With obesity rates rising year on year, weight loss surgery is increasingly considered as a treatment option. This article looks at its outcomes and safety.
According to a 2017 report by the Australian Institute of Health and Welfare (AIHW), there were over 22,000 weight loss surgeries performed in 2014-15, more than double the number of such procedures in 2005-06. Almost 80% of these were performed as ‘primary procedures’ rather than revisional surgeries, and more female patients accessed bariatric surgery services than males.
Obesity in Australia
Obesity is a chronic medical disease affecting more Australians every year. There are presently about 5.8 million people living with obesity in Australia, up from 2.7 million in 2007-08, meaning that almost one-third of the population is now obese (and over two-thirds are overweight or obese). If this trend continues, around 40% of the population will be living with obesity within the next decade.
This represents a major health issue given that being overweight or obese has been recorded as the second leading cause of preventable death, second only to smoking. In particular, the AIHW links being overweight or obese to diseases such as diabetes, cardiovascular disease, osteoarthritis, stroke, certain cancers (including bowel and breast cancer), chronic kidney disease and dementia.
These risks can be greatly reduced through significant and sustained weight loss, and for many patients with obesity this requires weight loss surgery as diet and exercise alone are often inadequate to achieve lasting weight loss.
Surgical Treatment of Obesity
Weight loss surgery, known as bariatric surgery, includes procedures such as the sleeve gastrectomy and Roux-en-Y gastric bypass. These procedures are almost always performed laparoscopically (i.e. by keyhole surgery), which is how they are performed by our specialist bariatric surgeons.
The landmark Swedish Obese Subjects study, which involved over 4,000 people with obesity, recorded average weight losses of 20-32% at one-to-two years after weight loss surgery. In the longer-term, the subjects sustained weight loss of 18% on average 20 years after surgery. Overall, the Roux-en-Y gastric bypass resulted in greater weight losses compared with the outcomes of adjustable gastric banding.
The study also found that weight loss surgery was associated with a decrease in overall mortality, with rates of cardiovascular and cancer mortality in particular being approximately halved. Furthermore, sustained significant weight loss is known to substantially improve control of type 2 diabetes, even to the point of remission.
“It has been estimated that obesity has a greater negative impact on quality of life than 20 years of ageing … Numerous studies have consistently found substantial improvement in health-related quality of life following weight loss from bariatric surgery.”
Australian Family Physician, July 2017
How Safe is Surgery?
As with all surgery, there are risks associated with bariatric procedures.
Bariatric surgery is generally regarded as safe surgery, in appropriately selected patients. A National Institutes of Health (NIH) study over ten years ago found the risks of bariatric surgery have dropped dramatically and are no greater than gallbladder or hip replacement surgery. The safety profile has improved over the last decade. Risks are lower than the longer-term risk of dying from heart disease, diabetes and other consequences of carrying more weight than a person’s organs can tolerate.
Studies from Stanford University and the Cleveland Clinic Florida have since been published regarding the safety of sleeve gastrectomy and gastric bypass surgery. These demonstrated the rate of serious complication within 30 days to be less than 1% for both procedures, and gastrointestinal leak rates to be lower than 0.5%. Re-operation rates were equally low at 1.5% for sleeve gastrectomy and 7.7% for gastric bypass.
At Sea Change Weight Loss Clinic, if our bariatric surgeons deem you a suitable candidate for weight loss surgery, they will discuss the risks of surgery with you and can answer any of your questions. Although there is inherently some risk in undergoing surgery, these are generally far less significant than the serious health risks associated with maintaining obesity.In other words, for most patients, the risk of doing nothing and suffering the negative effects of obesity are far more worrying than the minimal and controlled risk of surgery.
“Mortality is considerably lower among obese individuals who undergo bariatric surgery compared to non-surgical obese individuals.”
European Association for the Study of Obesity, as reported in Science Daily