % ) females . The mean age was 43 years ( range , 17–75 years ) . The mean body mass index ( BMI ) was 52 kg/m2 ( range , 31–94 kg/m2 ) . The prevalence of OSA in the severely obese group ( BMI 35–39.9 kg/m2 ) was 71 per cent . For the morbidly obese group ( BMI 40–40.9 kg/m2 ) , the prevalence was 74 per cent and for the superobese group ( BMI 50–59.9 kg/m2 ) 77 per cent . Those with a BMI 60 kg/m2 or greater , the prevalence of OSA rose to 95 per cent . The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study . Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained Background : Laparoscopic adjustable gastric b and ing ( GB ) is the most popular restrictive procedure for obesity in Europe . Isolated sleeve gastrectomy ( SG ) , is less common , but more invasive and with a higher learning curve . The aim of this prospect i ve r and omized study was to compare the results of GB and SG after 1 and 3 years of surgery . Methods : 80 patient c and i date s for laparoscopic restrictive surgery were operated consecutively and r and omly , between January and December 31 , 2002 , by GB ( 7 M , 33F ) or by SG ( 9 M , 31F ) ( NS ) . Median age was 36 ( 20 - 61 ) for GB versus 40 ( 22 - 65 ) for SG ( NS ) . Median BMI was 37 ( 30 - 47 ) for GB versus 39 ( 30 - 53 ) for SG ( NS ) . After 1 and 3 years : weight loss , feeling of hunger , sweet eating , gastroesophageal reflux disease ( GERD ) , complications and re-operations were recorded in both groups . Results : Median weight loss after 1 year was 14 kg ( −5 to + 38 ) for GB and 26 kg ( 0 to 46 ) for SG ( P<0.0001 ) ; and after 3 years was 17 kg ( 0 to 40 ) for GB and 29.5 kg ( 1 to 48 ) for SG ( P<0.0001 ) . Median decrease in BMI after 1 year was 15.5 kg/m 2 ( 5 to 39 ) after GB and 25 kg/m2 ( 0 to 45 ) after SG ( P<0.0001 ) ; and after 3 years was 18 kg/m2 ( 0 to 39 ) after GB and 27.5 kg/m 2 ( 0 to 48 ) after SG ( P=0.0004 ) . Median % EWL at 1 year was 41.4 % ( −11.8 to + 130.5 ) after GB and 57.7 % ( 0 to 125.5 ) after SG ( P=0.0004 ) ; and at 3 years was 48 % ( 0 to 124.8 ) after GB and 66 % ( −3.1 to + 152.4 ) after SG ( P=0.0025 ) . Loss of feeling of hunger after 1 year was registered in 42.5 % of patients with GB and in 75 % of patients with SG ( P=0.003 ) ; and after 3 years in 2.9 % of patients with GB and 46.7 % of patients with SG ( P<0.0001 ) . Loss of craving for sweets after 1 year was achieved in 35 % of patients with GB and 50 % of patients with SG ( NS ) ; and after 3 years in 2.9 % of patients with GB and 23 % of patients with SG ( NS ) . GERD appeared de novo after 1 year in 8.8 % of patients with GB and 21.8 % of patients with SG ( NS ) ; and after 3 years in 20.5 % of patients with GB and 3.1 % of patients with SG ( NS ) . Postoperative complications requiring re-operation were necessary for 2 patients after SG . Late complications requiring re-operation after GB included 3 pouch dilations treated by b and removal in 2 and 1 laparoscopic conversion to Roux-en-Y gastric bypass  ( RYGBP ) , 1 gastric erosion treated by conversion to RYGBP , and 3 disconnections of the system treated by reconnection . Inefficacy affected 2 patients after GB , treated by conversion into RYGBP and 2 patients after SG treated by conversion to duodenal switch . Conclusion : Weight loss and loss of feeling of hunger after 1 year and 3 years are better after SG than GB . GERD is more frequent at 1 year after SG and at 3 years after GB . The number of re-operations is important in both groups , but the severity of complications appears higher in SG 
    Output:
    
Surgery for morbid obesity increases health-related quality of life , and reduces the need for further treatments and total healthcare costs .
According to this analysis , non-operative care would be more costly for the Finnish healthcare system on average after 5 years following surgery