With obesity rates continuing to grow across much of the Western world we are becoming more and more concerned about the health risks associated with being substantially overweight and of the increased death risk resulting from obesity. But to what extent can these risks be lowered by bariatric surgery?
A study recently looked at the records of a large number of people who had gastric bypass surgery in the 10 years from 1995 to 2004 and discovered that in the region of one percent of patients died within a year of surgery and some 6 percent died inside 5 years. When the figures were adjusted for sex and age and matched against figures for the population at large they were discovered to be reasonably high. So just what does this say about the ability of bariatric surgery to lower the general risk to our health?
In order to answer this particular question then we need to look beyond the headline numbers and discover just why these deaths happened and where the true variation lies between obesity patients and the general population.
If we look at the detailed numbers two particular things stand out.
The first is the number of deaths resulting from heart disease which is the main cause of death in the obesity patients and is considerably higher than that seen in the population as a whole.
The second is the number of deaths that resulted from suicide and drug overdoses that, though not officially classified as suicide, must nevertheless raise the question of whether such overdoses were really accidental. Within the population as a whole you could expect to see approximately 2 suicides in a group of the same size as that used in the study and yet this group of patients showed a total of 30 deaths from suicide and drug overdoses.
If we examine these results and set them alongside our wider knowledge about people undergoing bariatric surgery then we might perhaps be able to explain this variation to a certain degree.
Despite the fact that weight loss surgery is usually extremely successful it is often not undertaken until people are at risk from other medical problems or comorbidities and, though surgery can cure many of these conditions and lower the risk from others, a lot of people still remain at some degree of risk following surgery. In a lot of cases for instance patients continue to be troubled by such things as diabetes mellitus and hypertension and it is therefore not surprising that this section of the population remains at higher risk from heart disease.
Further, while obesity surgery can lead to a significant reduction in weight a lot of patients are still heavily overweight for a long time following surgery and many people will stay that way for years to come.
Lastly, the lifestyle changes following surgery can be dramatic and a lot of people experience depression in the weeks following their surgery. Indeed much attention is given to the physical affects of surgery and the requirement for such things as a strictly controlled diet and an exercise program but, more often than not, very little attention is paid to the psychological affects of surgery.
Time will reveal whether this explanation holds water but there should be little doubt that improved post-operative care for obesity patients would go a long way to finding a solution for this difference.
