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Work absenteeism, presenteeism lower after bariatric surgery
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One year after undergoing bariatric surgery, adults with severe obesity missed fewer work shifts and worked fewer shifts compromised by a medical condition than they did before surgery, study data show.
However, absenteeism rates were not substantially changed from presurgical levels 2 and 3 years after the procedure.
David R. Flum, MD, MPH, director of the Surgical Outcomes Research Center at the University of Washington in Seattle, and colleagues evaluated data from 1,773 adults (baseline median age, 45 years) with severe obesity (median BMI, 46 kg/m2) undergoing bariatric surgery between February 2005 and February 2009 at 10 U.S. centers for the Longitudinal Assessment of Bariatric Surgery-2 study. Participants self-reported work status at baseline and annually after surgery using the Work Productivity and Activity Impairment questionnaire. Follow-up was conducted for 3 years until October 2012.
Most participants underwent Roux-en-Y gastric bypass (71%), and 24% underwent laparoscopic adjustable gastric band. At 3 years, weight loss was 28%.
There were no significant changes throughout follow-up from presurgery values for prevalence of employment or disability. From presurgery to year 3, unemployment increased from 3.7% to 5.6% (P = .02).
The work productivity sample included 1,092 participants. Compared with presurgery values, the prevalence of absenteeism was lower at 1-year follow-up (10.4% vs. 15.2%; P = .003); however, no significant differences were found between presurgery levels and years 2 and 3.
At all postsurgery times, prevalence of presenteeism was lower compared with presurgery levels (62.8% at baseline; 31.9% at year 1; 35.6% at year 2; 41% at year 3).
Lower risks for postsurgery absenteeism and presenteeism were independently associated with improvements in physical function and depressive symptoms. Postsurgery initiation or continuation of psychiatric treatment compared with no treatment before and after surgery were associated with higher risks.
“The small increase in unemployment by year 3 may reflect a secular trend in unemployment during the time of the study; the annual average rate of unemployment increased from 4.5% in 2007 to 8% in 2012,” the researchers wrote. “The reduction in presenteeism following surgery may be explained by weight loss, improved physical function or reduction in depressive symptoms. The increase in presenteeism between years 1 and 3 may reflect an adaptation to a new health state or deterioration of initial presurgery to postsurgery improvements.” – by Amber Cox
Disclosure: Flum reports being an adviser for Pacira Pharmaceuticals, providing expert testimony for Surgical Consulting and receiving travel expenses from the Patient-Centered Outcomes Research Institute. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Caroline M. Apovian
Bariatric surgery (most notably the Roux-en-Y gastric bypass and the sleeve gastrectomy procedures) is the only durable treatment for severe obesity as defined by BMI over 40 kg/m2 in that a significant amount of weight can be lost (28%-33%) and kept off long term. Severe obesity is associated with both metabolic and anatomic consequences, such as type 2 diabetes, cardiovascular disease, sleep apnea and osteoarthritis.
This study looking at work status and productivity after bariatric surgery asks a complicated question because of the typical timing of bariatric surgery in the life trajectory of the patient suffering from severe obesity. The average age in this study was 45 years, with 80% of the participants being women. Results did not show differences in employment rates presurgery and postsurgery, and percentage of disabled patients did not change. However, of those patients who were employed and stayed employed, presenteeism (any impairment while working due to health) and percentage reduction in productive work due to health problems did decrease significantly postsurgery.
I believe this is the most important take away from this study. If the patient is still employed and remains employed after surgery, quality of life and productivity improves. Unfortunately, many patients with severe obesity at this stage of midlife may already have such devastating metabolic and anatomic comorbidities of obesity that the surgery is too late even though it is not too little, at least for the workplace. Certainly bariatric surgery in this age group has been shown to reduce comorbidities and even decrease mortality when looking at longer-term data. So I think that this study is important and asks an important question: Would disability rates improve if bariatric surgery is performed earlier in the life trajectory of the patient with obesity?
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