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Cutting Calories Surgically
Patients who underwent bariatric surgery experienced long-term weight loss with lower overall mortality.
Obesity is associated with decreased life expectancy, and weight loss can reduce risk factors for many diseases. However, there have been no controlled interventional studies showing that obese people have a lower mortality risk with weight loss than without — until now. Swedish investigators followed 4047 obese individuals (1180 men; 2867 women) for a mean of 11 years to assess mortality after bariatric surgery (n=2010) or conventional nonsurgical obesity treatments (n=2037). Patients who underwent bariatric surgery (gastric banding, 19%; vertical-banded gastroplasty, 68%; gastric bypass, 13%) were matched with controls who received interventions ranging from no treatment to lifestyle and behavior modification.
After 10 years of follow-up, individuals who had bariatric surgery lost 14% to 25% of their baseline weight. In the surgery group, there were 101 deaths. In the control group, the average weight change did not exceed ±2%, and there were 129 deaths. The unadjusted hazard ratio for mortality was 0.76 (P=0.04) for the surgery group compared with the control group. The authors concluded that bariatric surgery seemed to be associated with long-term weight loss and reduced overall mortality.
Comment: The results of this well-controlled but observational study show for the first time that, compared with standard weight-loss treatments, bariatric surgery results in long-term maintenance of weight loss and a significant decrease in mortality. For those subjects in the surgery group whose BMI was above the median of 40.8, the risk for death was reduced by 30%. Clinicians would be wise to point out to patients with morbid obesity that bariatric surgery not only will promote long-term weight loss but also will significantly reduce their chances of early death.
Published in Journal Watch Women's Health September 20, 2007
Citation(s):
Sjöström L et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007 Aug 23; 357:741.
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