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Surgery for super-obese elderly patients

Bariatric surgery effective in super-obese elderly patients

The study demonstrated that bariatric surgery in elderly super-obese patients has profound effects on weight, obesity-related health problems and quality of life

Bariatric surgery results in impressive weight loss, improvement in obesity-linked diseases and good quality of life in the super-obese elderly patient, according to a study by surgeons from St George’s hospital, London, UK.

It is as effective in super-obese elderly patients as in less-obese elderly patients. These findings may have far-reaching implications for the allocation of health-care resources.

The paper. 'Super-Obesity in the Elderly: Is Bariatric Surgery Justified?', published in Obesity Surgery in September 2015 evaluated the results of bariatric surgery on 50 elderly patients (>60 years), 26 of whom were super-obese (BMI>50).

Bariatric surgery is by far the best method to achieve sustained weight loss and improve health problems caused by obesity, according to a recent Cochrane review. The proportion of patients that are both elderly and super-obese is on the rise. In 2007-2010 in the USA, 35% of adults aged 65 years or over were obese.

Traditionally, being elderly and being severely obese are both factors considered to increase the risk of any surgery. Retrospective studies looking at small numbers of patients have also suggested that the relative benefit of bariatric surgery may be less in older than younger people, and less in more severely obese than moderately obese patients. Therefore until recently patients that were both elderly and super-obese have been considered particularly ‘high risk, low benefit’ candidates for bariatric surgery.

However, the findings of surgeons at St George’s challenge this view.

The surgeons compared the outcomes of a consecutive group of elderly patients between January 2011 and October 2012 between those that were morbidly obese (BMI 35-50) and those which were super-obese (BMI >50).

Of the 50 patients studied, all had at least one health problem linked to obesity, including diabetes in 56%. Most patients underwent sleeve gastrectomy or gastric bypass, and all operations were completed laparoscopically. The average length of hospital stay for the patients was 2 days. There was one mortality in the 30-day period after surgery, and four additional patients were re-admitted with complications.

Co-author of this article, Conor McGlone

The patients were followed up for at least 18 months. All patients lost significant amounts of weight: on average just under 60% of their excess weight. The super-obese dropped on average 16.9 BMI points, while the morbidly-obese dropped 10.7. As expected, however, a greater proportion of the super-obese remained obese (BMI>30) at the end of the time period (68% vs 33%).

Prevalence of all obesity-related health problems decreased to a comparable extent in both groups of patients. Quality of life was measured with a validated bariatric questionnaire (Moorehead-Ardelt), which asked questions regarding self-perceived pleasure from sex, ability to work, approach to food, social contacts, enjoyment of physical activities and overall well-being.  

Co-author of this article, Emma Rose McGlone

Results were similar between the two groups, with generally positive responses regarding the latter four categories. Several patients left blank the questions relating to sex and work, which may reflect inadequacies of current methods for measuring quality of life post-bariatric surgery in this age group.

The study demonstrated that bariatric surgery in elderly super-obese patients has profound effects on weight, obesity-related health problems and quality of life. These effects were similar to those found in a comparable group of less obese patients. Although there is a risk of mortality in elderly patients undergoing bariatric surgery, it is worth considering recent findings of a large American study which showed that bariatric surgery in the veteran population improved all-cause mortality at 5 and 10 years compared to age-matched controls.

The St George’s study chimes with the findings of another recent American study, 'Bariatric and metabolic outcomes in the super-obese elderly', which analysed 30 super-obese patients over 65 years undergoing bariatric surgery. In this group there were no mortalities, and patients also experienced good weight loss and resolution of comorbidities after bariatric surgery.

This paper was co-authored by Conor McGlone and Emma Rose McGlone from St George’s hospital, London, UK

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