https://www.ajmc.com/focus-of-the-week/gastric-bypass-linked-to-improved-survival-for-those-over-age-35
Gastric Bypass Linked to Improved Survival for Those Over Age 35

Mary Caffrey

With more patients looking to surgery as an option to deal with severe obesity, the question for both doctors and patients is whether this solution both promotes weight loss and extends life.

A study published online today in JAMA Surgery examines all-cause and cause-specific mortality rates across various age groups to see whether the answer changes depending on the age at surgery.1

Lance E. Davidson, PhD, of Brigham Young University and co-authors looked records of 7925 patients undergoing gastric bypass surgery and records of 7925 matched, severely obese persons who did not have surgery, who were found through driving license records.

The 2 groups were divided into 4 age categories: younger than 35, 35 through 44 years, 45 through 54 years, and 55 through 74 years. Authors found that gastric bypass surgery was associated with improved long-term survival for all patients once they reached 35 years old.

Why did younger patients not have the same benefit? This was largely due to a high number of “externally caused deaths,” especially among women. What’s important is the finding that surgery appears to have a protective effect, even for patients above age 55.

Gastric bypass is typically not recommended in patients with a body mass index (BMI) lower than 30, which is the point that meets the official CDC definition of obesity. However, some studies show that the surgical method reverses type 2 diabetes (T2D), and for that reason persons who are overweight and have T2D may be recommended for surgery with a BMI as low as 27.

In a related commentary,2 Malcolm K. Richardson, MD, notes that some obese patients present such risks that their cases are rejected for surgery—which should serve as a warning to younger patients struggling with obesity that they cannot count on bariatric surgery when they get older. The incidence of female deaths from “poisonings” noted in the commentary may indicate drug use.

Richardson’s commentary is cautious. He calls gastric bypass a “powerful tool” and not a cure all. While the study published today suggests it may improve mortality across a broad age span, only those meeting risk criteria can participate. And that is not everyone.

References

1.       Davidson LE, Adams TD, Kim J, et al. Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality [February 10, 2016]. JAMA Surg. 2016; doi:10.1001/jamasurg.2015.5501.
2.       Richardson MK. Expanding our understanding of age-related mortality after gastric bypass surgery [published online February 10, 2016]. JAMA Surg. 2016; doi:10.1001/jamasurg.2015.5553.
 
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