The year began with a major study published in the January issue of the Journal of the American Medical Association (JAMA) that shows bariatric surgery cut the overall risk of death among those with severe obesity by more than half – a whopping 53 percent.
This study of 2,500 Veterans Affairs patients is but the latest proof that weight-loss surgery not only prevents, resolves or improves diseases including obesity, type 2 diabetes disease, and certain kinds of cancer, it could lead to a longer life. The study followed patients five to 14 years after surgery between 2000 and 2011. On average, patients were 52-years-old and had a body mass index (BMI) of 47.
David Arterburn, MD
"We have tracked a large group of patients for a long enough time that we can clearly see a strong link between bariatric surgery and long-term survival," said David Arterburn, MD, MPH, said study authors and affiliate associate professor of medicine at the University of Washington School of Medicine, in a press release. "As time passes, the risk of dying among the patients who've had surgery appears to be diverging from those of the matched controls who haven't had surgery."
People with obesity are more likely to have life-threatening conditions and diseases including type 2 diabetes, hypertension, sleep apnea and many others, yet the risk of death from the operation is exceptionally low. New studies have come out confirming the mortality rate has dropped to about 0.1 percent or about 1 in 1,000.
Previous data has shown an 89 percent reduction in mortality, as well as highly significant decreases in mortality rates due to diseases including cancer, type 2 and heart disease, diabetes, which after surgery, was reduced by about 60 percent, 90 percent, and
50 percent, respectively.
John Morton, MD
“Bariatric surgery is an American Surgical Success Story due to advances in techniques, quality improvement, accreditation and the incorporation of best practices including multidisciplinary approach, into many programs,” said John M. Morton, MD, ASMBS President. “It has become riskier to live with severe obesity than to have surgery to treat it.”
At the end of last year, research from the Cleveland Clinic Bariatric and Metabolic Institute showed laparoscopic gastric bypass surgery in patients with type 2 diabetes carries a complication and mortality rate comparable to some of the safest and most commonly performed surgeries in America, including gallbladder surgery, appendectomy, and total knee replacement.
In the study, the 30-day complication rate associated with metabolic surgery, specifically gastric bypass, was 3.4 percent, about the same as gallbladder surgery and hysterectomy. Hospital stays and readmission rates were similar to laparoscopic appendectomy. The month-long mortality rate for metabolic or diabetes surgery was 0.30 percent, about that of total knee replacement, and about one-tenth the risk of death after cardiovascular surgery.
Cleveland Clinic researchers reviewed a national database of nearly 67,000 patients with diabetes who had various surgical procedures including laparoscopic gallbladder surgery, appendectomy, partial colon resections, hysterectomy, heart surgery and total knee replacement between 2007 and 2012. The complication and mortality rates of these procedures were compared to those of the 16,509 patients in the group who had laparoscopic gastric bypass.
Stacy Brethauer, MD
“The risk-to-benefit ratio is excellent. There’s significant weight loss, diabetes improvement or remission, and a relatively low complication and mortality rate, and the earlier we intervene, the better off patients generally are,” said Stacy A. Brethauer, MD, associate director of the Cleveland Clinic Bariatric and Metabolic Institute, a co-author of the study and ASMBS Secretary/Treasurer. “This is a message patients and the primary care community need to hear. Bariatric surgery needs to be considered sooner because the data supporting its safety and effectiveness is overwhelming.”
Another Cleveland Clinic study published last year in The New England Journal of Medicine found diabetes remission rates three years after bariatric surgery were 35 percent, compared to zero for patients treated with pharmacotherapy.
Obesity Treatment Guidelines (2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society) provide recommendations on how doctors can help guide patients to the most effective approaches to weight loss, as well as when to recommend patients for bariatric surgery.
The guidelines recommend behavioral treatment for 140 million American adults or 65% of the population. It identifies 116 million candidates for adjunctive pharmacotherapy, and 32 million Americans who could be considered for metabolic and bariatric surgery. This, despite the fact that less than 1 percent of people with severe obesity have surgery in any given year.
“It’s really unfortunate to think about how many people’s lives could be changed for the better with surgery, and yet most never have the opportunity. This must change, and it will,” said Dr. Morton.