Weight Loss Surgery: It’s Not Just For Weight Loss

March 20, 2023

Obesity is a major public health concern in the United States. Diet and exercise are common strategies to lose weight. While some degree of weight loss can be achieved with these methods, it is common to regain weight over time. In people with severe obesity, or body mass index (BMI) greater than 35, the chance of achieving significant weight loss with diet and exercise alone is about 1%. Bariatric surgery is an option for these individuals and, when combined with healthy lifestyle changes, can lead to more significant weight loss in both the short- and long-term.

Weight loss surgery is beneficial for several reasons, not just for weight loss. The primary goal of bariatric surgery is to achieve significant weight loss, with individuals oftentimes losing more than 30% of their starting weight.

In the majority of patients, the new lower weight is sustained for years to come. In addition, several health benefits are seen when individuals can get themselves out of the morbidly obese BMI category of 35 or above. Weight loss surgery can improve or cure conditions like diabetes, heart disease, certain lung diseases, arthritis, and high blood pressure. There are also significant reductions in risk of death from these diseases, as well as certain cancers.

Type 2 Diabetes

The prevalence of type 2 diabetes is increasing dramatically worldwide. Evidence suggests that weight loss surgery provides better resolution of type 2 diabetes when compared to non-surgical treatment options such as lifestyle modification and intensive medical therapy[1]. These improvements appear as superior glycemic control, reduced number of diabetic medication usage and decrease of other cardiovascular risk factors. One study showed that bariatric surgery causes long-term remission of type 2 diabetes with rates of 45-95%, depending on the type of procedure performed[2].

Cardiovascular health is another major obesity-related comorbidity and includes coronary artery disease, stroke, high blood pressure and high cholesterol. A published review of the effect of weight loss surgery on cardiovascular health demonstrates a reduction in acute coronary events (heart attacks), and an improvement in the structure and function of the heart[3]. This leads to an overall reduced mortality due to cardiovascular disease in obese patients.

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement surgery due to chronic wear and tear on weight-bearing limbs. Reports suggest that weight loss after bariatric surgery reduces knee pain intensity as well as the number of patients with knee pain[4]. This leads to improved quality of life and functionality of knee osteoarthritis.

Obstructive Sleep Apnea

The relationship between obstructive sleep apnea and obesity is well known. Several studies demonstrate the improvement or resolution of sleep apnea with significant weight loss after bariatric surgery. In fact, after any type of weight loss surgery, reports indicate that over 75% of patients experience an improvement in their sleep apnea symptoms[5]. Another study shows complete cure in about 45% of patients[6].

Certain cancers, and the mortality associated with them, are linked to obesity. A large retrospective trial examined the relationship between weight loss after surgery and several types of obesity-associated cancers, including esophageal, kidney, breast, stomach, colorectal, liver, gallbladder, pancreas, ovary, thyroid, and certain blood cancers. They found reductions in both the incidence of cancer as well as cancer-related deaths after weight loss surgery compared to those who did not have weight loss surgery[7].

Bariatric surgery is a safe, effective, and invaluable method of achieving significant weight loss when combined with healthy lifestyle changes.

The ensuing weight loss affects almost everyone's organ system and can lead to improvements in several obesity-associated comorbidities including type 2 diabetes, high blood pressure, heart disease, obstructive sleep apnea, arthritis, infertility, depression, anxiety, and incidence of certain cancers. Altogether, this results in better quality of life as well as increased survival benefits. In summary, a reduction in weight is just the tip of the iceberg to the benefits that occur after weight loss surgery.

References

  1. Chumakova-Orin M, et al. Diabetes remission after bariatric surgery. World J Diabetes. 2021 Jul 15; 12(7):1093-1101.
  2. Vetter ML, et al. Comparison of Bariatric Surgical Procedures for Diabetes Remission: Efficacy and Mechanisms. Diab Spec. 2021 Nov; 25(4):200-210.
  3. Srinivasan M, et al. The Impact of Bariatric Surgery on Cardiovascular Risk Factors and Outcomes: A Systematic Review. Cureus. 2022 Mar; 14(3):e23340.
  4. Heuts EA, et al. The Influence of Bariatric Surgery on Hip and Knee Joint Pain: a Systematic Review. Surg Obes Relat Dis. 2021 Sep; 17(9):163-1653.
  5. Sarkhosh K, et al. The Impact of Bariatric Surgery on Obstructive Sleep Apnea: a Systematic Review. Obes Surg. 2013 Mar; 23(3):414-23.
  6. Peromaa-Haavisto P, et al. Obstructive Sleep Apnea: the Effect of Bariatric Surgery after 12 months. A Prospective Multicenter Trial. Sleep Med. 2017 July;35:85-90.
  7. Aminian A, et al. Association of Bariatric Surgery with Cancer Risk and Mortality in Adults with Obesity. JAMA. 2022;327(24):2423-2433.

Dena Arumugam, MD, is a board-certified general surgeon who practices at Jersey Shore Advanced Surgical Associates.

Not Just For Weight Loss

ABOUT THE AUTHOR

Dena Arumugam, MD, is a board-certified general surgeon who specializes in minimally invasive surgery, general surgery and bariatric surgery. She earned her medical degree at the Albert Einstein College of Medicine and completed a general surgery residency at Rutgers Robert Wood Johnson Medical School. She refined her laparoscopic surgery skills at New York University Winthrop Hospital with fellowship training in advanced gastrointestinal and bariatric surgery, before returning to New Jersey to practice at Jersey Shore Advanced Surgical Associates.