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JAMA Study Shows Bariatric Surgery May Not Lower Mortality Rates in Older Obese Veterans

June 16, 2011

Matthew Maciejewski, Ph.D., a VA HSR&D investigator at the Center for Health Services Research in Primary Care at the Durham Veterans Affairs Medical Center in Durham, N.C., recently published a study describing mortality rates after bariatric (weight-loss) surgery. The study, which was published in the June 12 online issue of JAMA, The Journal of the American Medical Association, showed that for extremely obese Veterans who are middle-aged or older, bariatric surgery may not lower mortality rates.

Dr. Maciejewski's study analyzed data from 850 Veterans who had bariatric surgery between January 2000 and December 2006 at one of 12 VA medical centers. Researchers compared those patients to a similar number of severely obese, high-risk Veterans who did not have the weight-loss surgery, but who had received usual care from the same facilities. Among patients who had bariatric surgery, 74% were male and 26% were female. Their average age was 49, and the average body mass index (BMI) was 47, which is considered severely obese. When researchers compared mortality rates between the two groups, results showed that having bariatric surgery did not decrease mortality during the 6.7 year follow-up period.

These findings differ from previously published research, some of which had shown a modest improvement in survival rates. However, many of these studies were conducted with younger, female, or healthier populations, while Dr. Maciejewski's study looked at an older, predominantly male group, many of whom had co-morbidities, such as diabetes. The authors do not suggest that bariatric surgery be discontinued for this population, as the resulting weight loss has been shown to improve disease control and quality of life. The authors also noted that post-surgical mortality is just one aspect of what is, overall, a cost-effective intervention for eligible patients.

These important study findings were reported by the Associated Press and carried by MSNBC, The Chicago Tribune, and US News & World Reports, among others.

Maciejewski M, Livingston E, Smith V, et al. Survival among High-Risk Patients after Bariatric Surgery. JAMA (online) June 12, 2011.