Struggling to Survive

Cutting the Risk of Death by 43% with Bariatric Surgery

JAMA released a special issue devoted to obesity late yesterday. Bariatric surgery is front and center. The study that’s grabbing headlines is a retrospective study of survival after bariatric surgery. In a very careful analysis, researchers found that after approximately 4.5 years, bariatric surgery cuts the risk of death by almost half, compared to usual medical care without surgery.

In the surgery group, 1.3% of patients died from any cause. But in the medical care group, 2.3% died.

An Option Many People Avoid

Oddly enough, most of the people who could benefit from bariatric surgery seem to believe just the opposite. In a 2015 study, we found that 68% of patients with severe obesity (Class III) reject bariatric surgery. For the most part, they believe it is too dangerous. As this study shows, the popular perception is dead wrong. The risk of death is lower if people have surgery when it’s indicated.

Sleeve or Bypass?

Also in this issue, you will find three new studies of gastric sleeve operations. Because it’s simpler compared to gastric bypass, it has quickly become a more common choice. Patients find it less daunting. And these new data suggest that the outcomes are nearly as good. We need better comparisons between these two procedures, but for now, the choice is a bit of a toss-up.

But the bottom line is this. Popular perceptions about bariatric surgery are out of line with reality. The risk of living with severe obesity exceeds the risk of surgery to bring it under control. For patients with type 2 diabetes and obesity, the benefits are especially dramatic.

Yes, we need better options. But for now, we have only ourselves to blame if we don’t use the options we already have.

Click here for the study of survival after surgery from JAMA and here for an overview of JAMA’s special obesity issue. Click here, here, here, here, here, here, and here for the other papers in this issue on bariatric surgery.

Struggling to Survive, photograph © Iyad Tibi / flickr

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January 17, 2018