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The first long-term studies of obesity treatments - including one conducted by the University of Utah School of Medicine and LDS Hospital - show that they not only lead to lasting weight loss but also dramatically improve survival.
Researchers in Sweden and Utah separately found that obese people who underwent gastric surgery had a 30 percent to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.
The research, published today in the New England Journal of Medicine, should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.
''It's going to dispel the notion that bariatric surgery is cosmetic surgery, and support the notion that it saves lives,'' said Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.
In Utah, researchers found severely obese patients who got a gastric bypass surgery were 40 percent less likely to die than those who did not get the surgery.
But there's a twist: Those same people were 58 percent more likely than their non-surgery counterparts to die from other causes, including accidents and suicide.
The Utah study raises interesting questions about how patients should be evaluated for the life-altering surgery and may point to a need for psychological evaluation and psychiatric treatment before surgery, as well as aggressive follow-up afterwards, said Ted Adams, lead author of the article.
"Patients and medical providers will be able to use this as another source of information to help in the decision of whether or not to have the surgery based upon risk and benefit," said Adams, a cardiovascular genetics professor at the U. "We should never lose track of the importance of individualized risk-benefit analyses."
Adams, also the co-founder of the Intermountain Health and Fitness Institute at LDS Hospital, speculates that people who lose weight become more active, perhaps making them more prone to accidents.
Some severely obese adults also have addictive personalities; once their addiction to food is gone, they may gravitate toward drug or alcohol abuse, he said.
"We can speculate but that's about all it will be because we don't know the life choices of [these people] or anything about their socioeconomic status," he said.
Funded by the National Institutes of Health, the retrospective study looked at 7,925 Rocky Mountain Associated Physicians patients who received a gastric bypass and 7,925 people Utahns who applied for drivers licenses. Persons in the control group - those who applied for drivers licenses - were selected on the basis of their age, gender, body mass index (BMI) and other factors, Adams said. They were followed for an average 7.1 years.
The researchers then matched up the records, both for the surgery and non-surgery groups, with the National Death Index.
Specifically, the surgery group showed 56 percent fewer deaths from coronary heart disease 60 percent fewer deaths from cancer and 92 percent fewer deaths from diabetes than the nonsurgery group.
"We didn't anticipate such a dramatic reduction in cancer mortality in such a period of time, so that was actually surprising to us," AdamsĀ said. "Some have speculated maybe part of it is due to improved quality of screening after weight loss. Certain screening techniques for cancer are a little compromised with persons who are severely obese."
The reduced mortality for any cause of death is likely related to significant health improvements that follow gastric bypass surgery, such as reduced blood pressure, improved or resolved diabetes, and reduced sleep apnea, AdamsĀ said.
Adams' group - which is currently conducting another study to investigate the connection between gastric bypass and morbidity - plans to work with the Utah Cancer Registry to further explore the relationship between obesity and cancer.
In the second study, Lars Sjostrom of the Goteborg University in Sweden and colleagues followed 2,010 obese patients who underwent stomach surgery and a similar group of 2,037 patients who had not had the operation, also known as bariatric surgery. Over the next 11 years on average, those who had surgery were about 30 percent less likely to die from any cause.
''This study for the first time offers strong evidence that intentional weight loss, or at least bariatric surgery, is associated with decreased mortality,'' Sjostrom said.
Sjostrom and Adams acknowledged that they did not have enough data about different levels of weight loss to determine how much of the benefit was from losing weight and how much might have been from other effects of the surgery.
''I think it's certainly related to weight loss, but there may be other mechanisms happening that are also playing a role in addition to weight loss connected to the surgery itself,'' Adams said.
Obesity surgeries have surged in recent years along with global waistlines. In the United States alone, 177,600 operations were performed last year, according to the American Society for Metabolic & Bariatric Surgery. The most common method was gastric bypass, or stomach-stapling surgery, which reduces the stomach to a small walnut-sized pouch and bypasses part of the small intestine where digestion occurs.
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* THE ASSOCIATED PRESS contributed to this article.