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Despite benefits, risks remain after bariatric surgery
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Patients with obesity who underwent bariatric surgery had increased risks for depression, anxiety, sleep disorders and treatment with opioid drugs vs. those who received lifestyle and medical interventions, according to findings.
However, surgery was more likely to decrease the risks for obesity-related comorbidities, researchers reported.
“The detrimental effects of bariatric surgery should not be underestimated in the shared decision-making process, and the patients who do not want surgery should be offered evidence-based nonsurgical treatment alternatives,” Jøran Hjelmesæth, MD, PhD, head of the Morbid Obesity Centre at Vestfold Hospital Trust in Norway, told Endocrine Today.
Hjelmesæth and colleagues evaluated data from a tertiary care outpatient center at Vestfold Hospital Trust on 1,888 adults (mean age, 43.5 years; mean BMI, 44.2 kg/m2; 66% women) to compare obesity-related comorbidities after bariatric surgery (n = 932) or specialized medical treatment (n = 956). Follow-up was a median 6.5 years after the start of treatment.
The specialized medical treatment included individual or group-based lifestyle intervention programs.
No differences were observed between the two groups for the proportion treated with drugs for hypertension, diabetes, dyslipidemia, depression or anxiety and sleep disorders at the start of treatment; however, there were more opioid users in the surgical group than the medical treatment group. After the start of treatment, the prevalences of hypertension, diabetes and dyslipidemia were lower (P < .001 for all) and the prevalences for depression and (P = .004) and opioid use (P < .001) were higher in the surgical group than in the medical treatment group.
The surgical group compared with the medical treatment group had a higher likelihood for hypertension remission (31.9% vs. 12.4%; RR = 2.1; 95% CI, 2-2.2) and a lower risk for developing new-onset hypertension (3.5% vs. 12.2%; RR = 0.4; 95% CI, 0.3-0.5).
The surgical group compared with the medical treatment group had a higher likelihood for diabetes remission (57.5% vs. 14.8%; RR = 3.9; 95% CI, 2.8-5.4) and dyslipidemia remission (43% vs. 13.2%; RR = 2.6; 95% CI, 2.4-2.8). The surgical group compared with the medical treatment group had a lower risk for new-onset diabetes (0.3% vs. 7.5%; RR = 0.07; 95% CI, 0.03-0.11) and dyslipidemia (1.1% vs. 6.4%; RR = 0.3; 95% CI, 0.2-0.4) and higher risks for new-onset depression (8.9% vs. 6.5%; RR = 1.5; 95% CI, 1.4-1.7), anxiety and sleep disorders (12.2% vs. 9.4%; RR = 1.3; 95% CI, 1.2-1.5) and treatment with opioids (19.4% vs. 15.8%; RR = 1.3; 95% CI, 1.2-1.4).
Adverse events were also higher in the surgical group compared with the medical treatment group: at least one additional gastrointestinal surgical procedure (31.3% vs. 15.5%; RR = 2; 95% CI, 1.7-2.4), operation for intestinal obstruction (8.7% vs. 0.8%; RR = 10.5; 95% CI, 5.1-25.5) and abdominal pain (26.1% vs. 13.5%; RR = 1.9; 95% CI, 1.6-2.3).
“It is well-known that bariatric surgery has several beneficial and large short- and long-term effects on serious obesity-related comorbidities,” Hjelmesæth said. “However, the results of the present study suggest that both physicians and patients should be more aware about the potential long-term detrimental effects of bariatric surgery, such as increased risk of drug-treated depression (50% increased risk in present study), anxiety and sleep disorders (30%) and opioid use (30%). In addition, patients who underwent bariatric surgery had a twofold increased risk of specialist-treated abdominal pain and any gastrointestinal surgery.”
Hjelmesæth said future research should focus on development of more efficient nonsurgical treatment strategies and weight stabilization after weight loss. – by Amber Cox
For more information:
Jøran Hjelmesæth, MD, PhD, can be research at joran.hjelmeseth@siv.no.
Disclosures: The authors report no relevant financial disclosures.
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