Weight-Loss Surgery Reduces Deaths From Obesity-Related Diseases

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Obese individuals who undergo bariatric surgery are less likely todie from heart disease, diabetes and cancer seven to 10 years after theprocedure 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 healthgains 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 Utahexamined records from 7,925 severely obese individuals who hadundergone bariatric surgery and 7,925 severely obese individuals whohad not. Researchers found that after an average of seven years,patients who had had bariatric surgery were about 40% less likely tohave died. Surgery patients were 92% less likely to die from diabetesand 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 "improvedquality 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 Universityin Sweden and colleagues followed 2,010 obese bariatric surgerypatients and 2,037 obese individuals who did not undergo surgery. Thestudy found that over an 11-year period, bariatric surgery patientswere 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 Healthand the University of Utah. The Swedish study was funded bypharmaceutical 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 insurgery 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 surgerythinking, 'This may be an important answer to some of my social issuesor my body image issues' and then they're disappointed" (Boston Globe, 8/23).

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

Limitations

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

Inaddition, because patients in the studies were mostly non-Hispanicwhites, the findings might not be applicable to other populations.However, Sjostrom said he would be "very astonished" if the resultswere 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 Centerat Louisiana State University, in an accompanying editorial wrote, "Thequestion as to whether intentional weight loss improves life span hasbeen answered, and the answer appears to be a resounding yes" (USA Today, 8/23).

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Braysaid the studies' results demonstrate that NIH should rethinkguidelines regarding who should be considered a candidate for bariatricsurgery. NIH suggests that individuals with body mass indexes greaterthan 40 consider the surgery as an option. People with BMIs exceeding30 are considered obese. However, Bray did not say that he necessarilysupports a lower standard for surgery because of its high cost, whichaverages 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 areconsidering this surgery will now have some additional information toconsider in terms of possible health outcomes" (Stewart, Newark Star-Ledger,8/23). Adams continued, "Patients and medical providers will be able touse this as another source of information to help in the decision ofwhether or not to have the surgery based upon risk and benefit. Weshould never lose track of the importance of individualizedrisk-benefit analyses" (Salt Lake Tribune, 8/23).

Sjostromsaid, "This study for the first time offers strong evidence thatintentional weight loss, or at least bariatric surgery, is associatedwith decreased mortality" (Washington Post, 8/23).

Thereduction in the risk of heart disease and type 2 diabetes was "prettysubstantial," Claude Bouchard of the Pennington Center, an author ofthe Swedish study, said, adding, "Severely obese patients shouldconsider bariatric surgery a serious option to address major weightloss" (Boyd, Baton Rouge Advocate, 8/23).

Criticism

Some experts said that the life-extending benefits of the surgery wererelatively small, especially when considered against the risks ofsurgery, 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 theargument that we should be doing weight-loss surgery to save lives." Headded, "The claim that we have to give people weight-loss surgery tokeep them from dying imminently is greatly exaggerated. At best, it's avery, very modest effect."

In addition, some experts said thedata show that mortality rates for untreated obese patients were lowerthan expected. Paul Ernsberger, a professor of nutrition at the CaseWestern Reserve University School of Medicine,in an e-mail said that even though untreated obese patients "ranged upto 60 years of age, 96% of them survived for 10 years. Nearly 88%survived for 16 years. These are far better odds than doctors arepredicting 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 iscosmetic surgery and support the notion that it saves lives" (Chang, AP/Detroit Free Press, 8/23).

KelvinHiga, president of the bariatric surgery society, said, "These arelandmark studies," adding, "These studies clearly show that bariatricsurgery 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, youare 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).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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