Weight loss surgery can prolong lives

Weight management is a unique process for each person: a mix of genetics, culture, environment, social stigma and personal health, say experts

Weight loss surgery reduces the risk of premature death, especially from obesity-related illnesses like cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with other people of similar weight, those who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the research found. The drop in deaths from obesity-related diseases such as heart disease, cancer and diabetes was even more pronounced.

“Deaths from cardiovascular disease were down 29%, while deaths from various cancers were down 43%, which is pretty impressive,” says lead author Ted Adams, adjunct associate professor in nutrition and integrative physiology at the University of Utah School of Medicine. .

“There was also a huge percentage drop – a 72% decline – in diabetes-related deaths in people who had surgery compared to those who didn’t,” he adds. One notable downside: The study also found that younger people who had surgery were at a higher risk of suicide.

Supports previous investigations

The study, published in late January in the journal Obesity, reinforces similar results from previous investigations, including a 10-year study in Sweden that found significant reductions in premature deaths, points out Eduardo Grunvald, professor of medicine and medical director of the obesity management program. weight at the University of California San Diego Health.

The Swedish study also found a significant number of people in remission from their diabetes, both two years and ten years after surgery.

“This new research from Utah is further evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” says Eduardo Grunvald, who co-authored the new American Gastroenterological Association guidelines for the treatment of obesity.

The association strongly recommends that patients with obesity use newly approved weight loss medications or surgery accompanied by lifestyle changes.

“And the key for patients is knowing that changing their diet becomes more natural, easier to do after having bariatric surgery or taking new weight-loss medications,” says Grunvald, who was not involved in the study. held in Utah.

“Although we still don’t quite understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet later.”

Despite the benefits, only 2% of patients who are eligible for bariatric surgery get it, often because of obesity-related stigma, says Caroline Apovian, professor of medicine at the Harvard School of Medicine and co-director of the Wellness Center. and Weight Management at Brigham Hospital for Women in Boston. Caroline was the lead author of the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance companies typically cover the cost of surgery for people over 18 with a body mass index (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, explains.

“I see patients with a BMI of 50, and I’ll invariably say, ‘You’re a candidate for everything – medication, diet, exercise and surgery.’ And many say to me, ‘Don’t talk to me about surgery. I don’t want it.’ a surgical solution to what society told them was a failure of willpower.”

“We don’t torture people who have heart disease: “Oh, it’s because you ate all that fast food». We don’t torture people with diabetes: “oh, it’s because you ate all that cake”. We tell them they have a disease, and we treat it. Obesity is also a disease, but we torture people with obesity by telling them it’s their fault.”

Both men and women can benefit

Most people who choose bariatric surgery — about 80% — are women, says Ted Adams. One of the strengths of the new study, he stresses, was the inclusion of men who had undergone the procedure.

“For all causes of death, mortality was reduced by 14% for women and 21% for men,” he says. In addition, deaths from related causes such as heart attack, cancer and diabetes were 24% lower for women and 22% lower for men who had surgery compared to those who did not, she argues.

Four types of surgeries performed between 1982 and 2018 were examined in the study: bypass gastric, gastric band, sleeve gastric and duodenal switch.

O bypass Gastric ulcer, developed in the late 1960s, creates a small pouch near the top of the stomach. A portion of the small intestine is ascended and attached to this point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In the gastric band, an elastic band that can be tightened or loosened is placed around the upper part of the stomach, thereby restricting the volume of food entering the stomach cavity. Since gastric banding is not as successful in long-term weight loss, the procedure “isn’t as popular these days,” explains Ted Adams.

“O sleeve gastric bypass is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” explains Ted. “It takes less time to create results, and food continues to pass through the now much smaller stomach. It has become a very popular option.”

Duodenal switching is usually reserved for patients who have a high BMI, adds Ted Adams. It is a complicated procedure that combines a gastrectomy in sleeve common bypass intestinal tract, and is effective for patients with type 2 diabetes, according to the Cleveland Clinic.

a serious complication

An alarming finding of the new study was a 2.4% increase in deaths from suicide, mostly among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they’re told life is going to be great after surgery or medication,” says Joann Hendelman, clinical director of the National Alliance on Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people will want to be with you, they’ll want to be your friend, and their anxiety and depression will disappear,” says Joann Hendelman. “But that’s not reality.”

In addition, there are post-operative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, explains Susan Vibbert, an advocate for Project HEAL, which supports people struggling with with eating disorders.

“How are we defining what is healthy in these scenarios? And is there another intervention – a weight-neutral intervention?” asks Susan Vibbert.

Studies in the past have also shown an association between the risk of suicide and bariatric surgery, underlines Eduardo Grunvald, but studies on the subject are not always able to know the mental history of a patient.

“Could it be that the person opted for 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 the bariatric surgery? We cannot answer that with certainty”, he argues. .

Intensive pre-surgery counseling is usually necessary for everyone undergoing the procedure, but it may not be enough, says Caroline Apovian. Her first bariatric surgery patient eventually broke down and committed suicide.

“She was older, in her 40s. She had surgery and lost 68 kilos. And then she got in front of a bus and died because she had an underlying bipolar disorder and was self-medicating through food”, says Caroline Apovian. “We as a society use food a lot to hide trauma. What we need in this country is more psychological counseling for everyone, not just people having bariatric surgery.”

Weight management is a unique process for each person: a mix of genetics, culture, environment, social stigma and personal health, experts say. There is no one-size-fits-all solution.

“First, we, as a society, must consider obesity as a disease, as a biological problem, and not as a moral failure”, emphasizes Eduardo Grunvald. “This is my first piece of advice.”

“And if you believe your life will benefit from treatment, then consider science-based treatments, which studies show to be surgery or medication, if you haven’t been able to resolve it with lifestyle changes alone.”