Effects of bariatric surgery on morbidity and mortality in severe obesity

Background Obesity is associated with premature mortality, particularly when very severe and/or complicated by significant co-morbidities such as diabetes mellitus, cardiovascular and respiratory disease. Conventional management of obesity, namely diet, exercise, behavioural modification and pharmacotherapy has limited and poorly sustained effects on weight loss and uncertain benefits for survival. Objectives We aimed to review the literature in to determine whether bariatric surgery for morbid obesity prolongs life. Search Strategy A Search was conducted of data bases including Medline, Cochrane library, and Science Direct. Results Bariatric surgery produces significant and sustained weight loss. Greater weight loss occurs with procedures that have both a restrictive and malabsorptive component. In addition to resolution of, or at least improvement in co-morbidities and enhanced quality of life, six studies provide compelling evidence that bariatric surgery significantly prolongs life, an effect which is most marked in diabetics and predominantly attributable to reductions in death due to cardiovascular causes and cancer. Conclusion Taken together, the cost, quality of life, and survival benefits provide a compelling argument for the provision of bariatric surgery as a management strategy of choice for severe obesity, particularly when associated with diabetes mellitus, or other factors conferring a significant cardiovascular risk. The optimal procedure and strategy for patient selection remains to be determined.