Weight-loss surgeries reduce risk of early death

26 August, 2007:

Two major studies have found that surgeries performed to reduce weight lower a patient’s risk for early death. The studies confirm what surgeons say they have known for years.

A study in the United States of about 16,000 obese people found that long-term mortality dropped by 40% for those who opted for gastric bypass.

Another study conducted in Sweden of over 4,000 overweight people showed that death rates fell by 29% for those who had gastric bypass or lap band surgeries as compared to those who did not.

This comes as no surprise at all, according to Dr George Fielding, a pioneering bariatric surgeon in New York City. “It is one of the reasons that I have been doing these procedures for so long, because I have seen the real benefit that this has had for people,” he added.

Dr Fielding, an associate professor of surgery at the New York University School of Medicine, was not involved in the studies, which have been published in the August 23, 2007, issue of the New England Journal of Medicine.

Over 120,000 weight-loss surgeries were performed in the United States in 2003 alone. These procedures essentially shrink the size of the stomach, using either a bypass technique or an adjustable band to squeeze off the gastric pouch.

The safety of these operations has greatly improved since the advent of minimally invasive laparoscopic techniques, experts say.

Still, though a huge weight loss might be expected to make patients live longer, there has been no hard evidence that it actually does so, and this has been a problem for Americans seeking coverage for expensive procedures.

Dr Anita Courcoulas, chief of the section of minimally invasive bariatric and general surgery at the University of Pittsburgh School of Medicine, the United States, said that in the last five years, there has been a movement in America to erect obstacles to prevent patients from gaining access to bariatric surgery.

At present, expert guidelines drawn up at a meeting of the US National Institutes of Health meeting held in 1991 relegate weight-loss surgery to only the morbidly obese (people with a body mass index (BMI) of 40 or above, with a BMI of 30 being the threshold for obesity). Even then, this was performed only after patients had exhausted all other weight-loss options.

For people who have over 80 pounds to lose, diets are not going to work in the long term, Dr Anita Courcoulas said.

In the absence of hard evidence that bariatric surgery boosts health and extends life, experts say that it has often been a struggle to convince health insurers to cover the procedure. That might now change.

In the Swedish trial, researchers at Gothenburg University and elsewhere tracked about 6,100 very obese adults (with BMIs over 34) for an average of 11 years. About two-thirds of the participants had undergone some form of weight-loss surgery, while others had tried non-surgical methods.

Death rates fell by 29% in the group that got surgery compared to those who had not. Most of the deaths were linked to heart disease.

Results were even more dramatic in the multi-centre American study, which followed 16,000 adults with BMIs of 33 or above for seven years. The American team estimated that 136 lives were saved for every 10,000 surgeries performed.

The statistics were impressive: death from any cause fell by 40% for those who underwent gastric bypass surgery versus those who did not.

And, death rates from specific diseases fell even lower. Diabetes mortality was improved by 92%, coronary artery disease by 56%, and cancer by 60%, according to lead researcher Dr Ted Adams, an associate professor in the division of cardiovascular genetics at the University of Utah School of Medicine in Salt Lake City.

The surgery itself appeared to carry little short-term risk. The death rate in the year after surgery (0.53%) was nearly identical to that of people who did not get gastric bypass, the researchers said.

Still, there were some longer-term risks associated with rapid weight loss, including a slight hike in the odds of death by injury, and an increase in psychological illnesses. Some studies have shown that, after bariatric surgery, a number of people go on to develop certain chemical dependencies.

This means that in-depth consultation with a doctor is crucial to make sure that weight-loss surgery is right for you, Dr Ted Adams warned.