The Evidence That Weight Loss Surgery – WLS Prevents Early DeathMarch 24, 2021
WLS Prevents Early Death: Obesity is a growing epidemic in the United States as well as around the world. As dietary choices have started including more processed foods, foods with higher caloric content, and unhealthy food choices that are more convenient and cheaper than healthy options, the problem of obesity in the United States continues to worsen.
Non-Surgical Options Have Limited Effectiveness
Effective means of combating obesity include diet and exercise, behavioral health programs, pharmacotherapy as well as surgical weight loss options. Many of the non-surgical options have been shown to have limited effectiveness over the long-term.
This does make things more difficult for people struggling with their weight, as simple options often do not lead to long-term effectiveness. There are many reasons for this, but an increased understanding of obesity has revealed that the body has multiple mechanisms to prevent weight loss, including regulation of metabolism, conservation of energy, especially during periods of decreased caloric intake, and finely tuned mechanisms for energy storage when a person does overeat.
Because the body is very resistant to weight loss, more involved therapy besides diet and exercise alone or even diet and exercise augmented by medical pharmacotherapy is needed.
Also, people with obesity offer suffer from medical conditions associated with obesity. Treatment of these conditions is of primary importance as they can lead to long-term life-limited illnesses and earlier death. Treatment for obesity that also improves these illnesses apart from the benefits of weight loss alone would be of increased importance.
WLS Prevents Early Death
Many surgical options have been shown to be highly effective for durable weight loss and improve underlying obesity-related diseases such as diabetes, sleep apnea, hypertension, and non-alcoholic fatty liver disease. These illnesses improve even more than what can be explained by weight loss alone.
Weight loss surgery has been shown to be quite durable, with low percentages of patients regaining weight and medical illnesses that go into remission after weight loss surgery, especially when compared to failure rates with non-surgical therapy.
Of particular importance, obesity is associated with increased death in patients, likely secondary to the comorbid medical conditions that are associated with excessive weight, such as diabetes, and the complications of diabetes, heart disease, lung disease, and even cancer.
Effectively improving a patient’s weight thereby may not only improve medical conditions associated with obesity but may also improve a patient’s lifespan. Effective weight loss may add years to a person’s life.
Research has shown that bariatric surgery decreases mortality or death and multiple other diseases, including endocrine disease (diabetes), cancer, cardiovascular diseases such as hypertension or coronary artery disease, and even mental health illness .
These impacts highlight the benefits that significant weight loss, particularly through weight loss surgery, can have on a patient’s life. In fact, a recent study from the Cleveland Clinic published in JAMA showed that, in particular, weight loss surgery decreased mortality from cardiovascular causes such as heart attacks and strokes .
The profound health benefits from weight loss surgery should be considered by patients who are obese and want to improve their health as well as health care providers who care for patients that struggle with their weight.
It should be pointed out that these surgical weight loss procedures are not without risks. However, most the effective surgical procedures have single-digit percentage rates of complications for most patients. Improving a patient's health often outweighs the low risks of weight loss surgery, especially when effective weight loss is not achievable by non-surgical methods.
The COVID-19 Pandemic
The COVID-19 pandemic that has stricken the United States, as well as countries around the world beginning in late 2019 through the current date, has been shown to more negatively impact certain groups of people, including the morbidly obese. Therefore, improving a patient’s weight may lead to decreased death from the coronavirus.
This is of increased importance as we do not know if the COVID-19 pandemic will be one that will continue for a much longer duration and whether or not COVID-19 infections may continue to occur in the future even once the pandemic comes under control.
The significant damage to the lungs and other organs that COVID-19 can cause may make conditions that morbidly obese patients suffer from worse, or these underlying conditions may make obese patients more susceptible to having damage from COVID-19. Regardless of how the virus impairs the health of patients with morbid obesity, these patients seem to be at increased risk. Thus, a therapy that decreases obesity and therefore decreases chances of complications from COVID-19 is of significant importance.
WLS Prevents Early Death Summary
Although losing weight and keeping it off for the long-term is difficult, the impact on long-term survival makes consideration of effective surgical therapy relevant for anyone struggling with their weight, which meets indications for surgical therapy, including a body mass index greater than 35 kg/m2 with comorbid medical illnesses or body mass index greater than 40 kg/m2.
If you have been trying to lose weight for years and find that it is very difficult to keep it off, know you are not alone, but many people are in your position. When considering how to lose weight effectively, one could say that literally, your life depends on it.
- N.V. Christou, J.S. Sampalis, M. Liberman, D. Look, S. Auger, A.P. McLean, L.D. MacLean, Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients, Ann Surg, 240 (2004) 416-423; discussion 423-414.
- A. Aminian, A. Zajichek, D.E. Arterburn, K.E. Wolski, S.A. Brethauer, P.R. Schauer, M.W. Kattan, S.E. Nissen, Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity, Jama, 322 (2019) 1271-1282.
ABOUT THE AUTHORAndrew Wheeler, MD currently practices at MU Health Care. He graduated from the University of Missouri with a degree in nutritional sciences and stayed at MU for medical school. He stayed at the University of Missouri to complete his general surgical residency. During his residency, he developed a love for treating obesity. The ability to help people who struggle with weight-related illness led him to a career in relieving obesity through surgical cures.