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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.
Sjöström L et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007 Aug 23; 357:741.
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.