Bariatric surgery leads to better health and decrease in some cancers
February 22, 2024
Bariatric surgery is associated with sustained weight loss of 15-20%, and we know that this weight loss leads to substantial medical benefits, including improved blood sugar and blood pressure. Nonetheless, only 1% of those with obesity have had bariatric surgery, and the GLP-1 drugs represent a less invasive approach, if covered.
Research published this week in JAMA Network Open found the health of 133 people who had bariatric surgery was much improved over two years of follow-up.
40% of those operated on had improvements of cognition of over 20% on a standardized scale.
Brain imaging showed increased cortex in the temporal lobe, which could explain improved cognition.
More than half were able to discontinue their antihypertensive medications.
Depression scores decreased by two-thirds.
Inflammatory markers in the blood decreased.
Patients exercised more.
An article from late January in JAMA Surgery reviewed the medical literature and found that bariatric surgery led to statistically significant decreases in the diagnosis of cancers of the breast, endometrium and uterus. Studies showed either a decrease or no change in rates of stomach, esophageal, liver, and pancreatic cancer after bariatric surgery. Some of these studies might have been concluded too early, as the decrease in cancer risk could take decades to appear. Many studies showed no change in the rate of colorectal cancer after bariatric surgery, but the authors report on two studies that showed increases after bariatric surgery. This might mean that those who have had bariatric surgery should be screened for colorectal cancer more frequently.
Two types of bariatric surgery, traditional bypass (Roux en Y) and gastric sleeve, lead to loss of about half of excess body weight on average. A third type of bariatric surgery, adjustable gastric banding (or lap banding), leads to much less weight loss which is often not sustained; this surgery is now rarely performed. Bariatric surgery requires a committed patient and a multidisciplinary team in a dedicated center, and many plans require that bariatric surgery be performed at a center credentialed by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Implications for employers:
Weight loss from bariatric surgery is clearly associated with substantial increase in health. Improvement in cognition and inflammatory markers is especially heartening.
Obesity is associated with many cancers, and bariatric surgery can potentially help to lower those risks.
We don’t know if the cancer benefits of bariatric surgery will be replicated in people currently being treated with the GLP-1 anti-obesity medications.
This research provides further evidence that health plans should cover bariatric surgery for patients with severe obesity as a medically necessary service. Here are links to the American Society for Metabolic and Bariatric Surgery guideline for adults, and the American Academy of Pediatrics guidelines for children.
Some plans might consider easing access to bariatric surgery done at an accredited center, which over the course of a few years is less expensive than GLP-1 medications.
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Illustration by Dall-E