medwireNews: A meta-analysis shows that bariatric or metabolic surgery markedly increases life expectancy relative to standard obesity care, with the greatest gains seen for people with type 2 diabetes.
The mortality risk overall was reduced by 49.2% with surgery versus standard care, show the findings published in The Lancet.
But when divided into people with and without diabetes, the risk reduction was markedly larger in the former group, at 59.1% versus 29.6% for those without diabetes.
Asim Shabbir (National University Health System, Singapore) and study co-authors calculated a number needed to treat of 8.4 to prevent one death over 10 years among people with type 2 diabetes and 5.3 to prevent one death over 20 years.
Again the effect was smaller among people without diabetes, at numbers needed to treat of 29.8 and 19.0 to prevent one death over 10 and 20 years, respectively.
And the same pattern was evident for life expectancy gains; bariatric/metabolic surgery was associated with a median additional 9.3 years for people with diabetes and 5.1 years for those without.
The researchers included 17 studies in their meta-analysis, which yielded patient-level data for 174,772 participants, 7712 of whom died during a median follow-up of 69.4 months. They found no significant differences in survival benefit according to the surgical approach, with Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding associated with overall mortality risk reductions of 57%, 52%, and 50%, respectively.
In a linked editorial, Geltrude Mingrone (Università Cattolica del Sacro Cuore, Rome, Italy) and Stefan Bornstein (King's College London, UK) observe “that only 1% of eligible individuals undergo metabolic–bariatric surgery for a series of reasons including obesity stigma.”
But the researchers calculate that each 1% increase in the number of eligible people undergoing bariatric or metabolic surgery would result in an additional 5,133,600 future life–years among people with diabetes and 6,568,800 future life–years among those without.
The commentators add that it is not currently clear if bariatric or metabolic surgery can restore people’s life expectancy to that of the general population, or if years lived with obesity has an irreversible impact, as has been implied in one previous study.
“The obvious implication is that prevention or early treatment of obesity is crucial to avoid organ damage,” say Mingrone and Bornstein.
They conclude: “Until anti-obesity medications can produce clinically meaningful and sustained weight loss, metabolic–bariatric surgery represents a precious tool to increase lifespan and reduce life-threatening obesity comorbidities.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet 2021; doi:10.1016/S0140-6736(21)00591-2
Lancet 2021; doi:10.1016/S0140-6736(21)00952-1