Bariatric Surgery: Longer Life, Certain Risks

Life ForceAn impressive new study in Obesity, with up to 40 years of follow-up, confirms that the benefit of a longer life after bariatric surgery is durable, but it comes with certain risks. The authors of this study, led by Ted Adams, explain:

“Results of this study attest to the decades-long durability of bariatric surgery in reducing death from all causes and reducing deaths related to cardiovascular disease, cancer, and diabetes when compared with matched participants with severe obesity. In addition, favorable mortality outcomes were evident for major bariatric surgery procedures.

”Serious concern, however, continues to be exhibited regarding increased mortality following bariatric surgery in relation to suicide, accidents, and cirrhosis of the liver. This study showed that the primary group associated with this untoward mortality outcome is patients choosing to have bariatric surgery between ages 18 and 34 years, suggesting that this age group may require more aggressive presurgical psychological screening and postsurgery follow-up.”

Four Decades of Follow-Up

The long follow-up in this study was possible because of the Utah Population Database, which is one of the world’s richest sources of in-depth information supporting research on genetics, epidemiology, demography, and public health. It holds data from state government records, family histories, and extensive health data. From this database, Adams and his colleagues were able to construct a study sample of 21,837 matched pairs of surgical and non-surgical patients.

By far, the most common procedure in this group was gastric bypass. But patients with a history of gastric sleeve, gastric banding, and duodenal switch were also in the study.

All cause mortality was 16 percent lower in the surgical versus non-surgical patients. The benefit was greatest for mortality due to diabetes – a 72 percent reduction.

Caution Is Wise

Caution and realistic expectations for bariatric surgery are important for people who are thinking about this procedure. It can be life-changing, and almost certainly has a net benefit for the people who choose to have it.

But this study does point to the need for careful screening and psychological care, especially for younger patients, because of an increased risk of suicide after surgery. Though suicide was not common (four deaths per 10,000 person years in the surgery group), the rate was more than twice as high for the surgical group compared to the non-surgery group. Still, the control group had more deaths from all causes.

Looking Ahead

Clearly, surgery is a daunting and yet beneficial treatment for obesity. For putting diabetes into remission, nothing else has yet matched it. However, there will be great interest in the long-term outcome studies from advanced drug therapies for obesity. Will those drugs deliver sufficient effectiveness to extend the lives of people who take them? Results from the first of these studies will be out later this year.

If survival benefits are significant, we will see the embrace of treatment for obesity grow stronger.

Click here for the study by Adams et al, here, here, and here for further reporting on it.

Life Force, linocut by M.C. Escher / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


January 26, 2023