Morbidly obese would live longer with surgery

A computerised model has suggested that most morbidly obese individuals would likely live longer if they had gastric bypass surgery, according to a new study.
Available evidence suggests that dietary, behavioural and pharmacologic treatments frequently do not result in meaningful weight loss for individuals who are morbidly obese, often defined as patients having a body mass index (BMI) of 40 or higher, according to background information cited by the study’s authors.

Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese. However, the procedure is not without risk, including in-hospital death.
Against that background, doctors used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery for individuals with morbid obesity.
The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications; data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates following the procedures; and outcomes from participants in a seven-year study to determine the effects of surgery on survival and to calibrate and validate the model.
According to the resulting model, an average 42-year-old woman with a BMI of 45 would gain an estimated additional three years of life expectancy as a result of undergoing bariatric surgery; a 44-year-old man with the same BMI would gain an estimated 2.6 additional years.
Additional analyses revealed that younger women with higher BMIs are projected to gain the most life expectancy from surgery. Younger men with higher BMIs might also gain more life expectancy after surgery, but the gain would be less for men than for women in each subgroup.
“In conclusion, while not all patients are guaranteed a good outcome, our model indicates that gastric bypass increases life expectancy for most patient subgroups; however, for those at high surgical risk or in whom efficacy of surgery is likely to be low, benefit will be minimal,” the authors wrote. “We believe results of this analysis can be used to better inform both patients’ and physicians’ decisions regarding gastric bypass surgery.”
Archives of Surgery
2010;145:57-62