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Does Weight-Loss Surgery Improve Long-Term Survival Rates?
VA studies 5- and 10-year survival rates among surgical patients
Bariatric surgery can cut the risk of early death by more than half in patients with severe obesity, concludes a retrospective cohort study of 2,500 patients (75% male) who underwent the surgery and 7,462 matched controls in the Veterans Affairs (VA) health system.
Researchers compared 5- and 10-year survival rates among subjects (average age, 52 years; BMI, 47) and controls (average age, 53 years; BMI, 46), and found that while initially no significant association between surgery and all-cause mortality was evident, over time the adjusted analysis showed a hazard ratio (HR) of 0.45 at 5 years and 0.47 at 10 years.
The following all-cause mortality rates were reported:
| Year | Subjects | Controls |
| 1 | 2.4% | 1.7% |
| 5 | 6.4% | 10.4% |
| 10 | 13.8% | 23.9% |
The study authors note that these results provide further evidence for the beneficial relationship between surgery and survival, previously demonstrated in younger, predominantly female populations.
Citation: Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62-70. doi: 10.1001/jama.2014.16968.
Commentary: This study further supports the long-term effectiveness of bariatric surgery for patients with severe levels of obesity. This builds on previous studies showing bariatric surgery decreases long-term mortality, and other studies showing 25% to 40% decreases in mortality over 7 to 15 years in patients with an average BMI of 45.1-4 The decrease in mortality increases over time. In addition, there is now good evidence that bariatric surgery can lead to reversal of diabetes, and weight-loss medication, specifically Qsymia, can substantially decrease progression from prediabetes to diabetes. It is clear that obesity is a critical health issue, and now with three major areas of intervention — lifestyle modification, medications, and bariatric surgery — the challenge will be determining which is the best approach for each individual patient. —Neil Skolnik, MD
1. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753-761.
2. Sjostrrom L. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52.
3. Dixon JB. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316-323.
4. Garvey WT. Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended-release. Diabetes Care. 2014;37:1–10.