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Why Presence Of A Comorbidity May Not Be Enough To Decide Who Will Benefit From Bariatric Surgery



sharma-edmonton-obesity-staging-systemIrrespective of the fact that bariatric surgery has now become so safe (at high-volume centres) that it compares well with other common surgical procedures like having your gall bladder removed, it is still surgery.

As even the safest surgery carries risk, it should never be taken lightly and thus the question of whether or not people with obesity but no related comorbidities stand to benefit from bariatric surgery is an important question.

One of the key outcomes (at least for patients) is the impact on quality of life which is why Hilde Risstad and colleagues from the University of Oslo, studied the effect of bariatric surgery on patients presenting with obesity related comorbidities and those without, published in Obesity Surgery.

They studied 232 patients with severe obesity before and 2 years after Roux-en-Y gastric bypass.

Obesity related disease was defined as having at least one of the following conditions: type 2 diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, obstructive sleep apnea, gastroesophageal reflux disease, or osteoarthritis.

Not only was baseline quality of life similar in patients with and without obesity-related disease prior to gastric bypass but it also improved equally in both groups.

This may not be entirely surprising.

Readers may recall that the Edmonton Obesity Staging System (EOSS), specifically designed to asses obesity related health risks, does not just consider medical comorbidities (as in this study) – EOSS gives as much importance to mental and functional health (not assessed in this study).

Thus, it is not surprising, that even without the presence of an obesity related medical complications like diabetes or sleep apnea, health (and thus quality of life) can be significantly affected by mental health and/or functional status, both of which can markedly improve after bariatric surgery.

This is why, pre-assessment or triaging patients for bariatric surgery should not only consider medical problems but also mental and functional health – as in EOSS.

@DrSharma
Edmonton, AB

2 Comments

  1. Arya, I am wondering how the patients with comorbid conditions had similar quality of life scores prior to surgery. Many studies show that those with severe diabetes, heart disease etc. have lower quality of life vs a similar population without these conditions, was this a glitch in the study, or are patients with obesity different than patients without obesity?

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  2. You contention (that the EOSS would do a better job) seems fairly plausible, but do you have any data supporting it?

    For it to work in this data set, we would need people without comorbidities to have, on average, more mental and functional impairments. That does not seem very likely to me (their sample was too big for that).

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