Bariatric surgery prolongs lifespan in obese

Obesity is on the rise. In the UK rates of obesity have increased from 13 to 24% in men and from 16 to 26% in women in the period 1993–2011.

Inpatient admissions to hospitals in England that have a primary diagnosis of obesity have tripled in the last 5 years to 11,740 (2011–2012). Most (3 : 1) of these admissions were for women. The economic burden of obesity on society was estimated to be £16 billion in 2007 (over 1% of UK gross domestic product). Although the short-term benefits of weight loss surgery—such as weight loss and better control of diabetes and blood pressure—are well known, there is concern about complications from the surgery. For example, there is some concern over malabsorption of nutrients including vitamin deficiency, anaemia and protein deficiency. Nevertheless, the number of surgeries being performed worldwide have increased. In 2011, 158,000 bariatric surgeries were performed in the U.S. and in 2016, 216,000 were performed, an increase of 37%.

A recent study investigated outcomes in obese middle-age men and women patients using electronic health records (here). The study compared 8,385 people who had the surgery (65% women and 35% men) to 25,155 who did not. The rate of death in individuals who did not have surgery was 2.3% compared to 1.3% in those who had surgery – almost twice the death rate of those who had traditional medical treatment over a 10-year period. The average age of a person in the study was 46 years old with a body mass index (BMI) of 40, the equivalent of being 5 feet 7 inches tall and weighing 265 pounds.

The study looked at three types of bariatric surgery compared to the usual care by a primary care physician, which may include dietary counselling and behaviour modification. The surgery types included roux-en-Y gastric bypass (creating a pouch at the top of the stomach that limits the amount a person can comfortably eat and bypassing the first part of the small intestine), laparoscopic adjustable gastric banding (restricting the amount of food the stomach can hold with an adjustable band) and physical sleeves to reduce the size of the stomach.

In order for patients and doctors to make the best-informed decisions about what weight loss strategies to pursue, they need to understand the true costs and benefits of the procedures. The study showed that the long-term effect of bariatric surgery was a longer life for obese patients and that this was not associated with a higher rate of anaemia, vitamin or protein deficiency. Previous studies looking at the question of treatment benefit were indefinite because follow-up data has been limited due to high costs and patients dropping out. We have previously attempted to look at the benefits of treatment in older patients but there are insufficient data to draw any conclusion (here). IN this case it si clear that delaying bariatric surgery until higher weight may result in poorer patient outcomes. To many patients surgery sounds like a radical approach to managing obesity, and a lot of people reject it because it seems like a risky thing to do, but it's actually less risky to have the surgery.