Obese adults seen living longer after stomach surgery

Cut in cancer, diabetes cited

By Stephen Smith, Globe Staff  |  August 23, 2007

For the first time, researchers have conclusively shown that losing weight through stomach surgery can extend the lives of severely obese patients, dramatically reducing deaths from heart disease, cancer, and diabetes.

Physicians said the findings are so dramatic that they could spawn a major shift in who is eligible for weight-loss surgery, a procedure once restricted to the most dangerously obese because of potential complications. Now, patients typically have to be at least 100 pounds overweight before doctors will consider the operation and before health plans will pay the bill, which can exceed $30,000 per patient. In 2006, 177,600 Americans had the surgery.

Scientists had known that losing weight can reduce blood pressure and the risk of developing diabetes. But until this research, it was an open question whether weight loss surgery actually extended life.

In two sweeping studies of weight-loss surgery released today, independent research teams in Sweden and Utah who tracked nearly 20,000 obese patients showed that those who had their stomachs surgically altered were up to 40 percent more likely to be alive years later than patients who didn't have the operation. Those who tried more conventional means of weight loss were unlikely to have lost substantial amounts.

"Nonsurgical weight loss is largely unsuccessful," said Dr. David Lautz, director of bariatric surgery at Brigham and Women's Hospital. "Those things should be tried, and for the patients who succeed, all the better. But if it doesn't, the mindset should go toward a bariatric procedure."

Lautz and other obesity specialists not involved with the research said the studies, which appeared in the New England Journal of Medicine, indicate that the operations can alleviate life-threatening medical conditions that are the legacy of years of excess weight.

The lead author of one of the studies, Dr. Lars Sjöström, said the reasons for the health improvements of the patients who underwent surgery remain unclear. For instance, it could be the sheer loss of weight or something about how the surgery rearranged the innards of patients.

Finding the answer is pivotal, Sjöström said. "We are going to focus our research very hard on trying to understand the mechanisms behind the beneficial effect of bariatric surgery on mortality," he said. "If we can understand what these mechanisms are, then it may be possible to use some of them without subjecting the patients to bariatric surgery."

Authors of the study, as well as other weight specialists, cautioned that any surgery carries risk and that no one should agree to it without careful consideration. While federal statistics show that deaths related to bariatric surgery have been declining, high profile cases such as that of former Patriots assistant coach Charlie Weis continue to underscore the potential dangers.

Patients must also consider how surgery radically and permanently alters their lives. Eating and exercise habits must change profoundly. Self-image shifts, too.

"A patient shouldn't wake up one day and say, 'Hey, I'm going to get my bypass because I don't want to be heavy anymore,' " said Dr. Scott A. Shikora of Tufts-New England Medical Center, who is president-elect of the American Society for Metabolic & Bariatric Surgery.

In one of the studies published today, Swedish researchers enrolled 2,010 patients who underwent bariatric surgery starting in 1987. At the same time, the researchers tracked 2,037 others who did not have an operation, but who tried to control their weight through other means.

After following patients for an average of nearly 11 years, the Swedish researchers found that those who had weight-loss surgery lived longer and weighed as much as 25 percent less than before their surgery. In contrast, the patients who dealt with their weight through diet, exercise, and other methods essentially had no weight change. The heaviest patients undergoing surgery appeared to benefit the most when compared to their peers.

Since the Swedes began their study, weight loss surgery has advanced and now requires smaller incisions that lower the risk of infection, suggesting, Sjöström said, that the benefits today may be even greater.

The Utah team compared the health of 7,925 surgery patients with an identical number of closely matched obese adults who did not have surgery, following them for an average of seven years. Cancer deaths were 60 percent lower among the surgical patients, while deaths attributable to diabetes were 92 percent lower. Heart disease deaths were 56 percent lower.

Ted Adams, lead author of the Utah study, said the reasons for the decrease in deaths are complex, potentially touching on matters from how the surgery affects certain hormones involved in diabetes to how having less fatty tissue may slow cancer growth.

Neither Sjöström nor Adams is a surgeon and, thus, does not stand to personally benefit from any increase in weight-loss surgery. The Utah study was paid for by federal and state agencies. The Swedish study was underwritten in part by pharmaceutical companies, although those firms do not have a financial stake in bariatric surgery, Sjöström said.

The researchers acknowledged that because their studies were conducted among overwhelmingly non-Hispanic white populations, the findings may not be applicable to more diverse groups of patients. But Sjöström said he would be "very astonished" if the results were substantially different among blacks and Hispanics.

The Utah study had one finding that concerned the researchers: Suicides and accidental deaths were higher among patients who had gastric bypass.

"Perhaps some individuals go into the surgery thinking, 'This may be an important answer to some of my social issues or my body image issues' and then they're disappointed," Adams said.

Michael Nigro said he decided to have the surgery because he sensed death looming as he entered his 40s. At his heaviest, he weighed 372 pounds. Climbing stairs to the bathroom exhausted him. He developed a serious heart condition, diabetes, and arthritis.

"The kids would say, 'Let's play.' I just couldn't," said Nigro, who lives in Quincy.

After repeatedly losing and then regaining weight on diets, he decided to have weight-loss surgery at the Brigham. His weight is now 206 pounds, and he can play with his son and daughter, 12 and 10, on the beach.

It's true, he said, the surgery has forced him to substantially change the way he eats. Indulging in sweets, for example, can lead to a sudden trip to the bathroom.

Nigro said he can still go to the Outback Steakhouse and have a filet, except it's the children's filet, which is a lot smaller and a lot cheaper.

"That puts a smile on my face," he said.

http://meltingmama.typepad.com/wls/2007/08/weight-loss-sur.html

Beth, Very interesting article. I must say that I can more relate to the one that you sent, because like you, I didn't have many illness for being overweight. Funny enough, I'm still "overweight" and do worry about the long term affects of reconstructing my stomach. It is scary when you think of all the unknown that comes along with the surgery.  I hope all is well with you and your family and would love to talk about this topic, maybe at our next support group meeting. See ya!

Oh, definitely.  It's a hot topic.  :)