Longer Life After Bariatric Surgery, but Suicide Risk in Young

Marlene Busko 

February 07, 2023

Men and women aged 35 and older with severe obesity who had bariatric surgery had improved survival up to four decades after compared with individuals of the same age, sex, and body mass index (BMI) who did not undergo surgery.

Death from cardiovascular disease, cancer, and diabetes was 29%, 43%, and 72% lower, respectively, in the bariatric surgery patients versus nonsurgery peers, during a mean follow-up of 13 years (all P > .001).

However, the youngest group of bariatric surgery patients — who were 18-34 years old — had a fivefold increased risk of suicide during follow-up compared with their peers who did not undergo surgery (P = .001).  

These findings are from a retrospective study in Utah that matched close to 22,000 patients with severe obesity who underwent Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, or duodenal switch in 1982-2018 with an equal number of nonsurgery individuals.  

The study, by Ted D. Adams, PhD, MPH, and colleagues, was published online in Obesity.

"Impressive" Data, in Men too, but Psychological Screening Important 

The overall improved survival and decreased deaths from diabetes, heart disease, and cancer over this long follow-up are "impressive," Adams, from Intermountain Surgical Specialties/Digestive Health Clinical Program, Salt Lake City, Utah, said in an interview.

Previous studies have not shown a survival benefit from bariatric surgery versus no surgery in men, he said. However, "because we had a fair number of male patients and because of the length of follow-up, we did show that the improved mortality was not only evident for the female patients but also for the male patients," Adams stressed.

Finding increased suicide rates among bariatric surgical patients who underwent surgery at a younger age (18-34 years) shows that "we need to try and determine who is at risk for suicide," according to Adams.  

Patients with severe obesity, especially younger ones, "may need more aggressive presurgical psychological screening and post-surgery follow-up," write Adams and colleagues.

The findings may also "stimulate important research related to the discovery of physiologic and biomolecular mechanisms leading to nonsurgical treatment that results in weight loss and improved mortality similar to that achieved by bariatric surgery," they suggest. 

Close to 1 in 10 Americans Has Severe Obesity

The prevalence of severe obesity (BMI ≥ 40 kg/m2) in the United States has increased from 4.7% in 1999-2000 to 9.2% in 2017-2018, based on National Health and Nutrition Examination Survey (NHANES) data, the researchers note.

They previously published a study of long-term mortality in 7925 patients who had gastric bypass surgery from 1984 to 2002 matched with patients with the same BMI who did not have bariatric surgery and were followed out to 2002.

The current study extends the follow-up through 2021, doubles the number of bypass patients, and includes three newer types of bariatric surgery.  

The researchers matched 21873 patients aged 18-80 who had Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, or duodenal switch in 1982-2018 in Utah (from the Utah Population Database) with people of the same BMI category, age category (18-34, 35-44, 45-54, and 55-80 years), and sex (from Utah driver license data).

Most patients were women (79%) and most were White (94% and 85%). They had a mean age of 42 years and a mean BMI of 46 kg/m2.

Most patients had Roux-en-Y gastric bypass (69%), and the rest had sleeve gastrectomy (14%), gastric banding (12%), and duodenal switch (4.8%).

During follow-up, 13.5% of patients in the bariatric surgery group and 14.6% of people in the nonsurgery group died.

Overall, all-cause mortality was 16% lower in patients who had bariatric surgery versus matched nonsurgical participants; it was 14% lower in women and 21% lower in men (all P < .001).

All-cause mortality was significantly lower in patients who had bariatric surgery when they were 35-44, 45-54, and 55-80 years old compared with matched peers who did not have surgery.

However, the findings "should not imply patients necessarily postpone surgery until older age," the researchers caution, "as postsurgical complications have been shown to increase with increasing age at surgery and surgical postponement may result in worsened clinical status related to certain conditions such as orthopedic joint health."

The researchers found significantly improved all-cause mortality following either type of surgery (gastric bypass, gastric banding, and sleeve gastrectomy) compared with no surgery.

Along with fewer deaths from cardiovascular disease, cancer, and diabetes, deaths from lung disease were 39% lower in the surgery group than in the nonsurgery group.

However, in the youngest group (age 18-34), deaths from cirrhosis of the liver were significantly higher in the patients who had bariatric surgery, and rates of suicide were significantly greater for both females and males, compared with similar people who did not undergo surgery.  

The study was supported by grants from Ethicon Endo-Surgery (Johnson & Johnson), NIDDK-NIH, US Public Health Service, and Intermountain Research and Medical Foundation of Intermountain Healthcare. Adams has reported receiving research funding from Ethicon Endo-Surgery and the Intermountain Medical Research and Education Foundation of Intermountain Healthcare. Steven C. Hunt has reported receiving funding from the Biomedical Research Program at Weill Cornell Medicine in Qatar, a program funded by the Qatar Foundation. The other authors have reported no relevant financial relationships.

Obesity. Published online January 25, 2023. Article

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