January 6, 2015

Surgery for obesity is linked to longer survival

JAMA study focuses mostly on male VA patients with more diseases than in prior studies

SEATTLE—Obese people seem likely to live longer if they have bariatric surgery (for obesity) than if they don’t—with 53 percent lower risk of dying from any cause at five to 14 years after the procedure. So concluded a study in the Journal of the American Medical Association (JAMA) involving 2,500 obese patients and nearly 7,500 matched controls. All of them were receiving care at medical centers across the United States in the Department of Veterans Affairs (VA) health system.

“We expanded what we’ve been learning and showed that older men in this study do just as well after bariatric surgery as younger women in previous studies have done,” said David Arterburn, MD, MPH, a Group Health physician and a Group Health Research Institute associate investigator. Dr. Arterburn, who is also an affiliate associate professor of medicine at the University of Washington School of Medicine, is the first author of the report, called “Association between bariatric surgery and long-term survival.”

“Previous studies of long-term survival after bariatric surgery involved younger, mostly female populations who tended to have few obesity-related diseases,” he said. “In contrast, our study’s population was older—with a mean age of 52—and 74 percent male. Also 55 percent of our population had diabetes, and many had other diseases such as high blood pressure, arthritis, heart disease, and depression.”

“We also found evidence that bariatric surgery has become safer,” said Matthew Maciejewski, PhD, a research career scientist in Health Services Research and Development at the Durham VA and a professor of general internal medicine at Duke University School of Medicine in Durham, NC. “We found that the risk of dying during and soon after bariatric surgery was lower in 2006–2011 than in 2000–2005.”

As severe obesity becomes more common, increasing numbers of Americans have been getting bariatric surgery, Dr. Maciejewski noted. Understanding the surgery’s long-term outcomes is a research priority for the National Institutes of Health.

“We have tracked a large group of patients for a long enough time that we can clearly see a strong link between bariatric surgery and long-term survival,” Dr. Arterburn said. “As time passes, the risk of dying among the patients who’ve had surgery appears to be diverging from those of the matched controls who haven’t had surgery.”

With still-longer follow-up, Drs. Arterburn and Maciejewski plan to explore various outstanding questions, such as:

  • Does bariatric surgery help certain subgroups of patients more or less?
  • How long does weight loss last after surgery, and at what level?
  • Is the course of associated diseases, such as diabetes, changed?
  • And do total costs of health care decrease in the long run?

“Our results may have broader implications for encouraging weight loss in general,” Dr. Arterburn said. “Despite the studies showing that patients with lower BMIs live longer, not much evidence has linked intentional weight loss (from surgery, medication, or diet and exercise) with longer survival. But our results, combined with other studies of bariatric surgery, may help to make that case.”

The U.S. Department of Veterans Affairs Office of Research and Development’s Health Services Research and Development Service (IIR 10-139) funded this research. Dr. Maciejewski was also supported by a Research Career Scientist award from VA (RCS 10-391).

Drs. Arterburn and Maciejewski’s coauthors were Maren K. Olsen, PhD, of the Durham VA Medical Center’s Center for Health Services Research in Primary Care and Duke University School of Medicine’s Department of Biostatistics and Bioinformatics in Durham, NC; Edward H. Livingston, MD, MS, of the VA North Texas Health Care System in Dallas, the University of Texas Southwestern Medical Center’s Division of Gastrointestinal and Endocrine Surgery in Dallas, Northwestern University Feinberg School of Medicine’s Division of General Surgery in Chicago, and JAMA in Chicago; William S. Yancy, Jr., MD, MPH, of Durham VA Medical Center’s Center for Health Services Research in Primary Care and Duke University School of Medicine’s Division of General Internal Medicine in Durham, NC; George Eid, MD, of the Pittsburgh VA Medical Center and the Division of Minimally Invasive Surgery in the Department of Surgery at Temple University School of Medicine at Allegheny Health Network in Pittsburgh; and Hollis Weidenbacher, PhD, Valerie A. Smith, MS, and Lynn Van Scoyoc of the Durham VA Medical Center’s Center for Health Services Research in Primary Care.

Department of Veterans Affairs

VA Research has been improving the lives of veterans and all Americans since 1925. The program, part of the nationwide VA health care system, is unique because of its focus on health issues that affect U.S. veterans. To learn more about VA Research, visit www.research.va.gov.

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