Weight-loss surgery leads to long-term benefits 

23/12/2015 00:00 
A large scale study of longer term outcomes of bariatric surgery patients has shown that surgery helps reduce the risk of patients developing serious health conditions such as heart attacks and type 2 diabetes, as well as improving existing conditions.
 

The findings were published in a paper co-authored by the head of the UCLH Bariatric Centre for Weight Management Rachel Batterham in PLOS Medicine yesterday evening. The study – the largest of its kind in the UK – suggests that widening the availability of bariatric surgery could boost the health prospects for thousands of people who are very obese (body mass index/BMI of 40 kg/m2 or more).

Using primary care records, researchers compared weight, BMI, and obesity-related illnesses between 3,882 bariatric surgery patients and similar control patients who did not have surgery, over an average period of three and a half years. They found that weight-loss surgery can significantly improve existing type 2 diabetes and reduce abnormally high blood pressure.

They also applied the findings to estimate that if the 1.4 million people believed to be morbidly obese in the UK had bariatric surgery, it could prevent 80,000 cases of hypertension, 40,000 cases of type 2 diabetes, and 5,000 heart attacks over a four-year period. Furthermore, 110,000 people with type 2 diabetes and 13,000 people with hypertension could significantly improve their condition.

Additionally, the study confirmed that the procedures stimulate dramatic and substantial weight loss which is sustained for at least four years, and suggested that gastric bypass and sleeve gastrectomy promote the most weight loss out of the different types of surgery.

Prof Batterham said: “Bariatric surgery is safe and produces unrivalled health benefits that are life-changing for patients and cost-saving for the NHS. Unfortunately, less than 1% of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings. Action is now needed to remedy this situation.”

And lead author Dr Ian Douglas, from the London School of Hygiene & Tropical Medicine, said: “Obesity is one of the biggest health problems of our generation. Rates of cardiovascular disease, although slowly declining, are still alarmingly high while type 2 diabetes is on the rise, affecting 3.5 million people in Britain. Finding effective ways to tackle the obesity crisis is therefore a key public health strategy.

“Whilst effective prevention is clearly needed, our findings show that as well as helping patients substantially lose weight, bariatric surgery improves serious obesity-related illnesses as well as reducing the risk of developing them. People having weight-loss surgery were 70% less likely to have a heart attack, and those with type 2 diabetes were nine times more likely to see major improvements in their diabetes. We also found positive effects on angina and the debilitating condition obstructive sleep apnoea.”

The study also indicated which type of surgery might be most effective for losing weight. Estimated average four-year weight loss was 38 kg for gastric bypass, 31 kg for sleeve gastrectomy, and 20 kg for gastric band.

The researchers note that the accuracy of these findings may be limited by the incomplete recording of some outcomes in primary care patient management records. They were also unable to look in detail at short-term adverse outcomes associated with bariatric surgery, but noted that nationally collected data suggests such complications are rare.

The study was supported by the NIHR UCLH Biomedical Research Centre, the Medical Research Council, the Wellcome Trust, and Rosetrees Trust.

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