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Background Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality.
Methods The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%).
Results The average weight change in control subjects was less than ±2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29).
Conclusions Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
Source Information
From the Institutes of Medicine (L.S., K.N., K.K., T.L., M.S., B.C., A.G., P.J., J.K., K.S., L.M.S.C.), Anesthesiology (C.D.S., B.L.), Surgery (H.L., T.O.), and Primary Health Care (C. Bengtsson), Sahlgrenska Academy, Gothenburg University, Gothenburg; Nordic School of Public Health, Gothenburg (H.W.); Börjegatan 10B, Uppsala (S.D.); Department of Surgery, University Hospital, Örebro (I.N., G.A.); and Department of Medicine, Northern Älvsborg Hospital, Trollhättan (J.T.) — all in Sweden; Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (L.S., C. Bouchard); and Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge University, Cambridge, United Kingdom (A.-K.L.).
Address reprint requests to Dr. L. Sjöström at the Swedish Obese Subjects Secretariat, Vita stråket 15, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden, or at lars.sjostrom{at}medfak.gu.se.
Related Letters:
Bariatric Surgery and Mortality
van der Woude D., Beedupalli J., Beale M., Sjöström L., Lystig T., Carlsson L.
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N Engl J Med 2007;
357:2633-2634, Dec 20, 2007.
Correspondence
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