Metabolic-Bariatric Surgery Tied to Lower All-Cause Mortality

(Reuters Health) – Adults with obesity have a longer life expectancy when they undergo metabolic-bariatric surgery, regardless of whether they have comorbid type 2 diabetes, a new meta-analysis suggests.

Researchers examined data on a total of a total of 174,772 participants in one prospective controlled trial and 16 matched cohort studies that compared longevity and all-cause mortality for people with severe obesity who received either bariatric surgery (n=65,785) or matched controls who received usual care (n=108,987). Overall, there were 7,712 deaths during 1.2 million patient-years of follow-up.

Metabolic-bariatric surgery was associated with a 49.2% reduction in hazard rate of death during follow-up compared with non-surgical care and a median life expectancy 6.1 years longer, researchers report in The Lancet. The treatment effect of surgery was more pronounced among people with type 2 diabetes (hazard ratio 0.409) than in those without type 2 diabetes (HR 0.704).

“People with obesity who undergo metabolic-bariatric surgery have sustained weight loss resulting in decreased risk of developing chronic ailments like diabetes, stroke, heart disease and decreased mortality during intensive care admission,” said senior study author Dr. Asim Shabbir of National University Hospital in Singapore.

“For one to reap the health benefits, what is needed is a sustained weight loss of 15-20%, and metabolic-bariatric surgery is currently the most effective tool in achieving this goal,” Dr. Shabbir said by email.

The study also found that individuals with type 2 diabetes who underwent metabolic-bariatric surgery had a median life expectancy 9.3 years longer than those who received usual care.

Over a 10-year period, the numbers needed to treat to prevent one additional death were 8.4 among individuals with type 2 diabetes and 29.8 among individuals without type 2 diabetes, the study found.

Researchers estimated that each 1% increase in utilization of metabolic-bariatric surgery among people worldwide with severe obesity could result in 5.1 million additional life-years for those with type 2 diabetes and 6.6 million additional life-years for individuals without type 2 diabetes.

One limitation of the study is that recent advances in pharmacological treatments for severe obesity might attenuate the advantages of surgical interventions, the study team notes. Along similar lines, several recently approved classes of diabetes medications might influence the advantages of surgery relative to non-surgical care, they add.

Another limitation is heterogeneity in the usual care protocols across the smaller studies included in the analysis, with practices ranging from no intervention to intensive non-surgical treatments.

Even so, several large studies, such as the Honolulu Heart Program, Framingham Heart Study and Treating to New Targets trial, all show that obesity weight is associated with higher all-cause mortality and cardiovascular mortality, said Dr. Geltrude Mingrone, a professor at the Universita Cattolica S. Cuore in Rome and King’s College London who coauthored an editorial accompanying the study.

“Hence, the large weight loss obtained with metabolic-bariatric surgery, which is maintained over time, reduces cardiovascular risk and mortality,” Dr. Mingrone said by email.

“Subjects with obesity and type 2 diabetes, especially if at high risk of cardiovascular disease should be not only considered but rather prioritized to metabolic/bariatric surgery because of its large effect on preventing cardiovascular disease and on increasing life expectancy,” Dr. Mingrone added.

SOURCE: and The Lancet, online May 6, 2021.

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