Lower Weight From Surgery Shows Benefit
By WILLIAM M. BULKELEYAugust 23, 2007; Page D6
Two studies and an editorial in today's New England Journal of Medicine support gastric-bypass surgery as a way to significantly improve mortality rates in obese people. But the author of the editorial stopped short of endorsing more surgery because of economic concerns about expanding use of the $25,000 operation.
Gastric-bypass surgery has become an increasingly popular response to the obesity epidemic. The surgery, which shrinks the stomach and sometimes reroutes the intestines, has been widely shown to provide long-term weight loss.
Last year, surgeons performed 177,600 gastric-bypass operations in the U.S., according to the American Society for Metabolic and Bariatric Surgery.
Until now, evidence that the lower weight resulting from the surgery actually saves lives has been scant.
The first of the studies, from Utah, involving gastric-bypass patients and a control group, found the surgery patients' mortality rate improved by 40%. The other study, from Sweden, followed overweight people who had different kinds of weight-loss operations. It found they had 29% improved mortality during the study against comparably overweight people who didn't have surgery.
The Journal's editorialist, George Bray, chief of the division of clinical obesity at Pennington Biomedical Research Center at Louisiana State University, said in an interview that the studies are the equivalent of "the statin trials that showed the drugs reduced death rates and not just cholesterol." Following those studies, cholesterol-fighting statins became a huge business for the pharmaceutical industry.
Dr. Bray said the studies -- which included people who had surgery at relatively low levels of obesity -- make it clear that the National Institutes of Health should reconsider guidelines that suggest the surgery as an option for patients whose body-mass indexes surpass 40. Normal BMIs range up to 25, and people with BMIs above 30 are considered obese. However, Dr. Bray said he isn't willing to come out in favor of a lower standard because, "You'll break the bank."
The Swedish Obese Subjects Study followed 2,010 patients from when they had the operation for as long as 16 years and compared them with a group of comparable subjects based on BMI, gender and other factors. The study found that the surgical patients after 10 years had kept off between 14% and 25% of their original weight, depending on whether they had older surgery types or the more modern gastric bypass.
In the Swedish study, 101 of those who had the surgery died in the study period; of those who didn't have the surgery, 129 died. Deaths from heart disease and cancer were both sharply lower in the group that received surgery.
The Utah study, led by Ted Adams of the University of Utah, compared 7,925 people who had gastric-bypass surgery after 1984 with a similar number of severely obese people culled from driver's license rolls. Those who received surgery had 213 deaths, compared with 321 for the control group. Surgery patients had 56% fewer deaths from cardiovascular events, 60% fewer from cancer and 92% fewer deaths from diabetes. However, people who had the surgery had 15 deaths from suicide compared with five suicides among the control group. The study didn't theorize about reasons for the higher suicide rate.
Write to William M. Bulkeley
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