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Weight-loss Surgery: The Quick Fix May Be Better Than You Think – Two New Studies Show How

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According to the U.S. Centers for Disease Control and Prevention (CDC), obesity affects a significant 42.4% of Americans. Extensive research demonstrates that obesity can weaken the body’s immune system, trigger chronic inflammation, and heighten the risk of numerous diseases and conditions, including cardiovascular disease, stroke, type 2 diabetes, certain cancers, and COVID-19.

For individuals with obesity, bariatric surgery stands out as the most effective approach for achieving sustainable weight loss, despite being the most invasive option available. While scientific studies have shown that diets do not yield long-term success for the majority of individuals, surgical reduction of the stomach’s size proves highly effective and may surpass certain popular drug treatments in terms of efficacy.

Moreover, bariatric surgery, also known as Metabolic surgery or weight-loss surgery not only leads to weight loss but also significantly reduces the risk of heart failure, heart attack, stroke, and atrial fibrillation in patients with moderate to severe obstructive sleep apnea (OSA), as indicated by a study presented by Cleveland Clinic.

Additionally, another recent study reveals that patients with diabetes who have undergone metabolic surgery experience significantly fewer heart attacks, strokes, hospitalizations, and deaths compared to matched patients who did not undergo the surgery.

In the first study, researchers reveal that patients who underwent metabolic surgery experienced a significant 40% reduction in the risk of death.

Obstructive sleep apnea (OSA) is a hazardous sleep disorder that affects nearly 1 billion adults worldwide, with approximately 70% of OSA patients also having obesity. Obesity can lead to the accumulation of excess fat around the upper airway, causing compression and obstructing breathing during sleep. The standard treatment for OSA is continuous positive airway pressure (CPAP), which alleviates symptoms but does not provide a cure or reduce the risk of major adverse cardiovascular events (MACE) or death, both of which are prevalent among OSA patients.

The study lead author, Dr. Ali Aminian, Director of Bariatric and Metabolic Institute at the Cleveland Clinic and a Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, emphasized, “No other therapy has been shown to reduce the risk of dying or developing heart attack or heart failure in patients with obesity and obstructive sleep apnea. Bariatric surgery is a very powerful tool that can help patients with sleep apnea live longer and healthier lives.”

In this cohort study comprising 13,657 patients from the Cleveland Clinic diagnosed with obesity and moderate to severe obstructive sleep apnea (OSA), 970 patients underwent gastric bypass or sleeve gastrectomy, while 12,687 matched patients received CPAP or standard non-surgical care between 2004 and 2018. The patients were monitored until September 2022 for major adverse cardiovascular events (MACE), which included all-cause death or cardiovascular disease.

After a 10-year follow-up period, MACE occurred in 27% of patients in the bariatric surgery group, in comparison to 35.6% in the nonsurgical group. Furthermore, the bariatric surgery patients who maintained an approximate 25% weight loss experienced a 37% lower rate of all-cause mortality (9.1% vs. 12.5%) compared to those in the nonsurgical group, who achieved less than a 5% weight loss.

Dr. Teresa LaMasters, President of the American Society for Metabolic and Bariatric Surgery (ASMBS), a bariatric surgeon, and a board-certified obesity medicine physician, who was not involved in the study, highlighted the benefits of bariatric surgery in managing obesity-related OSA.

She said, “Bariatric surgery not only improves the symptoms of obstructive sleep apnea in patients with obesity, but largely reduces or eliminates the cardiovascular complications that can often occur alongside it compared to routine care. Patients and their doctors should strongly consider this option and determine if it’s right for them. Further studies may explore the threshold of weight loss required for optimal clinical impact on outcomes.”

Several studies have also demonstrated the ability of weight loss surgery to achieve diabetes remission in 60% to 80% of cases. However, little is known about the cardiovascular outcomes in patients with diabetes. Over time, high blood sugar levels can lead to damage to blood vessels and nerves that control the heart. Studies indicate that individuals with diabetes face double the risk of developing heart disease or experiencing a stroke compared to those without diabetes.

In the second study, researchers from the University of Oklahoma – Tulsa utilized the National Inpatient Sample Database (2016-2019) to compare outcomes between patients with diabetes who underwent metabolic surgery but still had the disease (70,083 patients) and patients receiving standard care for diabetes (348,212 patients). The patient groups were matched based on age, gender, race, socioeconomic status, and the Charlson Comorbidity Index, which predicts the risk, severity, and survival of individuals with various diseases, including diabetes.

The findings showed that patients with diabetes who underwent metabolic surgery reduced their likelihood of being hospitalized due to a heart attack by over 35%, a stroke by more than 25%, and congestive heart failure by nearly 15%. Additionally, if patients did encounter these or other complications, their risk of death was significantly lower. Patients who experienced a myocardial infection reduced their risk of death by slightly over 27%, while those with congestive heart failure and stroke reduced their risk by more than 40% and nearly 27%, respectively.

Source: ASMBS 2023 Annual Scientific Meeting

Image Credit: Shutterstock

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