The Risk of NOT Having Weight Loss Surgery

During the past few years, there have been a number of articles and reports focused on the risk of complications associated with surgical procedures performed for the treatment of morbid obesity.

This flurry of negative publicity for weight loss surgery followed a deluge of positive publicity in newspapers, magazines, blogs and television programs, touting the weight loss that can be achieved after gastric bypass surgery. Indeed, a number of well known celebrities, including Al Roker, Carnie Wilson, and Star Jones have received a lot of public attention following their successful weight loss.

The Mortality Risk of Severe Obesity

The Risk of NOT Having Weight Loss SurgeryOne important issue that has escaped the attention of the media is the underlying mortality risk associated with severe obesity. Until recently, the magnitude of this risk has been largely unknown.

In 1980, the late Dr. Ernst Drenick published an article in a major medical journal entitled “Excessive Mortality and Causes of Death in Morbidly Obese Men.” This study examined the mortality rate and causes of death in a group of morbidly obese veterans studied through the VA hospital system over a seven year period. Drenick found that the death rate in young (25-34) and middle age (35-44) obese men was 6-12 times higher than that of normal weight men of the same age.

Since 1980, very little information associated with mortality rate and morbid obesity (100 pounds over ideal body weight) has appeared in the medical literature. Although the mortality rate of a variety of surgical procedures performed for treatment of morbid obesity has been published numerous times during the past 40 years, there have been no studies since Drenick’s comparing this surgical mortality with a matched (similar age and gender) group of patients who did not have surgical treatment.

Recent Studies of Bariatric Surgery Mortality

“28% of the non-surgical group died versus only 9% of the surgically treated patients.”

In 1997, MacDonald and colleagues from East Carolina University evaluated 232 morbidly obese diabetic patients who volunteered as candidates for surgical treatment. 154 of these patients actually had gastric bypass surgery; the remaining 78 did not have surgery for a variety of reasons. These authors found that the annual mortality rate in the non-surgical group was nearly 5 times higher than that of the surgical group during the 6-9 year follow up interval. In fact, 28% of the non-surgical group died during this time versus only 9% of the surgically treated patients.

Recently several sophisticated formulas were used to simulate life expectancy in severely obese patients who had gastric bypass surgery versus those who did not. These researchers found that gastric bypass surgery added two or more years of life expectancy in all age groups. The greatest gains were predicted for younger male and extremely obese patients.

The Washington State Study

During the past several months, two large studies have reported lower mortality rates for surgically treated patients in comparison with obese patients matched for age and gender that did not have weight loss surgery. Two authors from Washington state found that the mortality rate over a 15 year period was 1/3 lower in patients who had surgical treatment via a number of different procedures versus those who did not.

A more dramatic difference between surgical and non-surgical patients was found by a group in Canada who reported a mortality rate of less than 1% in the surgical group versus more than 6% in the non-surgical group representing a reduction in mortality risk by nearly 90% during the 5 year study. The remarkable feature of the two most recent studies is that the non-surgical group was known only to be “obese” rather than morbidly obese. This suggests that many of the patients in the non-surgical group were probably not heavy enough to qualify for surgical treatment, making the difference in mortality rate all the more striking.

“The surgical mortality rate among inexperienced surgeons is nearly five times higher than that of more experienced surgeons.”

The Washington state study also reported that surgical mortality rate was correlated with surgical experience. Indeed, the surgical mortality rate among inexperienced surgeons (less than 20 operations performed) was nearly five times higher than that of more experienced surgeons. Another study in Pennsylvania reported similar results with an almost five times higher major complication rate in patients whose surgeons had performed less than 50 anti-obesity operations.

Conclusions

Today, we have solid data supporting the position that the mortality risk of untreated morbid obesity is extremely high — much higher than the mortality risk associated with bariatric surgery. Medicare is now taking a serious look at the results of surgical treatment for severe obesity in light of the huge cost associated with treating the so-called comorbid illnesses, e.g., diabetes, high blood pressure, sleep apnea, degenerative arthritis, high cholesterol, etc.

Since obesity has nearly overtaken smoking as the number one cause of “preventable” death in the US, Medicare and other health care providers are looking for ways to effectively treat obesity and its related illnesses. At this point in time, surgery offers the only realistic hope of sustained, long term weight loss for the severely obese.

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  1. Drenick EJ, Bale GS, Seltzer F, Johnson DG.; Excessive mortality and causes of death in morbidly obese men. JAMA, 1980; 243: 443-445.
  2. MacDonald KG, Long SD, Swanson MS et al.; The gastric bypass operation reduces the progression and mortality of non-insulin dependent diabetes mellitus. J Gastrointest Surg, 1997; 1:213-220.
  3. Flum DR, Dellinger EP.; Impact of gastric bypass operation on survival: a population based analysis. J Am Coll Surg, 2004; 199: 543-551.
  4. Christou NV, Sampalis JS, Lieberman M et al.; Surgery decreases mortality, morbidity and health care use in morbidly obese patients. Ann Surg 2004; 240:416-424.
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