Most bariatric surgery today is performed laparoscopically, said study leader Ted Adams. (Portra, Getty Images)
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SALT LAKE CITY — Weight-loss surgery lowers the risk of premature death, especially from obesity-related complications like cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people in Utah who underwent bariatric surgery.
The study found that people who had one of four weight-loss surgeries were 16 percent less likely to die from any cause than those who were the same weight. The number of deaths from diseases caused by obesity, such as heart disease, cancer and diabetes, was even more staggering.
Lead author Ted Adams, assistant professor of nutrition and integrative physiology at the University of Utah School of Medicine, said: “Cardiovascular disease deaths decreased by 29 percent and deaths from various types of cancer decreased by 43 percent.”
“There was also a significant percentage reduction – a 72% reduction – in diabetes-related deaths in people who underwent surgery compared to those who did not,” he said. One significant downside: The study also found that young people who underwent the surgery were at a higher risk of suicide.
It supports previous research
The study, It was published Wednesday in the journal Obesity. It reinforces similar findings from previous studies, a 10 years study in Sweden Dr. Eduardo Grunwald, M.D. and professor of medicine in the weight management program at the University of California, San Diego Health, said significant reductions in premature deaths were found.
The Swedish study found that a significant number of people remained diabetes-free at two years and 10 years after surgery.
“This new study from Utah is more evidence that people who undergo these procedures have positive and beneficial long-term outcomes,” said Grunwald, MD, director of the American Gastroenterological Association. New instructions In the treatment of obesity.
The association strongly recommends that obese patients use recently approved weight loss medications or surgery in combination with lifestyle.
“The main thing for patients is to know that changing the diet will be more natural, it can be done easily after bariatric surgery or after taking the new weight loss drugs,” said Grunwald, who was not involved in the Utah study.
Although we do not yet fully understand why, these interventions change the chemistry in your brain, which makes it much easier to change your diet afterwards.
Obesity is a disease, but we suffer from obesity by telling people that it is their fault.
– Dr. Carolyn Apovian, professor of medicine at Harvard Medical School
Despite the benefits, only 2% of patients eligible for bariatric surgery receive it, often because of the stigma of obesity, said Dr. Caroline Apovian, MD, professor of medicine at Harvard Medical School and coordinator of the Center for Weight Management. and Health at Brigham and Women’s Hospital in Boston. Apovian was lead author of the Endocrine Society. Clinical practice guidelines Pharmacological management of obesity.
Insurance carriers typically cover the cost of surgery for people over the age of 18. Body mass index 40 or more, or BMI 35 if the patient has associated conditions such as diabetes or high blood pressure, she said.
“I see 50 BMI patients, and I always 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.’ They don’t want a surgical solution because society has told them it’s a failure of will,” she says.
“We don’t torture people with 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, and obesity is a disease, but we make people suffer from obesity by telling them it’s their fault.
Both men and women can use it
Most people who choose bariatric surgery — about 80% — are women, Adams said. One of the new study’s strengths, he said, was the inclusion of men who had been through the process.
“All-cause mortality was reduced by 14% in women and 21% in women,” Adams said. They also reported that deaths from related causes, such as heart attack, cancer and diabetes, were 24 percent lower in women and 22 percent lower in men who underwent surgery.
Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.
A gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A portion of the small intestine rises up and attaches to that area, bypassing the duodenum, which is the first part of the stomach and small intestine.
In gastric banding, an elastic band that can be tightened or loosened is placed around the upper part of the stomach, thus limiting the amount of food that enters the stomach. Because gastric banding has not been very successful at producing long-term weight loss, the procedure is “not popular these days,” Adams said.
“A gastric sleeve is essentially a procedure where two-thirds of the stomach is removed laparoscopically,” he said. “It takes a little time to perform, and food still passes through the small stomach. It has become a very popular option.”
A duodenal switch is typically reserved for patients with a high BMI, Adams added. The sleeve is a complex procedure that combines the gastric gland with the intestinal bypass and is effective for type 2 diabetes. According to the Cleveland Clinic.
A serious problem
One alarming finding of the new study was a 2.4 percent increase in the number of people who died by suicide, mostly among people between the ages of 18 and 34 who underwent bariatric surgery.
“This is because they are told that life will be good after surgery or medication,” said Joan Hendelman, MD, clinical director. National Eating Disorders, Non-profit advocacy group.
“All you have to do is lose weight, and people will want to hang out with you, people will want to be your friend, and your anxiety and depression will go away,” she says. “But that’s not true.”
There are also complications and side effects after surgery, such as nausea, vomiting, alcoholism, weight loss or weight gain, advocate Susan Vibbert said. Project Health, It provides help to those struggling with eating disorders.
“How are we defining health in these circumstances? And is there another intervention—a weight-neutral intervention?” Vibert asked.
Past studies have also shown a link between suicide and bariatric surgery, Grunvald said, but studies on the topic can’t always determine a patient’s mental history.
First, we as a society need to treat obesity as a disease, not a biological problem, not a moral failure.
– Dr. Eduardo Granvald, Professor of Medicine
“Did the person opt for the surgery because they had some unfulfilled hopes or psychological problems that were not resolved after the surgery? Or is this somehow a result of the bariatric surgery? We can’t answer that for sure,” he said.
Apovian said intensive preoperative counseling is typically required for all those undergoing the procedure, but may not be sufficient. She lost her first bariatric surgery patient herself.
“She was big, in her 40s. She had surgery and lost 150 kilograms. And she put herself in front of a bus and died, because she was self-medicating with food for her bipolar disorder.” “We as a society use a lot of food to hide disability. What we need in this country is more psychological counseling for everyone, not just people undergoing bariatric surgery.”
Weight control is a unique process for each person, a combination of genetics, culture, environment, social isolation and personal health, experts say. There is no one-size-fits-all solution.
“First, we as a society need to treat obesity as a disease, as a biological problem, not as a moral failure,” says Grunwald. “This is my first advice.
“And if you believe your life could benefit from treatment, if you can’t do it with lifestyle changes alone, consider evidence-based treatment, such as surgery or medication, according to studies.”