Portrait of Grandmother Ana Sewing

Bariatric Surgery? Only if You Want a Longer Life

We understand. Surgery is daunting. Bias against people living with obesity is rampant. Some friends and family will criticize. Some doctors will discourage. Health plans often make it hard. So many people feel reluctance about seeking bariatric surgery. But a new study in the New England Journal of Medicine reminds us. This is not right. Bariatric surgery offers patients better odds for a longer life.

Longer Life Expectancy

These results come from the Swedish Obese Subjects study. They represent 24 years of follow-up on 2,007 surgery patients and 2,040 patients in a matched cohort of patients receiving usual obesity care. In addition, the researchers analyzed a reference cohort of 1,135 individuals from the general population.

Folks who had bariatric surgery lived three years longer than the control group. With usual care, obesity shortened the lives of people in the control group by eight and a half years compared to the general population.

But bariatric surgery does not completely erase the impact of living with obesity for years. Though the surgery group lived longer than the control group with obesity, their lives were an average of five and a half years shorter than the general population.

COVID and Bariatric Surgery

For some people, the coronavirus adds another reason for pursuing bariatric surgery. Obesity and diabetes add to the risk for serious illness and death when a person becomes infected with the coronavirus. So if a person has both obesity and diabetes, the reasons for bariatric surgery might seem especially compelling.

That’s because better diabetes control is likely to improve your odds for a better outcome if you get infected. And bariatric surgery offers the best odds for putting type 2 diabetes into remission. In Obesity, Manuel Fortún Landecho and Gena Frühbeck explain the potential importance:

“Prospective studies are difficult to design and perform; thus in the absence of class 1A evidence,
this retrospective study supports that having undergone bariatric surgery prior to
COVID-19 and the subsequent improved glycemic control seems to protect people living with
obesity from more severe COVID 19.”

But they also note a counterintuitive finding. Patients with the lowest weight status after bariatric surgery had worse outcomes with COVID-19. They suggest that this might be an indication of functional malnutrition in this subset of patients. Certainly, this is something that requires close attention and further research.

Barriers to Good Care

This brings us back to the barriers that stand in the way of people who could benefit from bariatric surgery. They are social, they are psychological, they are medical, and they are financial. But above all they are irrational. It makes no sense that 99 percent of people who might benefit from bariatric surgery do not receive it.

Apparently, some patients agree because volumes of bariatric surgery are growing. This might be despite the pandemic. Or it might be in part because of it. Regardless, surgeons are seeing double-digit growth in procedures this year compared to last year.

We take it as a good sign of recognition for the value of treating obesity.

Click here for the study in the NEJM.

Portrait of Grandmother Ana Sewing, painting by Salvador Dali / WikiArt

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October 16, 2020

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