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Weight loss surgery slashes mortality rate.

7 February 2023

Hi again,

If you are wondering if Bariatric surgery is right for you, then, keep reading!  This pooled data study includes good quality studies that have been meticulously analysed.  This inclusion process culminated in 18 studies being assessed, with data from a total of 1.5 million patients.  It showed that patients who had weight loss surgery (including gastric bypass/sleeve/band/BPD) were 38% less likely to die from any cause (heart attack, stroke, cancer etc) compared with a matched group of people who hadn't had bariatric surgery.  What an astounding result!  Not only that, but the list of other medical benefits of having weight loss surgery is long - see below.  Obviously bariatric surgery is not a magic bullet on its own, and operating on people who are not prepared for the lifestyle changes that it brings about, will not do well in the longterm.  However, governments should take notice of this type of research and facilitate surgery for those who need and want an operation.  I'm sure you agree..!  Happy New Year and lets talk soon!

Kind regards

Steph

A pooled analysis of large-scale registry studies by UK researchers suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related diseases (new-onset diabetes, high blood pressure, high cholesterol and heart disease etc) in patients with obesity for the whole operated population. The outcomes highlight that broader (increased) access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.

For the study, ‘Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis’, published in Plos Medicine, the researchers performed a systematic literature search and found 18 studies suitable for inclusion encompassing some 1,539,904 patients with 269,818 receiving bariatric surgery and 1,270,086 control patients.

The types of surgery were gastric bypass (n=137,578, 51%), sleeve gastrectomy (n=58,916, 22%), adjustable gastric band (n= 52,973, 20%), vertical banded gastroplasty (n=6,397, 2%), biliopancreatic diversion (with or without duodenal switch) (n=1,002, 0.4%) and an alternative procedure or unspecified operation (n=12,952, 5%). Median patient follow-up across all studies was 59 months (range 18 to 144 months).

The authors report that 11 studies found a significant reduction in relative risk of long-term all-cause mortality for patients following bariatric surgery compared to controls with a pooled odds ratios (PORs) of 0.62 (95% CI 0.55 to 0.69, p<0.001). A further three studies reported significantly reduced relative risk of cardiovascular mortality for patients following bariatric surgery vs controls (POR 0.50, 95% CI 0.35 to 0.71, p<0.001).

In addition, the study found:

• Six studies reporting a reduction in incident T2DM after bariatric surgery vs controls (POR 0.39, 95% CI 0.18 to 0.83, p=0.010)
• Five studies found that incident hypertension was reduced after bariatric surgery vs controls (POR 0.36, 95% CI 0.32 to 0.40, p<0.001)
• One study reported incident obstructive sleep apnoea relative to controls (therefore it was not possible to do a pooled analysis) with a reduced rate of new-onset obstructive sleep apnoea in patients undergoing bariatric surgery (new-onset obstructive sleep apnoea rate of 1.1%), vs controls (2.0%) (HR 0.55, 95% CI 0.37–0.82, p=0.004)
• Two studies reported significantly reduced incident dyslipidaemia following bariatric surgery vs controls (POR 0.33, 95% CI 0.14 to 0.80, p=0.010)
• Five studies reported significantly reduced incident ischemic heart disease after bariatric surgery vs controls (POR 0.46, 95% CI 0.29 to 0.73, p=0.001)
• Two studies reported the rate of incident cardiac failure and found no statistically significant protective association with bariatric surgery (POR 0.23, 95% CI 0.05 to 1.10, p=0.066)
• One study reported incident venous thromboembolism in bariatric surgery patients relative to controls (therefore it was not possible to undertake a pooled analysis), demonstrating a reduced incidence of new-onset venous thromboembolism in bariatric surgery patients (1.7%), vs controls (4.4%) (HR 0.60, 95% CI 0.43 to 0.84, p=0.003)

Adjusted ORs for incident comorbidities revealed the same patterns with reduced incidence of T2DM (POR 0.28, 95% CI 0.11 to 0.73, p=0.009), hypertension (POR 0.32, 95% CI 0.21 to 0.47, p<0.001), ischemic heart disease (POR 0.67, 95% CI 0.49 to 0.90, p=0.009), and cardiac failure (POR 0.43, 95% CI 0.29 to 0.64, p<0.001) in bariatric surgical patients vs controls.

“To our knowledge, this is the first published study of pooled data from population-based studies of incident disease following bariatric surgery. Our results represent real-world data that may be generalisable to routine clinical practice…This meta-analysis of large-scale registry studies indicates that patients receiving bariatric surgery have improved long-term mortality rates compared to controls at a population level,” the authors concluded. “They also have significantly reduced incidence of obesity-related disease including T2DM, hypertension, dyslipidaemia and ischemic heart disease. Healthcare providers may use the data on relative risk reduction as part of the discussion with patients considering bariatric surgery."

Weight-loss threshold for improved cardiac health

23 August 2022

Hi Everyone,

Another high powered study that gives additional insights into the effects of Bariatric surgery - this time on the heart and its function.  It is high powered because of the number of patients who are included in the study.  This allows us to see a small effect very clearly, and in this study it turns out to be a rather large difference between the two groups ie those who have lost weight because of weight loss surgery (including Gastric Bypass and Sleeve) and those who have lost weight through non-surgical means eg diet and exercise and anti-obesity medications.  My guess is that weight loss due to bariatric surgery goes hand in hand with improving diabetes control and blood pressure control and cholesterol levels - all of which are having their own beneficial effects on the heart and its function.  These benefits, however, may not be so dramatic for the patients who are losing weight in the non-surgical group.  Fascinating and 'watch this space' as I'm sure further studies will be seeded from this one to answer the questions it throws up with more certainty.  

Look forward to meeting some of you soon.

Steph

Five to 10 percent of surgically induced weight loss is associated with improved life expectancy and cardiovascular health compared with about 20 percent weight loss is necessary to observe similar benefits with a non-surgical treatment, according to researchers from Cleveland Clinic. In comparison. The findings also show that metabolic surgery may contribute health benefits that are independent of weight loss.

The paper, ‘How Much Weight Loss is Required for Cardiovascular Benefits? Insights From a Metabolic Surgery Matched-cohort Study’, published in the Annals of Surgery, sought to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE) as the minimum amount of weight loss to have a meaningful impact on cardiovascular health and survival is unknown.

The large, observational study examined 7,201 Cleveland Clinic patients: 1,223 patients with obesity and type 2 diabetes who underwent bariatric/metabolic surgery were matched to 5,978 patients who received usual medical care. About 80 percent of the patients had hypertension, 74 percent had dyslipidaemia and 31 percent were taking insulin to treat their diabetes.

Using different statistical models, the effects of weight loss were studied to identify the minimum weight loss needed to decrease the risk of death and of experiencing major adverse cardiovascular events, such as coronary artery events, cerebrovascular events, heart failure, kidney disease, and atrial fibrillation.

Following metabolic surgery, the risk of death and major heart complications appears to decrease after about 5 percent and 10 percent weight loss, respectively,” said Dr Ali Aminian, director of Cleveland Clinic's Bariatric & Metabolic Institute and lead author of the study. “Whereas, in the nonsurgical group, both the risk of death and major cardiovascular complications decreased after losing approximately 20 percent of body weight.”

Researchers continue to study the physiological changes in the surgically modified gastrointestinal tract, the impact on hormone secretion and the microbiome. Those beneficial changes may contribute to the cardiovascular and survival benefits of metabolic surgery, independent of weight loss. More research is needed to better understand the underlying mechanisms for the health benefits of metabolic surgery in patients who have obesity and type 2 diabetes.

"This study suggests greater heart disease benefits are achieved with less weight loss following metabolic surgery than medical weight loss using lifestyle interventions,” said Dr Steven Nissen, Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, and the study's senior author. “The study findings suggest that there are important benefits of metabolic surgery independent of the weight loss achieved.”

People struggled to manage their weight during COVID-19 lockdown

26 July 2022

Hi All,

Just in case you were wondering, you are not alone in having been negatively affected by lockdowns with respect  to your eating habits and, as a result, your weight.  It is no surprise to me that it is such a big proportion of people (65%) for whom lockdowns caused weight gain.  Lockdowns were such a unique situation and it brought about changes in our lifestyle that we were definitely unprepared for.  Interestingly, there was a proportion of people who were experiencing positive impacts, and these were people who were receiving support from a 'slimming club'.  I take from that  that building up a support network that will help with your weight loss journey would seem to be extremely important.  This also applies to people who choose to go down the bariatric surgery pathway as well!  Look forward to meeting you soon.

Kind regards,

Steph  

More than half of adults have found it difficult to manage their weight during the COVID-19 lockdown, according to the results of an online survey involving over 800 UK adults, presented at The European and International Congress on Obesity. Most of the respondents said their difficulties stemmed from increased snacking, not exercising as much as usual, increased anxiety or stress and not being able get hold of healthier food. However, those questioned who had received weight-management support from a slimming club continued to lose weight during this time, exercised more and reporting higher overall wellbeing compared to respondents from the general population.

The findings come at a time when the UK Government has unveiled a new obesity strategy with its 'Better Health' campaign to encourage millions of adults to kick start their health and reduce their risk of serious illness, including COVID-19. An estimated two-thirds (63%) of UK adults are above a healthy weight, with 36% having overweight and 28% having obesity.

The research was organised by Slimming World as part of their Health and Wellbeing Study, which is surveying new members regularly over the course of one year about aspects of their health and lifestyle. The survey at the six-month point coincided with lockdown, so questions were added to learn more about how lockdown measures had impacted the nation's health, wellbeing, and lifestyle behaviours.

Between April and May 2020, 222 Slimming World members (94% female, average age 52 years) and a representative sample of 637 adults in the general population completed an online survey asking their opinions about their general health, mood, diet, alcohol intake, physical activity and weight management.

Similar proportions of the general population (65%; 414/637) and Slimming World members (59%; 131/222) admitted to finding managing their weight since lockdown "very" or "somewhat difficult". The four key reasons given by both groups included difficulty getting to the shops and obtaining the usual healthy foods; boredom and being at home leading to increased snacking; higher levels of stress and anxiety leading to comfort eating; and more sedentary time and exercising less. However, some respondents in both groups reported some benefits of lockdown including more time to plan meals, cooking from scratch and sticking to a routine.

Two in five (42%) Slimming World members and one in three (34%) of the general population admitted eating more sugary foods during lockdown, while one in four (27%) members and one in five (18%) of the general population reported reaching for fatty foods. When looking at key parts of the diet, data indicated that members had a healthier overall diet than non-members (healthy eating score 13 vs 10; with a higher value indicating better overall diet quality).

This could help explain why Slimming World members reported continuing to lose weight during this time, with an average weight loss of 2kg (4.4 lbs) at the early stages of lockdown compared to three months earlier.

The research also highlighted differences in the impact of lockdown on overall health and wellbeing - fewer members said that their general health had been negatively affected compared to the general population (14% vs 22%). In addition, members said they had exercised more (25% vs 17%) and reported higher overall wellbeing (wellbeing score 28 vs 24; with a higher score indicating more positive wellbeing).

More than a quarter (28%) of members and 16% of the general population said they were drinking more alcohol during lockdown. Their reported alcohol intake was within government guidelines, with Slimming World members consuming around 13 units per week and respondents from the general population 14 units per week.

"Lockdown inevitably had an effect on our choices around food, drink and activity. Given that excess weight is associated with a higher risk of severe illness from COVID-19 and with lots of people coming out of lockdown feeling concerned about their weight and health, the findings of the study show behaviour change support is more important now than ever,” said study lead, Dr Sarah-Elizabeth Bennett, Slimming World's Senior Research Associate.

The authors of the study point to several limitations, including the reduced sample size of those who had completed all surveys to the point of lockdown and the inclusion of self-reported data which could be prone to reporting biases. The study included a representative sample of the general population at each timepoint, rather than following the same people, therefore it was difficult to make certain comparisons over time. The authors also noted that there could be variations in behaviour and wellbeing depending upon when respondents completed the survey, given the rapidly changing news and guidance during lockdown. Finally, they did not account for potentially confounding factors such as comorbidities, which may have influenced lifestyle behaviour changes.