Obese, middle-age men and women who had bariatric surgery
have half the death rate of those who had traditional medical treatment over a
10-year period, reports a study published in JAMA that answers questions about the long-term risk of the
The study was conducted by Northwestern University Feinberg
School of Medicine and the Clalit Research Institute in Israel, which has one
of the highest rates of bariatric surgery in the world
“We showed that a
long-term effect of bariatric surgery is a longer life for obese patients,”
said study co-author Dr Philip Greenland, professor of preventive medicine at
Northwestern University Feinberg School of Medicine. “They had half the death
rate, which is significant.”
The rate of death in individuals who did not have surgery
was 2.3% compared to 1.3% in those who had surgery. The study compared 8385
people who had the surgery (65% women and 35% men) to 25 155 who did not.
The average age of a person in the study was 46 years old
with a Body Mass Index (BMI) of 40. Previous studies looking at this question
were indefinite because follow-up data was limited due to high costs and
patients dropping out.
In addition, most people in Israel remain with the same
medical practitioner throughout their life, allowing researchers to track the
same individuals for long periods of time.
The new results illuminate the real-world experience of
patients having bariatric surgery. This study, based on electronic health
records from an HMO in Israel, looked at detailed data on 33 540 obese individuals
for up to a decade.
“Bariatric surgery is an increasingly frequent treatment for
severe obesity,” said study co-author Laura Rasmussen-Torvik, an assistant
professor of preventive medicine at Feinberg. “It’s highly effective in
promoting weight loss but also invasive and can lead to short- and long-term
complications. In order for patients and doctors to make the best-informed
decisions about what weight loss strategies to pursue, they need to understand
the true costs and benefits of the procedures.”
While the short-term benefits of weight loss surgery – such
as weight loss and better control of diabetes and blood pressure – are well
known, there is concern about complications from the surgery. Among the
concerns are malabsorption of nutrients including vitamin deficiency, anaemia
and protein deficiency. But there was not a higher rate of anaemia, vitamin or
protein deficiency among those who had surgery in this study.
The study looked at three types of bariatric surgery
compared to the usual care by a primary care physician, which may include
dietary counselling and behaviour modification. The surgery types included
roux-en-Y gastric bypass, laparoscopic adjustable gastric and sleeve.
“Surgery sounds like a radical approach to managing obesity,
and a lot of people reject it because it seems like a risky thing to do, but
it’s actually less risky to have the surgery,” Greenland said.
P, et al. Association of Bariatric Surgery Using Laparoscopic Banding,
Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care
Obesity Management With All-Cause Mortality. JAMA. Published online 16 January