Obesity increases the risk of developing type 2 diabetes as well as worsens several risk factors for heart disease and stroke. Diet and exercise can work for some individuals in their effort to lose weight. In addition, several new medications have been approved for those individuals who fail to lose weight with dieting and exercise. Individuals who are severely obese, with a body mass index (BMI) over 35, usually need additional help for weight loss to be successful. For people who have a BMI over 35, the best option for long term successful weight loss remains bariatric surgery. We have previously discussed the finding that bariatric surgery can reverse type 2 diabetes in some patients, and can prevent the development of diabetes in pre-diabetic patients.
Researchers, led by Dr. Ted Adams of the University of Utah School of Medicine in Salt Lake City, Utah, have found that Roux-en-Y gastric bypass (RYGB) surgery is associated with high rates of diabetes remission and lower risk of heart disease during the first 6 years after surgery. The results of their study were published online in the Journal of the American Medical Association. The researchers used a prospective study of 418 severely obese (BMI over 35) individuals aged 18 to 72 years of age who underwent RYGB surgery. There were 417 severely obese study participants in one control group who sought but did not receive surgery, and 321 severely obese study participants in a second control group selected from a population based sample. Six years after surgery, patients lost 27.7% of their initial body weight compared to 0.2% gain in weight for control group 1 and 0% in control group 2. Diabetes remission rate 6 years after surgery were 62% in the surgery group, 8% in control group 1, and 6% in control group 2. In addition, other cardiovascular risk factors such as dyslipidemia and high blood pressure improved for the surgery group.
The authors wrote, “Our study reports significant weight loss and 6-year improvements in major cardiovascular and metabolic risk factors in patients receiving RYGB surgery compared with severely obese control participants, including frequent remission and lower incidence of diabetes, dyslipidemia, and hypertension. In contrast, cardiovascular and metabolic status of severely obese control participants generally worsened during the 6-year period”.
The authors also wrote, “Obesity is associated with premature and accelerated coronary atherosclerosis, and improvements in coronary risk factors after bariatric surgery have been predicted to lower the 10-year risk of ischemic heart disease events by approximately 50%. Our study demonstrated a sustained improvement in cardiovascular risk factors measured at 6 years”.
The authors concluded, “…significant weight loss was sustained for an average of 6 years in the majority of patients having RYGB surgery. Diabetes remission was also sustained and the incidence of diabetes was much lower during the 6-year follow-up period in patients in the RYGB surgery group compared with the severely obese control participants. Similarly, metabolic and cardiovascular risk profiles during the 6 years of follow-up remained significantly improved after RYGB surgery”.
This study adds to the growing body of evidence that shows that bariatric surgery is a good option for some obese individuals who cannot lose weight with dieting and exercise alone. In addition, several improvements in health occur as a result of the weight loss and these include remission of type 2 diabetes, improvement in lipid profiles, as well as other cardiovascular risk factors. It will be interesting to see even longer term effects, such as the influence on overall survival and lifelong reduction in heart attack and stroke incidence for bariatric surgery patients.
Ted D. Adams et al. “Health Benefits of Gastric Bypass Surgery After 6 Years” JAMA 2012; 308(11):1122-1131. doi:10.1001/2012.jama.11164