Weight loss surgery extends lives, study reveals
Weight loss surgery reduces the risk of premature death, especially from obesity-related conditions such as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.
Compared with those of a similar weight, people who underwent one of four types of weight-loss surgery were 16% less likely to die from any cause, the study found. The decline in deaths from diseases caused by obesity, such as heart disease, cancer and diabetes, was even more dramatic.
“Death from cardiovascular disease decreased by 29%, while death from various cancers decreased by 43%, which is quite impressive,” said lead author Ted Adams, assistant professor of nutrition and integrative physiology at the University of Utah School of Medicine.
“There was also a huge percentage drop – a 72% drop – in diabetes-related deaths in people who had the surgery compared to those who didn’t,” he said. One notable flaw: The study also found that younger people who had the surgery were at greater risk of suicide.
Study, published Wednesday in the journal Obesity, corroborates similar findings from earlier research, including a 10-year study in Sweden that found a significant reduction in premature death, said Dr. Eduardo Grunvald, professor of medicine and medical director of the weight management program at University of California San Diego Health.
A Swedish study also found that a significant number of people were in remission from diabetes both two years and 10 years after surgery.
“This new study from Utah is yet more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who co-authored the American Gastroenterological Association study. new guidelines in the treatment of obesity.
The association strongly recommends that morbidly obese patients use recently approved weight loss medications or surgery combined with lifestyle changes.
“The key for patients is to know that dietary change becomes more natural, easier to do after bariatric surgery or new weight loss medications,” said Grunvald, who was not involved in the Utah study.
“Although we still don’t fully understand why, these interventions actually change the chemistry in your brain, making it easier to change your diet afterward.”
Yet despite the benefits, only 2% of patients eligible for bariatric surgery receive it, often because of obesity stigma, said Dr. Caroline Apovian, professor of medicine at Harvard Medical School and co-director of the Weight Management and Wellness Center at Brigham and Women’s Hospital. in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological treatment of obesity.
Insurance carriers usually cover the cost of surgery for people over the age of 18 body mass index of 40 or higher, or a BMI of 35 if the patient also has an associated condition such as diabetes or high blood pressure, she said.
“I see patients with a BMI of 50 and I’ll always say, ‘You’re a candidate for everything—medication, diet, exercise and surgery.’ And many people tell me: ‘Don’t talk to me about the operation. I don’t want it.’ They don’t want a surgical solution to what society has told them is a lack of willpower,” she said.
“We don’t torture people who have heart disease, ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, that’s because you ate all that cake.’ We tell them they have a disease and treat it. Obesity is also a disease, but we torture people with obesity by telling them it’s their fault.”
The majority of people who opt for bariatric surgery — about 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.
“For all causes of death, mortality was reduced by 14% for women and by 21% for men,” Adams said. In addition, mortality from related causes, such as heart attack, cancer and diabetes, was 24% lower for women and 22% lower for men who underwent the surgery compared to those who did not, he said.
The study examined four types of surgery performed between 1982 and 2018: gastric bypass, gastric band, gastric sleeve, and duodenal switch.
Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A section of the small intestine is lifted and attached to this point, bypassing most of the stomach and duodenum, the first part of the small intestine.
In gastric banding, an elastic band that can be tightened or loosened is placed around the upper part of the stomach, thereby limiting the volume of food entering the gastric cavity. Because gastric banding is not as successful at producing long-term weight loss, the procedure “isn’t as popular today,” Adams said.
“The gastric sleeve is a procedure where approximately two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform and the food still passes through a much smaller stomach. It has become a very popular option.”
A duodenal switch is usually reserved for patients who have a high BMI, Adams added. It is a complicated procedure that combines sleeve gastrectomy and intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.
One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.
“It’s because they’re told life will be great after surgery or medication,” said Joann Hendelman, MD, clinical director of National Eating Disorders Association, non-profit advocacy group.
“All you have to do is lose weight and people will want to hang out with you, people will want to be your friend, and your anxiety and depression will go away,” she said. “But that’s not reality.”
In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help to people struggling with eating disorders.
“How do we define health in these scenarios? And is there another intervention — a weight-neutral intervention?” Vibbert asked.
Past research has also shown a link between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.
“Did the person decide to have surgery because they had some unrealistic expectations or because of psychological disorders that were not resolved after the surgery? Or is it a direct effect of bariatric surgery? We cannot answer that with certainty,” he said.
Intensive pre-surgery counseling is usually required for everyone who undergoes the procedure, but that may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.
“She was older, in her 40s. She had an operation and lost 150 kilograms. And then she put herself in front of the bus and died because she had bipolar disorder in the background and was self-medicating with food,” Apovian said. “As a society, we use a lot of food to hide trauma. What we need in this country is more psychological counseling for everyone, not just people undergoing bariatric surgery.”
Weight management is a unique process for each person, a mix of genetics, culture, environment, social stigma and personal health, experts say. There is no one-size-fits-all solution.
“First, we as a society must consider obesity a disease, a biological problem, not a moral deficiency,” said Grunvald. “That’s my first piece of advice.
“And if you believe your life will benefit from treatment, then consider evidence-based treatment, which studies show is surgery or medication, if you haven’t been able to do that with lifestyle changes alone.”