Stomach surgery to curb the appetite offers a radical weight-loss option for extremely obese people. Two studies now show that those who get the surgery live longer than those who don’t. The research may put to rest lingering doubts about survival after these operations.
Surgeons have developed three forms of stomach surgery aimed at limiting food intake. After these so-called bariatric surgeries, a person feels full after eating even a small amount of food.
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Two of the surgeries work by constricting the stomach with elastic bands or staples. A third, called gastric-bypass surgery, reconfigures the gastrointestinal tract so that food collects at the top of the stomach and is then shunted to the small intestine. This is now by far the most common form of bariatric surgery in the United States, where stapling has largely fallen out of use. Gastric bypass typically produces better results than the other operations.
The surgeries induce weight loss with a much lower relapse rate than dieting. Historically, however, epidemiological studies have linked rapid weight loss and early death. Since sudden weight loss can be unintentional, scientists have suspected that hidden ailments may account for this link.
In 1987, researchers in Sweden enrolled 4,047 severely obese people in a study intended to clarify the matter. Half the volunteers underwent one of the three bariatric surgeries. The others received counseling, behavior modification, or no treatment. The surgical group lost much more weight.
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What’s more, people getting the surgery were 29 percent less likely than the others to die over the next 11 years, the researchers report in the Aug. 23 New England Journal of Medicine.
In the same journal issue, a U.S. team reports a study of 15,950 severely obese people, half of whom had undergone gastric-bypass surgery starting as early as 1984. People who had the surgery had a 40 percent lower death rate during 7 years of comparison than did nonsurgical patients.
The researchers found that the better survival rate stemmed from lower rates of heart disease, cancer, and other serious illnesses in people who had surgery. On the other hand, people in that group were more prone to die from accidents, suicide, or poisoning than were nonsurgical patients, says study coauthor Ted D. Adams, a physiologist at the University of Utah in Salt Lake City.
Bariatric-surgery patients also face an increased risk of death from complications for a short time after their procedures. However, that temporary risk has declined with the advent of laparoscopic surgery, which is done through small openings in the abdomen, says internist Lars Sjöström of Gothenburg University, who coauthored the Swedish study.
Surgeon David R. Flum of the University of Washington in Seattle says that past research had shown that people’s blood pressures decline after the procedures and that some type 2 diabetes patients subsequently need less medication. The two new studies show “that if you have surgery and significant weight loss that’s sustained, it will translate into improved survival,” says Flum.
Endocrinologist George A. Bray of Louisiana State University in Baton Rouge says that the new results might justify expanding the pool of candidates for bariatric surgery.