As the problem of obesity continues to rise in many Western countries people are becoming increasingly conscious of the health risks associated with being substantially overweight and of the increased risk of death as a result of obesity. But just how far can these risks be lessened by bariatric surgery?
A recent study looked at the histories of a large number of people who underwent weight loss surgery from 1995 to 2004 and reported that approximately one percent of patients died within a year of surgery while approximately 6 percent died inside 5 years. When these statistics had been adjusted to take account of sex and age and matched against statistics for the general population they were found to be fairly high. So what does this say about the ability of bariatric surgery to reduce the overall risk to our health?
If we are to answer this particular question we need to look beyond the headline figures and discover why these deaths happened and where the real variation lies between the population at large and gastric bypass patients.
If we look at the detailed figures two particular things stand out.
The first is the figure for people who died from heart disease which is the major cause of death in the gastric bypass patients and is considerably higher than that found in the population at large.
The second is the figure for deaths resulting from suicide and drug overdoses that, though not formally classified as suicide, must nonetheless raise the question of whether or not such overdoses were really accidents. Within the population as a whole you may expect to find about 2 deaths from suicide in a group of the same size as that used in the study and yet this study group showed no fewer than 30 suicides and drug overdoses.
If we examine these findings and consider them alongside our wider knowledge of people having bariatric surgery then we might perhaps be able to explain this variation to some extent.
Although gastric bypass surgery is frequently very successful it is often not undertaken until people are at risk from other medical problems and, although surgery will cure many of these problems and reduce the risk from others, many people still remain at some degree of risk even after surgery. In many cases for example people continue to be troubled by such things as diabetes mellitus and high blood pressure and it is possibly unsurprising that this section of the population remains at higher risk from heart disease.
Further, while bariatric surgery may result in a large weight loss many people remain heavily overweight for a long time after surgery and many people will remain so for months or years to come.
As a final point, the changes in lifestyle following surgery are dramatic and many people find that depression sets in the weeks and months following their surgery. Certainly much attention is given to the physical affects of surgery and the need for such things as a strict diet and exercise but, frequently, little attention is paid to the psychological affects of surgery.
Only time will reveal the extent to which this explanation holds water but there can be little doubt that improved post-operative care for obesity surgery patients would go a long way towards solving this anomaly.