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Weight Loss Surgery and its Effect on Quality of Life

Weight loss surgery helping in the reduction of T2, hypertension, dyslipidemia, cardiovascular disease sexual dysfunction — even mortality rate.

Obesity is becoming an epidemic and since it is associated with increased risk of various disease, there is a need to address this problem. Bariatric surgery is recommended by the National Institute of Health for Obese patients with a body mass index (BMI) of at least 40 or less obese patients with serious coexisting medical condition I and a BMI of at least 35. According to National Health and Nutrition Examination Survey, 34% of Americans have metabolic syndrome, with a waist circumference ≥ 102cm (men) or 88cm (women); triglyceride ≥150 mg/dl, HDL <40 mg/dl (men) or 50 mg/dl (women); hypertension ≥ 130/85 mmHg; and fasting glucose ≥ 100 mg/dl.

The purpose of this study is to determine whether surgical weight loss helps in the reduction of type 2 diabetes and decreases mortality rate. Numerous prior studies have demonstrated a connection between drastic surgical weight loss and an improvement in type 2 diabetes, as well as a decrease in mortality rate. The primary endpoint of bariatric surgery is weight loss. The overall percentage of excess weight loss (EWL) is 47-70%. A systematic review discovered EWL > 50 %. A meta-analysis study also concluded that adjustable gastric banding (AGB) is associated with less weight loss.

In another prospective observational study, 4,776 consecutive patients undergoing a bariatric surgery reported a low mortality rate of 0.3%. There are a number of complications associated with surgical weight loss surgery, about 70%, such as myocardial infarction and pulmonary embolism, which are the major causes of mortality. Those with higher mortality rate after bariatric surgery are patients with a higher BMI, males, older age, smokers and those with multiple comorbidities.

Observational and meta-analysis both demonstrate that bariatric surgery is effective in controlling T2DM, decreasing anti-diabetic drug usage and a high remission rates. Of the 135,246 subjects using meta-analysis, 78% had complete resolution with HbA1c <6.5%. However, factors like shorter duration of diabetes, greater weight loss, and former oral antidiabetic drug usage are some of the anticipating reasons of T2DM remission. For clinical outcome, a study performed by Brethauer et al performed between 2004 and 2007 had a mean EWL of 55% and a mean HbA1c, which decreased from 7.5±1.5% to 6.5±1.2% (p<0.001). In another study organized at Cleveland clinic, 150 patients with T2DM were randomized to conventional medical therapy with HbA1c level of 7.5±1.8% in the medical therapy group. For the mortality rate, a meta-analysis of 44,022 subjects from eight trials demonstrated a reduced risk of global mortality with (OR =0.58, CI 0.49-0.63).

Another study was organized to determine whether bariatric surgery improves one’s sexual function. Patients undergoing this procedure fill gender relevant questionnaires, whereby their sexual performance is assessed. This is done before the surgery and 6-7 months after surgery. A statistical analysis test was done using SPSS 11.0 software. Continuous variables were compared using student t-test for independent samples. Of the 51 patients who underwent the surgery, 48 of them finished the second half after the 6-7 months post-surgery questionnaires. With a P <0.001, the results were statistically significant. Of the 43 women, 20 of them had a Female Sexual Function Index (FSFI) score of 24.66 before surgery, indicating a sexual dysfunction; but only 4 remained with dysfunction after post-surgery. This indicated a P <0.001. For the men, there was a baseline of 40.2 to 43.9, so they did not achieve statistical significance. This study shows that weight loss positively influences sexual function in the obese population. A limitation of this study included a low response by bariatric patients.

In conclusion, there have been a number of studies that have broadened our knowledge on the safety and efficacy of bariatric procedures and the effect on obesity and T2DM and sexual dysfunction. The surgery therefore helps to improve one’s quality of life.

Practice Pearls:

  • Obesity is connected to an increased risk of developing various diseases like T2DM, hypertension, dyslipidemia, cardiovascular disease , increased mortality and many more.
  • Weight loss and shorter duration of diabetes were the main predictors of HbA1c level of ≤6% after surgery.
  • Studies addressing metabolic outcomes after bariatric surgery in type 2 diabetic patients with BMI < 35 are beginning to surface and are likely to represent future directions in dynamic specialty.
  • Weight loss surgery has been shown to improve cardiac function and reverse remodeling of the heart up to 3 years post.
  • Bariatric or weight loss surgery has significant positive effect on sexual functions.

References:

Adams TD, Davidson LE, Litwin SE, et al. Health Benefits of Gastric Bypass Surgery After 6 Years. JAMA. 2012;308(11):1122-1131. doi:10.1001/2012.jama.11164.

Harris, David A., and Ali Tavakkoli. “Is Early Bariatric Surgery the Answer for Diabetes in Obesity?” JAMA surgery (2016).

Van Hout GC, et al. “Psychological profile of the morbidly obese”. Obes Surg 2004; 14: 579-88

Sjöström L, Peltonen M, Jacobson P, et al. Bariatric Surgery and Long-term Cardiovascular Events. JAMA. 2012;307(1):56-65. doi:10.1001/jama.2011.1914.