Is surgery better than dieting for weight loss outcomes?
There are many different ways to manage weight, but which is better for our long-term health? A new study has found a link between multiple types of weight loss surgery and lower all-cause mortality rates overall.
The most common ways to manage excess weight are dieting, physical exercise, weight loss drugs, and bariatric, or weight loss, surgery.
Individuals aiming to get back into shape may opt for one or a combination of these treatments, depending on what choices are most suitable for them.
This surgery type aims to make the stomach smaller, so that a person’s appetite — as well as the amount of food that they can ingest — is reduced.
Types of bariatric surgery include:
- laparoscopic banding, during which a ring is placed around a segment of the stomach so as to “section off” part of it, thereby reducing how much of the stomach a person can use to ingest food
- gastric bypass, or Roux-en-Y gastric bypass, which requires both “sectioning off” the stomach so that less food can be ingested, and cutting the low intestine so that it can be attached directly to the now-smaller section of the stomach
- laparoscopic sleeve gastrectomy, in which much of the stomach is removed, with only a smaller “wedge” left, which can hold a lower amount of food
Recently, Orna Reges, Ph.D., and others from Clalit Health Services in Tel Aviv, Israel, conducted a study that explored which types of weight loss strategy and procedures are associated with a lower risk of all-cause mortality.
The findings of their study are published in the Journal of the American Medical Association.
Reges and her team conducted a retrospective cohort study that involved 8,385 people diagnosed with obesity, all of whom had had some type of weight loss surgery (either laparoscopic banding, gastric bypass, or gastrectomy) between 2005 and 2014, and 25,155 people who followed alternative obesity management programs, as advised by their physicians.
Obesity management interventions included counseling sessions that targeted diet and working to improve eating behaviors. The participants in the two groups were matched as closely as possible for age — with a median age of 46 — and biological sex.
The final follow-up date for all of the participants was December 31, 2015.
After analyzing the data obtained from these cohorts over a period of approximately 4.5 years, Reges and colleagues found that the individuals diagnosed with obesity who had undergone bariatric surgery had a lower rate of all-cause mortality than those who had opted for nonsurgical management.
The researchers argue that their study is relevant in the context in which much research has been conducted about the short-term outcomes of weight loss surgery, but information about its long-term outcomes is limited.
Specifically, they were interested in gathering more data about the associations between this type of intervention and all-cause mortality rates.
This kind of information, they say, had not been reliably available before, because previous studies were unable to compare the data for patients of bariatric surgery with those of individuals who had opted for nonsurgical interventions.
“This study is unique in that it is demonstrates lower rates of all-cause mortality during up to 11 years of follow-up compared to non-surgical patients,” Reges told Medical News Today.
“The present study has the largest aggregation of patients undergoing the three popular types of bariatric procedures,” she added, noting that the research team was “somewhat surprised to see how similar the impact on mortality was for all three types of surgery.”
Reges and her team, however, warn that their study is observational, so it is difficult to infer a direct causal relationship between bariatric surgery and lower death rates. The findings, they say, could be influenced by a range of different factors that the researchers were unable to control.
Other limitations include “group imbalance” created by matching the participants based on their age, sex, BMI, and an existing diagnosis of diabetes.
Nevertheless, the authors conclude that their study will enrich the existing resources addressing the health outcomes of various obesity treatments. They write:
“The evidence of [the] association [between bariatric surgery and lower all-cause death rates] adds to the limited literature describing beneficial outcomes of these three types of bariatric surgery compared with usual care obesity management.”
Following these “reassuring results,” Reges told MNT, the team plan to “study in depth each specific outcome and population subgroup to reach further insights and inform local and global policy.”
Dieting by Weight Loss Surgery
Those who are what is considered morbidly obese have few options when it comes to losing weight when time is of the essence. Many have bounced from one diet to the next for the vast majority of their lives only to find failure after failure and a growing sense of hopelessness and helplessness.
One common misconception when it comes to the morbidly obese is that they did it to themselves and if they didn't want to be overweight they wouldn't be. While this is nice in theory it isn't always true in practice. There are certain medical conditions that can result in a person being unable to control the weigh they gain. There are also environmental issues that can affect the weight of a person as well. It's ironic that in many cases alcoholics and drug addicts are treated and viewed with greater compassion than someone who is obese.
The surgery itself is major surgery and not an option that should be taken lightly and without a great deal of thought. Most people find that weight loss surgery involves a major change in lifestyle before and after as well as an entirely new way of eating that is a lifelong commitment. Because of the life altering changes that result from this surgery it is recommended that those receiving the surgery have a BMI that is greater than 40. This means that it is recommended for men who are greater than 100 pounds overweight and women who overweight by 80 or more pounds.
You should carefully weigh the benefits and the risks of a surgery such as this before deciding that this is the course of action you need to take. The risks are great with this surgery and should not be overlooked in desperation to shed the weight you've wanted to shed for so long. Nutritional deficiencies occur in almost 20% of those who have received this sort of surgery as the result of insufficient nutrients. This can lead to osteoporosis and other conditions as you age. Complications can result from the surgery itself. You can have lifelong issues when consuming too much or the wrong sorts of foods, and there are some who achieve their goals only to find that the weight comes back in time. As with anything in life there are no guarantees when it comes to weight loss surgery.
In order to determine whether or not this surgery will be beneficial to you, you may want to ask yourself the following questions.
Is my weight significantly hampering day-to-day activities?
Is my weight causing other secondary conditions that may be harmful to my health?
Is my weight something I honestly feel I can take control of on my own?
Can I commit to the lifelong consequences and follow up that will be required?
The problem with most people who find the need to resort to weight loss surgery is that they cannot take control of their bodies back. The odds of a good candidate for weight loss surgery losing the weight of his or her own design are very slim as he or she has most likely tried and failed every diet in the books.
Only you can determine whether or not weight loss surgery is a viable option for your weight loss needs. If you decide that this is something you are interested in learning more about, be sure to discuss the possible consequences thoroughly with your physician.