Bariatric surgery prolongs life, study finds

CNN
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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-old study of nearly 22,000 people with had bariatric surgery in Utah.

Compared to those of similar weight, people who had one of four types of bariatric surgery were 16% less likely to die from any cause, according to the study. The decline in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, has been even more dramatic.

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

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

The study, published Wednesday in the journal Obesity, reinforces similar findings from previous research, including a 10 years of study in Sweden which found significant reductions in premature deaths, said Dr. Eduardo Grunvald, professor of medicine and medical director of the Weight Management Program at University of California San Diego Health.

The Swedish study also found that a significant number of people were in remission from diabetes two years and 10 years after surgery.

“This new research from Utah is further evidence that people who undergo these procedures have positive and beneficial long-term outcomes,” said co-author Grunvald from the American Gastroenterological Association. new guidelines on the treatment of obesity.

The association strongly recommends that obese patients use recently approved weight loss drugs or surgery combined with lifestyle changes.

“And the key for patients is knowing that changing their diet becomes more natural, easier to do after they’ve had bariatric surgery or taken the new weight-loss drugs,” said Grunvald, who didn’t attend the Utah study.

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

Despite the benefits, only 2% of patients eligible for bariatric surgery get it, often due to obesity-related stigma, said Dr. Caroline Apovian, professor of medicine at Harvard Medical School and co-director of the Center for WeightManagement. and wellness at Brigham and Women’s Hospital in Boston. Apovian was the senior author of the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance companies usually cover the cost of surgery for people over the age of 18 with a body mass index of 40 or more, 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 invariably I say, ‘You’re a candidate for everything – drugs, diet, exercise, and surgery.’ And many tell me, ‘Don’t talk to me about surgery. 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, it’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 that it is their fault.

Most people who choose 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 21% for men,” Adams said. In addition, deaths from related causes, such as heart attacks, cancer and diabetes, were 24% lower in women and 22% lower in men who had surgery compared to those who did not. didn’t, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass surgery, developed in the late 1960s, creates a small pouch near the top of the stomach. Part of the small intestine is lifted and attached at 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 stomach cavity. Because gastric banding isn’t as effective at creating long-term weight loss, the procedure “isn’t as popular today,” Adams said.

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

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

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

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

Additionally, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, potential inability to lose weight or even gain weight, said Susan Vibbert, attorney at HEAL Project, which helps people with eating disorders.

“How do we define health in these scenarios? And is there another intervention – an intervention without weight? asked Vibbert.

Previous research has also shown an association 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 psychological issues that were not resolved after surgery? Or is it a direct effect of some sort of bariatric surgery? We cannot answer that with certainty,” he said.

Intensive preoperative counseling is usually needed for anyone undergoing 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 surgery and lost 150 pounds. And then she got 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 hide trauma. What we need in this country is more psychological counseling for everyone, not just people having bariatric surgery.

According to experts, weight management is a unique process for each person, a mix of genetics, culture, environment, social stigma and personal health. There is no one-size-fits-all solution.

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

“And if you think your life is going to benefit from treatment, consider evidence-based treatment, which studies say is surgery or medication, if you haven’t been able to do that with changes in way of life alone.”