Posted by: Chris Maloney | January 4, 2012

Will Weight-Loss Surgery Save Your Life? 53% Better Vs. 1.3%.

Cover of the first issue of Journal of the Ame...

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The headlines are clear.  Let’s all run out and get our stomachs chopped.  The Journal of the American Medical Association reports that getting bariatric surgery will prevent 53% of cardiac deaths.

Whoa.  That’s huge.  But I also read in my local paper a short blurb that briefly mentioned that weight loss wasn’t the determining factor for prevention.  I went looking for the actual study and couldn’t find it easily.  But we have plenty of information on the study in question.  The reduction in risk translated to only 1.3% difference in mortality after ten years.

Wait.  How do go from 53% to 1.3%?   The bigger number is cardiovascular eventsHere are the numbers.  Total number of people in each group:  2010 surgical patients, 2037 matched controls.  They weren’t randomized because the surgery has a chance of mortality on the operating table, at least 0.28% (other studies put it as high as 4.6%).  Out of the 2010 surgical patients, 199 had a heart attack or stroke.  Of the 2037 controls, 234 had a heart attack or stroke.  BUT…28 patients died of cardiovascular events vs. 49 controls.  It still doesn’t quite make 53% because you need to cut off the timeline at the right point.  Yay!  There’s our front page headline!

For those of you counting, the really change in mortality (which is what we care about, right?) is about 1.3%.  Other studies have found no long-term benefit.

So I’m not an advocate, right?  Well, not of this study and the misleading headlines.  We have a great deal of literature on this subject, and long-term significant weight loss does seem to make a huge difference in overall risks of dying.  I am a huge advocate of long-term significant weight loss when it is permanent and the person is healthier overall.

Here’s the review  I use when I’m discussing the issue with patients.  It’s a free full text article, which I would definitely look through as well as do a great deal of reading before I went under the knife.  The surgeries are much safer than they were when people started out, but I suspect the complication rate is higher than is reported.

 

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