Weight-Loss Surgery Significantly Reduces Deaths From Obesity-Related Diseases, Study Finds

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 27 Aug 2007 - 10:00 PST

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Obese individuals who undergo bariatric surgery are less likely to die from heart disease, diabetes and cancer seven to 10 years after the procedure compared with obese people who do not undergo surgery, according to two studies published Thursday in the New England Journal of Medicine, USA Today reports (Hellmich, USA Today, 8/25). The studies "offer the first convincing evidence that the health gains of losing weight translate into living longer," according to the Washington Post.

In the first study, researchers led by Ted Adams of the University of Utah examined records from 7,925 severely obese individuals who had undergone bariatric surgery and 7,925 severely obese individuals who had not. Researchers found that after an average of seven years, patients who had had bariatric surgery were about 40% less likely to have died. Surgery patients were 92% less likely to die from diabetes and 56% less likely to die of heart disease, according to the study (Stein, Washington Post, 8/23). Surgery patients were 60% less likely to die from cancer, which Adams attributed to "improved quality of screening after weight loss" (Rosetta, Salt Lake Tribune, 8/23). In total, there were 213 deaths in the surgery group, compared with 321 in the control group (Bulkeley, Wall Street Journal, 8/23). The researchers estimated that the mortality rate declined by 136 per 10,000 operations (USA Today, 8/23).

In the second study, Lars Sjostrom of Goteborg University in Sweden and colleagues followed 2,010 obese bariatric surgery patients and 2,037 obese individuals who did not undergo surgery. The study found that over an 11-year period, bariatric surgery patients were about 30% less likely on average to die from any cause (Washington Post, 8/23). In that study, there were 101 deaths in the surgery group and 129 deaths in the control group (USA Today, 8/23). The U.S. study was funded by NIH, the Utah Department of Health and the University of Utah. The Swedish study was funded by pharmaceutical companies and the Swedish Medical Research Council (Maugh, Los Angeles Times, 8/23). The companies do not have financial ties to bariatric surgery enterprises, according to the Boston Globe (Smith, Boston Globe, 8/23).

Other Findings
Researchers in the U.S. study found a slightly higher risk of death in surgery patients from non-disease causes, such as accidents or suicide (USA Today, 8/23). In the study, 15 surgery patients committed suicide, compared with five patients in the control group (Bulkeley, Wall Street Journal, 8/23). Adams said, "Perhaps some individuals go into the surgery thinking, 'This may be an important answer to some of my social issues or my body image issues' and then they're disappointed" (Boston Globe, 8/23).

Adams and his colleagues recommended further research into methods of evaluating candidates for surgery, "including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery" (Desmon, Baltimore Sun, 8/23). Adams said that the increased number of deaths due to accidents might indicate that surgery patients were participating in more normal activities after losing weight (Los Angeles Times, 8/23).

Limitations
The studies did not examine if losing moderate amounts of weight similarly would translate into longer, healthier lives. Bariatric surgery patients on average lose between 14% and 25% of their body weight. Because of the lack of data on different levels of weight loss, Sjostrom and Adams said they could not determine how much of the benefit derived from losing weight and how much might have stemmed from other effects of the surgery (Washington Post, 8/23).

In addition, because patients in the studies were mostly non-Hispanic whites, the findings might not be applicable to other populations. However, Sjostrom said he would be "very astonished" if the results were to differ dramatically among blacks and Hispanics (Boston Globe, 8/23).

Editorial
George Bray, chief of the division of clinical obesity of Pennington Biomedical Research Center at Louisiana State University, in an accompanying editorial wrote, "The question as to whether intentional weight loss improves life span has been answered, and the answer appears to be a resounding yes" (USA Today, 8/23).

Bray said the studies' results demonstrate that NIH should rethink guidelines regarding who should be considered a candidate for bariatric surgery. NIH suggests that individuals with body mass indexes greater than 40 consider the surgery as an option. People with BMIs exceeding 30 are considered obese. However, Bray did not say that he necessarily supports a lower standard for surgery because of its high cost, which averages about $25,000 per operation. "You'll break the bank," he said (Wall Street Journal, 8/23).

NIH this fall will convene a panel to discuss altering the guidelines for who should undergo bariatric surgery (Los Angeles Times, 8/23).

Author Comments
Adams said, "I am excited that both physicians and patients who are considering this surgery will now have some additional information to consider in terms of possible health outcomes" (Stewart, Newark Star-Ledger, 8/23). Adams continued, "Patients and medical providers will be able to use this as another source of information to help in the decision of whether or not to have the surgery based upon risk and benefit. We should never lose track of the importance of individualized risk-benefit analyses" (Salt Lake Tribune, 8/23).

Sjostrom said, "This study for the first time offers strong evidence that intentional weight loss, or at least bariatric surgery, is associated with decreased mortality" (Washington Post, 8/23).

The reduction in the risk of heart disease and type 2 diabetes was "pretty substantial," Claude Bouchard of the Pennington Center, an author of the Swedish study, said, adding, "Severely obese patients should consider bariatric surgery a serious option to address major weight loss" (Boyd, Baton Rouge Advocate, 8/23).

Criticism
Some experts said that the life-extending benefits of the surgery were relatively small, especially when considered against the risks of surgery, according to the Post. Paul Campos, a law professor at the University of Colorado, said, "I would hate to see these studies being used to justify the argument that we should be doing weight-loss surgery to save lives." He added, "The claim that we have to give people weight-loss surgery to keep them from dying imminently is greatly exaggerated. At best, it's a very, very modest effect."

In addition, some experts said the data show that mortality rates for untreated obese patients were lower than expected. Paul Ernsberger, a professor of nutrition at the Case Western Reserve University School of Medicine, in an e-mail said that even though untreated obese patients "ranged up to 60 years of age, 96% of them survived for 10 years. Nearly 88% survived for 16 years. These are far better odds than doctors are predicting for their fat patients" (Washington Post, 8/23).

Additional Comments
Philip Schauer, director of bariatric surgery at the Cleveland Clinic and a past president of the American Society for Metabolic and Bariatric Surgery, said that the study will "dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives" (Chang, AP/Detroit Free Press, 8/23).

Kelvin Higa, president of the bariatric surgery society, said, "These are landmark studies," adding, "These studies clearly show that bariatric surgery saves lives" (Washington Post, 8/23).

George Fielding, a bariatric surgeon at New York University Medical Center, said, "The message is that if you are a morbidly obese diabetic, you are going to get sick and you are going to die young." Fielding added, "Here is an opportunity to take control of that situation" (Los Angeles Times, 8/23).

An abstract of the U.S. study is available online. An abstract of the Swedish study is available online. An extract of the editorial is available online.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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