Res Ipsa

New Study on the Health Benefits of Weight Loss Surgery

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The New York Times just published an article on a recent medical study that observed that bariatric surgery may significantly reduce the risks of strokes, heart attacks, heart failure and kidney disease, in addition to being the preferred treatment of Type 2 diabetes.  Wow.  I have not read the study itself, but maybe @BurgundyBoy and other medical professionals here at TTF can give us all their thoughts on it.

The NYT article is here:

Since the link to the article may not work for long, the introductory paragraphs of the NYT article are as follows:

Every year, hundreds of thousands of obese Americans undergo weight-loss surgery in a last-ditch effort to shed pounds and control their Type 2 diabetes. 

Now a new study suggests that bariatric surgery may also have other significant health benefits, cutting the overall risk of serious cardiovascular events and premature death by almost half. 

The study, published in the medical journal JAMA on Monday, is not definitive. Though it compared the long-term outcomes of about 2,300 bariatric surgery patients with some 11,500 closely matched patients who had not undergone surgery, it was an observational study, not a randomized controlled trial of the kind considered the gold standard in medicine.

But the findings were so striking that an editorial accompanying the paper suggested that weight-loss surgery, rather than medications, should be the preferred treatment for Type 2 diabetes in certain patients with obesity.

“The new information here is the ability of bariatric surgery to control macrovascular events like strokes, heart attacks, heart failure and kidney disease,” not just improve weight and diabetes control, said Dr. Edward H. Livingston, the editorial’s author. “That’s a big deal.”

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Hi All, 

This study, published in the journal JAMA (Journal of the American Medical Association) is being reported very widely. It comes from the Cleveland Clinic Health System, where the electronic medical record system was used to track people. It is a WOW study because of the large number of people in it, and the very major decreases in Bad Things happening to people. 

2,287 people with a mean BMI of 45.1 and type 2 diabetes were compared to 11,435 similar persons who received "usual care." The average followup time (technically, median time) was 3.9 years. The comparison group was slightly older (54.8 years old in the "usual care" group versus 52.5 years in the surgery group) and they had slightly higher blood pressures. Surgery included not only bypasses (63%) and vertical sleeves (32%), but also gastric banding (5%) and duodenal switches (only 5 people total). Each person with bariatric surgery was compared to 5 similar people who did not have surgery, using a method called propensity matching. This form of matching is sophisticated.

8 years after surgery, 10% of the surgical group had died, compared to 17.8% of the comparison (no surgery) group who had died. Don't forget, these people were already (on average) already in their 50s, had high BMIs, and had diabetes, so their death rates were going to be substantial. This is a 41% lower death rate. There is very little in life that reduces your death rate by 41%. 

Moreover, heart failure (down 62%), atrial fibrillation (down 22%), kidney disease (down 40%), strokes (down 33%), and coronary artery events (e.g. heart attacks, down 31%) were also all reduced. Lower rates of needing medications like insulin, other diabetes medications, blood pressure meds, lipid lower medications, and aspirin were all significantly lower in the surgery group. Having fewer strokes, heart attacks, heart failure, and the like has to mean a better quality of life, although there were no " how is the quality of your life?" questions. 

The medical establishment sees this study as informative but not definitive; to be definitive, people would have to be randomly assigned to have surgery or 'usual care.' It's possible the people in the bariatric surgery group were more motivated than the comparison group. One doesn't know why a person chooses surgery, or does not. Having said that - the results are extremely consistent, and similar to other observational studies where people looked to see what happened to persons after bariatric surgery over time. A set of technical statistical analyses also showed that no confounding issue was likely to have led to this impressive, major, big, difference in outcomes. 

There is an editorial accompanying the article in JAMA. The author of the Editorial notes that studies of "intensive treatment" of diabetes have never shown this level of dramatic benefits. 

At the end of the day, you can take away that people in this study had a 40% decrease in their death rates over the 8 years after surgery. You can also take away that there were dramatic reductions in the rates of strokes, heart attacks, kidney disease, and so forth. Until such time as a randomized clinical trial of bariatric surgery is done, I will use this estimate of the reductions in deaths and disability when I am talking to to others!

Here is a link to the article and to the editorial for those of you who want to read it: It is a free download.

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This is fascinating stuff.  As someone heavily invested (through work) in diabetes care and prevention, the impact of WLS vs what we usually do for people with diabetes is amazing.  There is simply no comparison.  No amount of "eat these foods" or "take these meds" achieves the kinds of results described in this article.  And given the difference in cost between WLS + followup and lifetime treatment of a patient for diabetes?  I'm kind of amazed WLS isn't the first line of defense for health plans instead of the last thing after all other treatments fail. 

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@Kio I heavily agree with you.  I was taking 6 pills a day (3 different meds) for diabetes alone.  And it still wasn’t under control.  Not once did my doctors recommend or bring up wls.  After I learned on my own, bypass could possibly put it in remission did I decide to do it.

one of my doctors told me I’d have to lose a lot of weight to do that (no, it was in remission 5 days out).  When I asked another why wls wasn’t brought up more often, he said it was a “drastic step”: well do you think?!  I guess I feel losing a leg is too, or a life...

i would do it again in a heartbeat!  

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Thanks for posting, @Res Ipsa. Really interesting stuff. And a great explainer by @BurgundyBoy. Thank you both. 

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