SOURCES: David Arterburn, M.D., M.P.H., associate investigator, Group Health Research Institute, Seattle, Wash.; John Lipham, M.D., chief, division of upper GI and general surgery, Keck School of Medicine, University of Southern California, Los Angeles; John Morton, M.D., chief, bariatric and minimally invasive surgery, Stanford University School of Medicine, Stanford, Calif.; Jan. 6, 2015, Journal of the American Medical Association
TUESDAY, Jan. 6, 2015 (HealthDay News) -- Weight-loss surgery appears to prolong life for severely obese adults, a new study of U.S. veterans finds.
Among 2,500 obese adults who underwent so-called bariatric surgery, the death rate was about 14 percent after 10 years compared with almost 24 percent for obese patients who didn't have weight-loss surgery, researchers found.
"Patients with severe obesity can have greater confidence that bariatric surgical procedures are associated with better long-term survival than not having surgery," said lead researcher Dr. David Arterburn, an associate investigator with the Group Health Research Institute in Seattle.
Earlier studies have shown better survival among younger obese women who had weight-loss surgery, but this study confirms this finding in older men and women who suffer from other health problems, such as diabetes and high blood pressure, he said.
The findings were published Jan. 6 in the Journal of the American Medical Association.
"We were not able to determine in our study the reasons why veterans lived longer after surgery than they did without surgery," Arterburn said. "However, other research suggests that bariatric surgery reduces the risk of diabetes, heart disease and cancer, which may be the main ways that surgery prolongs life."
Dr. John Lipham, chief of upper gastrointestinal and general surgery at the Keck School of Medicine at the University of Southern California, Los Angeles, said that patients who have weight-loss surgery usually see their diabetes disappear.
"This by itself is going to provide a survival benefit," he said. Shedding excess weight also lowers blood pressure and cholesterol levels and reduces the odds of developing heart disease, he said.
"If you are obese and unable to lose weight on your own, bariatric surgery should be considered," Lipham said.
Arterburn said most insurance plans including Medicare cover bariatric surgery.
As with any surgery, however, weight-loss surgery carries some risks. "The main risk from surgery is the risk of dying from a major complication such as bleeding or infection, which typically occurs in less than 0.3 percent of patients," Arterburn said.
Other possible complications include blood clots in the legs or lungs or the need for another operation because of a surgical problem, bleeding or infection, he said.
For the study, Arterburn and his colleagues tracked 2,500 patients who had weight-loss surgery at Veterans Affairs bariatric centers from 2000 to 2011. Their average age was 52 and their body mass index (BMI) was 47, which is considered extremely obese.
Three-quarters of the patients had gastric bypass surgery, which alters the way the stomach and intestines handle food. Fifteen percent underwent sleeve gastrectomy, which reduces the size of the stomach, and 10 percent had adjustable gastric banding, which reduces food intake.
The researchers compared these patients with about 7,500 patients of similar age and size who did not have a weight-loss procedure.
Over 14 years of follow-up, 263 patients who had weight-loss surgery died from any cause, compared with almost 1,300 obese patients who didn't have surgery, the study found.
Arterburn's team estimated the death rates for the surgical patients was about 6 percent after five years and 13.8 percent at 10 years. The estimated death rates for patients who didn't have weight-loss surgery were about 10 percent at five years, and about 24 percent at 10 years.
Recent surgical improvements should ensure even better results today, one expert said.
"The results of the study could be better if it were done now," said Dr. John Morton, chief of bariatric and minimally invasive surgery at Stanford University School of Medicine in Stanford, Calif.
Since more than 90 percent of weight-loss surgery now is done with minimally invasive procedures that use smaller incisions and involve fewer complications, survival should be even greater, he contends.
For more on weight-loss surgery, visit the U.S. National Library of Medicine.