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MURRAY — A 40-year study conducted by Intermountain Health shows that people who have weight-loss surgery tend to live longer than patients with severe obesity who don't have the surgery.
The study followed patients for up to 40 years after having bariatric weight-loss surgery and found a significant reduction in death rates from heart disease, diabetes and cancer compared to matched patients with severe obesity who didn't have surgery.
"Obesity and weight is a hot topic and we see that rates of obesity in our country, in our state, in our community are increasing significantly," said Dr. Nathan Richards, study author and associate medical director of general surgery for Intermountain Health. "The ever-elusive pursuit of 'How do we help manage weight?' is a question that we've been looking at for quite some time."
He said that this is done through conventional methods focused on diet and exercise — but also through surgery.
Weight-loss surgery has existed for years and the study conducted by Intermountain Health looked at examining the effectiveness and safety of such procedures.
"This study, specifically, wanted to look at what happens to death. What is the risk of death after having bariatric or weight-loss surgery versus patients who die without having surgery?" Richards said.
Richards noted that it is important to understand some of the misconceptions about obesity and managing it.
The prevailing thought of the past was a "calories in, calories out," approach where if someone diets and exercises, they won't gain weight.
"We know that that's not correct thinking. Yes, there's a role for diet and exercise and we will continue to advocate for that, but what we have learned more and more over the past 10 years, 20 years, is that it's not just about what we put into our mouths, it's what happens to our food once it's there and that is controlled by things like genetics," Richards said.
Obesity can also be strongly tied to socioeconomic factors and what types of food are available — and accessible — to certain groups of people.
"Most healthy food is more expensive. Readily available food tends to be less healthy, so things like fast food and cheaper solutions tend to be less healthy," Richards said. "There's a disproportionate effect, then, on folks who have different socioeconomic status or don't have the ability to have access to healthy food. I think that's a push that we need to really make as a community."
With these in mind, Richards said that he's excited for what this study means for the future of weight-loss treatment and curbing the obesity epidemic.
Findings from the study were published in the medical journal Obesity and found that the overall cause of death for both male and female bariatric patients was 16% lower than matched patients who did not have surgery. For cardiovascular-related deaths, the rate was 29% lower; for cancer deaths it was 43% lower; and diabetes-related deaths were 72% lower.
This study not only shows that people who have weight-loss surgery have less chance of dying from heart-related disease, diabetes and cancer, but that the benefits are durable and last for years — there is staying power.
–Ted Adams, principal study author
"This study not only shows that people who have weight-loss surgery have less chance of dying from heart-related disease, diabetes and cancer, but that the benefits are durable and last for years — there is staying power," said Ted Adams, principal author of the study from the Intermountain Health surgical specialties/digestive health clinical program and adjunct associate professor in nutrition and physiology at the University of Utah School of Medicine.
Noting the benefits of weight-loss surgery, the study also found evidence that suggests an increased risk of death from chronic liver disease and higher death rates from suicide in patients who underwent bariatric surgery at younger ages.
Adams noted that the increased risk of death from chronic liver disease could be related to how alcohol is absorbed by the body after weight loss, though the study didn't test liver health before or after patients had the weight-loss surgery.
The increased risk of suicide in younger patients who undergo the surgery, Richards said, is "surprising and confusing."
"It underscores the importance of caring for the whole patient during the weight loss journey and really focusing on mental health care pre- and post-operatively to make sure patients understand the changes associated with surgery, weight loss and have the behavioral skills necessary to handle these changes," Richards said.
The four procedures included in the study were Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy and biliopancreatic diversion with duodenal switch.
Researchers gathered their data from the Utah population database which included nearly 22,000 participants who had bariatric surgery in Utah from 1982 to 2018. Patients who had the surgery were identified through bariatric surgery practices in Salt Lake City and through Intermountain Health and University of Utah medical records.
Richards said that the benefits of surgery are that the weight comes off and usually stays off, without the "yo-yo" effect of losing weight and gaining it back, something often seen with dieting.
"I think surgery is a tool. It's not the solution for everybody but it certainly is a solution. I think this study underscores the fact that we can really have significant benefit by helping people live and live longer and have less disease," Richards continued.
"The takeaway is that surgery continues to really shine in the appropriate patients and if folks are dealing with obesity and looking for answers, I think more than ever surgery is an option that they have to consider with their treating physician."
