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Life expectancy

Surgery reduces life expectancy for super obese diabetics

A 45-year-old woman with diabetes and a BMI45 gained an additional 6.7 years of life expectancy with bariatric surgery
Life expectancy decreased once BMI reached 62 with bariatric surgery

Bariatric surgery improves life expectancy for many obese diabetic patients, but it may cut life expectancy for patients who are super obese with very high body mass indexes, according to a University of Cincinnati researcher. The findings in the paper 'Impact of Bariatric Surgery on Life Expectancy in Severely Obese Patients With Diabetes: A Decision Analysis', were published in the Annals of Surgery.

"For most patients with diabetes and a BMI greater than 35, bariatric surgery increases life expectancy," said Dr Daniel Schauer, assistant professor in the Division of General Internal Medicine at UC. "However, the benefit of surgery decreases as BMI increases. The patients with a BMI over 62 likely don't gain any life expectancy with surgery."

Daniel Schauer

Schauer and a team of researchers developed a decision analytic model to compare life expectancy in a group of severely obese diabetic individuals who had bariatric surgery to a group that did not have bariatric surgery. They used data involving approximately 200,000 patients from three HMO Research Network sites as well as data from the Nationwide Inpatient Sample and the National Health Interview Survey linked to the National Death Index.

The model used data from three large cohorts: (1) 159,000 severely obese diabetic patients (4185 had bariatric surgery) from 3 HMO Research Network sites; (2) 23,000 subjects from the Nationwide Inpatient Sample; and (3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index.

In the main analyses of the study, researchers found that a 45-year-old woman with diabetes and a BMI45 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery versus 31.7 years without). However, the gain in life expectancy decreased once BMI reached 62 with bariatric surgery. Similar results were seen for both men and women in all age groups. The study did not look at differences associated with race.

"This was surprising. We expected those with higher BMIs to benefit more from bariatric surgery," said Schauer, also a UC Health physician and member of both the UC Cancer Institute and the Center for Clinical Effectiveness.

Super obese patients may have had diabetes for a longer duration and are more likely to have complications after surgery resulting in adverse health outcomes, explains Schauer.

About 15 million adults in the US suffer from severe obesity, which is defined as having a BMI>35. Obesity and diabetes are closely linked and severe obesity increases the risk of diabetes by more than seven-fold, says Schauer.

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