Surgery for weight loss extends lives, study finds


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 undergoing bariatric surgery in Utah.

Compared to people of a similar weight, people who underwent one of the four types of weight-loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases caused by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“The number of deaths from cardiovascular disease decreased by 29%, while the number of deaths from various cancers decreased by 43%, which is quite impressive,” said lead author Ted Adams, an adjunct associate professor of nutrition and integrative physiology. at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% drop — in diabetes-related deaths in people who had surgery compared to those who didn’t,” he said. One major downside: The study also found that younger people who had the surgery had a higher risk of suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from previous research, including a 10-year study in Sweden that found a significant reduction in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The 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 more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” says Grunvald, who co-authored the American Gastroenterological Association’s new guidelines on treating obesity.

The association strongly recommends that patients with obesity use recently approved weight loss medications or surgery in conjunction with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, easier to do after you’ve had bariatric surgery or taken the new weight loss drugs,” said Grunvald, who was not involved in the study in Utah.

“While we don’t fully understand why yet, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

However, despite the benefits, only 2% of patients who qualify for bariatric surgery ever get it, often because of the stigma surrounding obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and co-director of the Center for Weight Management. and wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author of the Endocrine Society’s Clinical Practice Guidelines for the Pharmacological Treatment of Obesity.

Insurance companies typically cover the cost of surgery for people over age 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition, such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and I’ll invariably say, ‘You’re a candidate for everything — medication, diet, exercise, and surgery.’ And many say to me, “Don’t talk to me about surgery. I don’t want to.” They don’t want a surgical fix for what society has told them is a lack of willpower,” she said.

“We don’t torture people with heart disease: ‘Oh, that’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 we treat it. Obesity is also a disease, but we torture obese people by telling them it’s their fault.”

Most 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, deaths from related causes, such as heart attack, cancer and diabetes, were 24% lower for women and 22% lower for men who had surgery compared to those who didn’t, he said.

Most bariatric surgery today is done via laparoscopy, said Ted Adams, the study's lead author.

The study examined four types of surgery performed between 1982 and 2018: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Developed in the late 1960s, gastric bypass creates a small pocket near the top of the stomach. Part of the small intestine is brought up and attached to that 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, limiting the volume of food entering the stomach cavity. Because gastric banding isn’t as successful at creating long-term weight loss, the procedure “isn’t as popular these days,” Adams said.

“The gastric sleeve is a procedure in which about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform and food still passes through the much smaller stomach. It has become a very popular option.”

The duodenal switch is usually reserved for patients with a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass and is effective for type 2 diabetes, according to the Cleveland Clinic.

An alarming finding of the new study was a 2.4% increase in suicide deaths, primarily among people undergoing bariatric surgery between the ages of 18 and 34.

“That’s because they’re told life will be great after surgery or medication,” says Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit 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 be gone,” she said. “But that’s not the reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even gain weight, said Susan Vibbert, an advocate with Project HEAL, which offers 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.

Previous research has also shown a link between suicide risk and bariatric surgery, Grunvald said, but studies on the topic aren’t always able to determine a patient’s mental history.

“Did the person opt for surgery because they had unrealistic expectations or underlying mental health disorders that were not resolved after surgery? Or is this somehow a direct effect of bariatric surgery? We can’t give a definite answer to that,” he said.

Intensive presurgery counseling is usually required for anyone undergoing the procedure, but it may not be enough, Apovian said. She lost her first patient for bariatric surgery to suicide.

“She was older, in her forties. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder that she self-medicated with food,” Apovian said. “As a society, we use a lot of food to cover up trauma. What we need in this country is more psychological support 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 not one solution for everything.

“First, as a society, we need to view obesity as a disease, as a biological problem, not as a moral flaw,” Grunvald said. That’s my first piece of advice.

“And if you think your life will benefit from treatment, consider an evidence-based treatment, which studies show is surgery or medications, if you haven’t been able to manage it with lifestyle changes alone with to do success.”

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