Bariatric Surgery Outcomes: Obesity-associated Diseases and Longevity after Weight Loss Surgery
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UW Health's Medical and Surgical Weight Management program knows that the key to making the right decision about bariatric surgery and maintaining a healthy lifestyle after surgery is to have the right information at your fingertips.
Below you will find a summary of outcomes in regards to resolution or improvement of obesity-associated diseases and longevity after weight loss surgery.
Type 2 Diabetes Mellitus
Obesity worsens the metabolic abnormalities found with type 2 diabetes mellitus, including hyperinsulinemia, hyperglycemia, hypertension and hyperlipidemia. Complete remission of type 2 diabetes mellitus is obtained in about 80 percent of patients after laparoscopic gastric bypass and in about 50 percent after laparoscopic banding. When complete remission is not obtained, patients are able to reduce dosing of medications and have improved glycemic control. Relapse of type 2 diabetes mellitus after remission has been reported and is associated with weight regain and markers of poor pre-operative pancreatic beta cell function.
The relationship between rising boday mass index (BMI) and the incidence of hypertension is well known. A dramatic improvement in both systolic and diastolic blood pressures is observed about 62 percent of affected patients after weight loss surgery. As with type 2 diabetes mellitus there is also the possibility for relapse, and body weight regain is associated with the rise in blood pressure.
Dyslipidemia is closely associated with obesity. Lipid profiles have been show to improve significantly after weight loss surgery. One study in JAME showed resolution in 97 percent of patients after laparoscopic gastric bypass and in 59 percent after laparoscopic banding.
Obstructive Sleep Apnea
Obesity is the most common predisposing factor for obstructive sleep apnea and it is estimated that more than 80 percent of patients with a BMI greater than 35 have obstructive sleep apnea. Surgically-induced weight loss has proven benefits in both obstructive sleep apnea and type 2 diabetes mellitus, and morbidly obese individuals with obstructive sleep apnea and type 2 diabetes mellitus may benefit more by bariatric surgery than treatment of these complications individually. Resolution of obstructive sleep apnea is obtained in about 85 percent of patients after weight loss surgery.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is associated with obesity. The most dramatic improvements are observed after laparoscopic gastric bypass where gastroesophageal reflux disease is reliably and immediately resolved. The small gastric pouch and creation of a Roux-en-Y limb renders reflux of gastroduodenal secretions into the esophagus nearly impossible.
Degenerative Joint Disease
Although degenerative joint disease is one of the 1991 NIH qualifying criteria for surgery, there are only a few case series reporting improvement in symptoms. Despite the lack of firm evidence, many orthopedic surgeons recommend that patients undergo weight loss surgery prior to joint replacement.
Polycystic Ovarian Syndrome (PCOS)
Long associated with obesity, polycystic ovarian syndrome also manifests many of the metabolic abnormalities and diseases associated with metabolic syndrome. Weight reduction is a mainstay of treatment for the overweight polycystic ovarian syndrome patient. Trials have shown no greater benefit of one type of diet over another. There is no information specifically addressing surgery as the means for weight loss in this population.
Surgically-induced Weight Loss and Longevity
Obesity appears to be associated with a higher mortality, mostly from cardiovascular disease and cancer. There is recent evidence from two studies, both published in the New England Journal of Medicine, that weight loss surgery improves longevity.
- Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-37.
- Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122:248-56 e5.
- Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753-61.
- Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741-52.
- Gregg EW, Cheng YJ, Cadwell BL, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005;293:1868-74.
- Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142:547-59.
- NIH. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. In: Annals of Internal Medicine; 1991:956-61.
- Guth ES, Livingston EH. Bariatric surgery: is it right for your patient? Postgrad Med 2008;120:E01-14.