Weight-Loss Surgery Lengthens Life Span, Study Shows
Obesity is tied to premature death, but researchers have found that weight-loss surgery can add a few years to your life.
In a study involving more than 4,000 obese people, those who had obesity, or bariatric, surgery lived three years longer on average than those who didn't. But life expectancy was nearly six years less than for non-obese individuals.
"Our finding will help patients to make an informed choice when considering obesity treatment," said researcher Dr. Peter Jacobson.
"Most of the remaining mortality after surgery is from diseases which are preventable," said Jacobson, of the Department of Molecular and Clinical Medicine at the University of Gothenburg in Sweden.
Besides early death, obesity is associated with type 2 diabetes, cancer and heart disease.
One way to boost longevity is to control cardiovascular risk factors such as blood pressure, smoking and cholesterol, Jacobson said.
For the study, researchers collected data on patients who took part in the Swedish Obese Subjects study. Participants were followed for more than 20 years on average. Over that time, 23% of those who had weight-loss surgery died, as did 26% of those who didn't have an operation.
In the surgery group, BMI (body mass index) dropped 11 points on average in the year after the operation. There was some weight regain up till year eight, after which BMI stabilized at around 7 points below baseline.
Heart disease and cancer were the most common causes of death, the researchers reported.
"We hope this information increases the awareness among doctors about the importance of offering appropriate follow-up after obesity surgery," Jacobson said.
Dr. Mitchell Roslin is chief of obesity surgery at Lenox Hill Hospital in New York City. Reviewing the findings, he said, "It is clear that bariatric surgery is underutilized."
Primary care doctors and specialists need to pay more attention to obesity and recognize that referral for bariatric surgery is not optional, but lifesaving, Roslin said.
He added that outcomes after weight-loss surgery are better in terms of extending life than those of heart bypass surgery and stents.
"Yet few view that as elective for those in need. We need to start rethinking the management of our morbidly obese patients. Surgery needs to be done more often and earlier before irreversible changes occur," Roslin said.
Dr. John Morton, director of bariatric surgery at Yale School of Medicine, also reviewed the study and said many of the Swedish patients had procedures that aren't used anymore. If they had the currently used operations, life expectancy would be even higher, he noted.
"Life expectancy could have been longer if you substitute more effective operations than the gastric band," Morton said. "But there is a legacy effect of carrying extra weight. Even though you get the weight off, there may be some lingering effects from carrying that extra weight."
The longer you remain heavy, the more chronic conditions you develop and the harder they are to get rid of, Morton said.
Given that, Morton believes the earlier obese patients have weight-loss surgery, the more likely they are to remain alive and healthy.
About 250,000 weight-loss operations are done each year in the United States. But 20 million Americans are obese, so that's only about 1% a year who get surgery, Morton said.
"Carrying extra weight increases comorbidities and decreases life span, but with weight loss, you can reverse that," he said.
The study results were published Oct. 14 in the New England Journal of Medicine.
For more on bariatric surgery, see the America Society of Metabolic and Bariatric Surgery.
SOURCES: Peter Jacobson, M.D., Ph.D., Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden; Mitchell Roslin, M.D., chief, obesity surgery, Lenox Hill Hospital, New York City; John Morton, M.D., director, bariatric surgery, Yale School of Medicine, New Haven, Conn.; New England Journal of Medicine, Oct. 14, 2020