Among obese adults, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and a longer life expectancy than standard medical treatment for this chronic disease. Survival benefits are much more pronounced for people with pre-existing diabetes. This was revealed by a recent meta-analysis published in The Lancet, which included 174,772 participants.
Specifically, from the analysis of 16 matched cohort studies and one prospective controlled trial, the authors concluded that metabolic-bariatric surgery was associated with a 49.2% reduction in the risk of death rate, while the median life expectancy was 6.1 years longer than that of patients who received usual medical care .
Furthermore, the meta-analysis revealed that the beneficial effects of surgical treatment were considerably greater for participants with diabetes, in whom the median life expectancy was 9.3 years longer in the surgery group than in the non-surgical group. , while the increase in life expectancy was 5.1 years for patients without diabetes.
“This study is very important because it provides more solid and precise information about long-term survival after bariatric and metabolic surgery in adults with obesity ”, emphasized Dr. Estuardo Behrens, advanced laparoscopic surgeon and bariatric and metabolic surgeon, president of the Latin American chapter of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSOLAC).
The specialist also highlighted that the beneficial effects regarding the reduction of the risk of mortality from all causes and the increase in life expectancy did not show significant differences between the different surgical techniques used: gastric bypass, gastric sleeve or gastric band, although clarified: “We know that patients with gastric bypass will have a more important benefit than the other two populations.”
What causes increase the risk of death from obesity?
Regarding what are the factors that contribute to increase the risk of death from all causes in people with obesity, Behrens explained that they are “those components of the metabolic syndrome, that is, high blood pressure, diabetes, polycystic ovary syndrome, non-alcoholic hepatic steatosis , and sleep apnea ”.
In that sense, he stressed that with metabolic-bariatric surgery, a loss of between 35 and 70% of excess weight is obtained in patients, while those who undergo medical treatment usually lose only 5 to 10% of excess weight with maintenance for more than five years, which is not enough to obtain a significant benefit.
“When we operate on these patients, we are going to significantly reduce the causes of cardiovascular complications, both microscopic and macroscopic, that is, all microvascular and macrovascular problems, which is the greatest fear we have: acute myocardial infarction, stroke, congestive heart failure. All these complications are remarkably reduced because dyslipidemias, which are also part of the metabolic syndrome, go into a very important remission ”, argued the President of IFSOLAC.
Beneficial impact on diabetes
Another of the outstanding aspects that the meta-analysis revealed was the greater benefit obtained with metabolic-bariatric surgery by those patients who, in addition to being obese, had diabetes.
About, Behrens He recalled that it is estimated that “About 65% to 70% of obese patients develop diabetes mellitus florida” and that the process usually begins 13 years before with insulin resistance, and then passes to a stage of prediabetes that often occurs five years before the diabetes itself.
“Therefore, If we have a patient with morbid obesity, who has insulin resistance but does not have prediabetes or diabetes, with surgery we will find that he will never develop diabetes mellitus because we are reducing the risks associated with insulin resistance“Said the expert, who insisted that nevertheless, people with diabetes were the ones who benefited the most from surgery in this study.
For her part, the doctor Carla Musso, doctor specializing in endocrinology and diabetes, coordinator of Diabetes from the Favaloro Foundation, confirmed that “metabolic-bariatric surgery achieves a very important therapeutic success in terms of remission of diabetes, either partial or complete, and in the long term, which is when diabetes does not appear for a period greater than five years.”
Likewise, the specialist stated that, after the surgical procedure, a very high percentage of patients “can stop all the medication they used for diabetes”, but he stressed that regular monitoring by the multidisciplinary team is crucial “to detect early the cases in which it is necessary to administer any of the medications that have been suspended.”
For whom is bariatric surgery indicated?
Metabolic-bariatric surgery is not only indicated for patients with diabetes and a body mass index (BMI) of more than 35, but based on growing scientific evidence that shows great benefits also for patients with diabetes and a BMI of between 30 and 35, is that the Argentine Society of Diabetes (SAD), the Argentine Society of Nutrition (SAN) and the Argentine Society of Surgery of Obesity (SACO) published in 2015 a consensus in which the inclusion criteria are established and exclusion to perform surgery in the latter group of patients.
Musso He specified: “The specialist will also evaluate the commitment and adherence of the patient, which will be essential in the post-surgery”.