Gastric Bypass Lowers Risk of Death

Whether one regards bariatric surgery — last-resort weight-loss operations such as gastric bypass and stomach stapling — as an essential treatment for obesity or as a failure of the fat person's will, the fact is, it works. Studies have shown that after surgery, patients often lose 50% or more of their excess weight — and keep it off — and symptoms of obesity-related conditions like diabetes, high blood pressure, high cholesterol and sleep apnea are improved or eliminated altogether. Now, two new studies in the New England Journal of Medicine (NEJM) show another long-term benefit: a lower risk of death.

The larger of the two studies — the largest of its kind — led by researchers at the University of Utah School of Medicine, looked specifically at gastric bypass surgery, also known as Roux-en-Y gastric bypass, which accounts for 80% of all bariatric surgeries in the U.S. The operation involves creating a small walnut-size pouch at the top of the stomach, which is then stapled off and connected to the small intestine lower down than usual; the result is that patients can eat only an ounce of food at a time, and the food bypasses most of the stomach and the top part of the intestine, limiting the number of calories the body absorbs.

In the Utah study, researchers compiled data on 15,850 severely obese people, half of whom had undergone gastric bypass surgery between 1984 and 2002, and half who were from the general population and had had no surgical intervention for obesity. Overall, researchers found, the surgery patients were 40% less likely to die from any cause during a mean 7 years of follow-up, compared with the obese controls. What's more, the mortality rate attributable to obesity-related disease was 52% lower on the whole in the surgery group: after gastric bypass, patients were 92% less likely to die from diabetes, 59% less likely to die from coronary artery disease, and 60% less likely to be killed by cancer.

Results like these have got some doctors intrigued enough to start thinking about bariatric surgery as a treatment for conditions other than obesity —especially diabetes. A growing body of research suggests that the surgery may reverse the disease, a potential solution that could help some 20 million American diabetics. Though the current NEJM study did not specifically study the impact of bariatric surgery on diabetes, it did reveal a 92% reduced risk of death from the disease in surgery patients —findings that support what has been emerging in other experiments. "In more than 80% of patients who are severely obese and have diabetes and then have gastric bypass surgery, the diabetes is cured," says Ted Adams, professor of cardiovascular genetics at the University of Utah School of Medicine and lead author of the new study. "The interesting thing is that the resolution of diabetes happens within a few weeks following surgery, long before patients have lost their weight." Like some other researchers in the field, Adams believes that the surgery triggers other biological mechanisms, separate from weight loss — perhaps an interruption of a crucial biochemical pathway or a change in the release of certain hormones in the stomach or small intestine — that may have powerful effects on diabetes.

"The gastric-bypass patient is really providing a source of intriguing research related to all kinds of disease treatment as well as weight gain and weight loss," says Adams.

The second study, led by researchers at Gothenburg University in Sweden, involved 4,047 obese volunteers, 2,010 who underwent some form of bariatric surgery and 2,037 *****ceived conventional obesity treatment, including lifestyle intervention, behavior modification or no treatment at all. Ten years after surgery, researchers report, the bariatric surgery patients had lost more weight and had a 24% lower risk of death than the comparison group. Though the overall number of subjects in this study is much smaller than the first, the results confirm general benefits of bariatric surgery, and gastric bypass in particular: after 10 years, bypass patients had maintained a 25% weight loss, compared to a 16% loss in patients who had stomach stapling, and 14% in those who underwent a banding procedure.

In both studies, surgery patients had an overall lowered risk of death, but an interesting finding in the Utah study shows that these patients were 58% more likely to die from other causes, such as suicide and accidents. The authors speculate that as people lose weight and become more active, they also become more prone to accidents, which may up their risk of death. Surgery patients may also have pre-existing psychological problems — a history of abuse, perhaps — that can't be resolved by losing weight. "There have been some studies reporting that following bariatric surgery, some individuals may be more prone to chemical dependency, such as increased alcohol use," says Adams. "There's some speculation that certain addictive behaviors that are in place before the surgery — with food, for example — are transferred to alcohol or another addictive behavior."

"Hopefully this research will stimulate additional evaluation of what the optimal approach is for evaluating candidates for this surgery," says Adams. "I think we should never lose track of the importance of individual evaluation of benefits and risks."

Last year, an estimated 177,600 patients underwent bariatric surgery, a figure that's likely to grow as Americans get fatter and fatter. Though modern surgery techniques have become more sophisticated, less invasive and safer than in the past, the bariatric procedure still carries all the risks of any other operation. Patients have a .5% to 1% chance of death. The risk of gallstones goes up. Sometimes a second surgery is necessary. And all patients must be careful to make up for vitamin and mineral deficiencies. The surgery isn't for everyone; current guidelines recommend it as a last resort, only for the morbidly obese who have a BMI of 40 and higher, or for the obese with a BMI of 35 and higher plus a serious weight-related illness like diabetes or hypertension.

Russ, I heard that on the news this morning coming into work. This is really good news and hopefully it will waken up several companies including mine that wrote in a roadblock to employees needing WLS. I was lucky to have mine before they wrote that clause in, but several others that have talked to me about it have not been able to get the company to bend.  Off the subjst, you posted yesterday about the compression garments. How did you know what size to get. I now wear a size 38 pants but have no ideal what size my upper torso will be after my PS next Friday. I woul;d like to get the garment ordered so I could have it right after the surgery. Any suggestions?

Hey jack.... I ordered 2 mediums, and my doc said no, so one went back for a small....That was with the LBL...I was in 36 pants before, and 31" when all the swelling went away...I ordered and x small for the thighs in 2 weeks....can you beleve that from a 5 x... what you having done???? I got before and afters, if you send me an e-mail Russ

I think I will order a medium and a small to see what fits best. I am having a LBL done on the 31st. I am going thru the UT Southwestern Plastic Residents program. Its very affordable that way. I know they have to start on someone and it might as well be me for the reduced cost of 6300. I am very nervous about the outcome and whatever else I will have to have done after that. But after losing 220 lbs I got to do something. Some day I will get down to one of the Houston get together and get a chance to meet you. Some of our Ft. Worth group got to go to Kemah last week and had a blast. My email address is [email protected] for the pictures. Thanks again for the answers, Jack Young 

Thanks Russ.  I know I went from being diabetic for 10 years to non-diabetic in 5 weeks. Glad to see this is getting in the research.  Thanks for sharing.

Greg

 

… an interesting finding in the Utah study shows that these patients were 58% more likely to die from other causes, such as suicide and accidents.” All you “Gotta-Go-Sky-Diving-Now” Guys Are skewing the stats! Stop it! And don’t drop any of those weights on your head When you’re maxing out your lifts. Thanks for the article….. Best Wishes- Dx