Weight loss surgery lowers the risk of premature death, particularly from obesity-related conditions like cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.
The study found that people who underwent one of four types of weight-loss surgery were less likely to die from any cause than those of a similar weight. The decline in deaths from diseases caused by obesity, such as heart disease, cancer and diabetes, has been even more dramatic.
“Deaths from cardiovascular disease decreased by 29%, while deaths from various types of cancer decreased by 43%, which is impressive,” said lead author Ted Adams, assistant professor of nutrition and integrative physiology at the University of Utah College of Medicine. .
“There was also a significant percentage reduction — a 72% reduction — in diabetes-related deaths in people who had surgery compared to those who did not,” he said. One significant downside: The study also found that younger people who had the surgery were more likely to commit suicide.
The study, published Wednesday in the journal Obesity, reinforces similar findings from previous research, including a 10-year study in Sweden that found a significant reduction in premature mortality, said Dr. Eduardo Grunwald, professor of medicine and medical director of weight management. Program at University of California San Diego Health.
The Swedish study also found that a significant number of people were in remission of their diabetes at both 2 and 10 years after surgery.
“This new research from Utah is even more evidence that people who undergo these procedures have positive and beneficial long-term outcomes,” said Grunwald, who co-authored the American Gastroenterological Association’s new guidelines on obesity treatment.
The association strongly recommends that patients with obesity use recently approved weight loss medications or surgery in combination with lifestyle changes.
“The key for patients is knowing that changing your diet becomes natural, easy to do after bariatric surgery or taking new weight-loss medications,” said Grunwald, who was not involved in the Utah study.
“While we don’t fully understand why, these interventions actually change the chemistry in your brain, making it a lot easier to change your diet afterwards.”
Dr. Caroline Apovian, associate professor of medicine at Harvard Medical School and co-director of the Bariatric Center, said that despite the benefits, only 2 percent of patients who qualify for bariatric surgery get it, often because of the stigma around obesity. Weight Management and Wellness at Brigham and Women’s Hospital, Boston. Abovian was the lead author of the Endocrine Society Clinical Practice Guidelines for the Pharmacological Management of Obesity.
She said insurance companies usually cover the cost of surgery for people over 18 with a BMI of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure.
“I see patients with a BMI of 50, and I will always say, ‘You are a candidate for everything—medication, diet, exercise, surgery. And many say to me, ‘Don’t talk to me about surgery. I don’t want that.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.
“We don’t torture people with heart disease: ‘Oh, because you ate all this junk food.’” We don’t torture diabetics: ‘Oh, because you ate all that cake.’ We tell them they have a disease and we cure it. Obesity is a disease too, and yet we torture obese people by telling them it’s their fault.”
Most people who choose bariatric surgery — about 80 percent — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who underwent the procedure.
“For all causes of death, the death rate decreased by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, were 24% lower for females and 22% lower for males who had surgery compared to those who did not, he said.
Four types of surgeries performed between 1982 and 2018 were examined in the study: gastric bypass, gastric band, sleeve gastrectomy, and duodenal switch.
Developed in the late 1960s, gastric bypass creates a small pouch near the top of the stomach. A portion of the small intestine is brought in and attached to this point, bypassing most of the stomach and duodenum, the first part of the small intestine.
In gastric banding, an elastic band that can be tightened or loosened is placed around the upper part of the stomach, which limits the volume of food that enters the stomach cavity. Because gastric banding is not successful for long-term weight loss, the procedure is “not very popular today,” Adams said.
He said, “Gastric sleeve is a procedure in which two-thirds of the stomach is removed laparoscopically.” “It takes less time to perform, and the food still passes through a much smaller stomach. It has become a very popular option.”
Adams added that duodenal switch is usually reserved for patients who have a high BMI. It’s a complex procedure that combines gastric sleeve with intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.
One of the alarming findings of the new study was a 2.4% increase in deaths from suicide, especially among people who had bariatric surgery between the ages of 18 and 34.
“It’s because they’ve been told life will be great after surgery or treatment,” said Joan Hendelman, clinical director of the National Eating Disorders Alliance, a nonprofit advocacy group.
“All you have to do is lose weight, people will want to hang out with you, people will want to be your friends, and your anxiety and depression will disappear,” she said. “But this is not true.”
In addition, there are risks and post-surgical side effects associated with bariatric surgery, such as nausea, vomiting, alcohol dependence and possible failure to lose weight or even gain weight, said Suzanne Vibert, an advocate with the HEAL Project, which provides help for people struggling with eating disorders.
How do we define health in these scenarios? And is there another intervention – a weight-neutral intervention? Vibert asked.
Previous research has also shown an association between suicide risk and bariatric surgery, Gronwald said, but studies on this topic can’t always pinpoint a patient’s mental history.
“Did the person choose the surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect in some way of bariatric surgery? We cannot answer this for sure,” he said.
Abovian said counseling in intensive compression surgery is usually required for all who undergo the procedure, but it may not be enough. She lost her first bariatric surgery patient and committed suicide.
“She was older, in her 40s. She had surgery and lost 150 pounds. Then she put herself in front of the bus and passed out because she had bipolar disorder and she was self-medicating with food,” said Abovian. We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everyone, not just people who have had bariatric surgery.”
Experts say managing weight is a unique process for each person, a combination of genetics, culture, environment, social stigma, and personal health. There is no single solution for all.
“First, we as a society must view obesity as a disease, as a biological problem, not as a moral failure,” said Grunwald. “This is my first tip.
“And if you think your life will benefit from treatment, consider evidence-based treatment, which studies show is surgery or medication, if you are not able to do so successfully with lifestyle changes alone.”