Sept. 23, 2022 - Weight Loss Surgery: Bariatric Surgery is Associated with Longer Life Expectancy

For this Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is joined by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS). Dr. Irgau specializes in bariatric surgery, which is also known as weight loss surgery. A person meets criteria for weight loss surgery when they are considered morbidly obese, when their body mass index (BMI) is at least 40. People who have a BMI of 35 with previously developed illnesses related to morbid obesity can also be eligible for bariatric surgery. Today the pair are discussing how bariatric surgery is associated with a longer life expectancy. For people who have morbid obesity, if they undergo bariatric surgery, they are likely to live longer than those who have not received bariatric surgery.

Many people do not see morbid obesity as a life-threatening condition but more so as a problem with appearance. Erkan explains a situation he had with a patient recently where they were offended because they were categorized as morbidly obese. Dr. Irgau then mentions how if the patient were to receive a comment warning them that they were at risk for colon cancer, the response would have been immensely different; the patient probably would have thanked Erkan for warning them of this problem. This is not just a one-off occurrence; this is a major issue in society. Dr. Irgau states, “obesity is the leading cause of disease… obesity is related to the most prevalent cause of death in our country.” Heart disease, cancer, stroke, and diabetes are all in the top ten leading causes of death in the United States, and they are all directly related to obesity. Obesity does not only trigger these correlated diseases but could make them exponentially worse in severity. If an individual is not aware of their obesity, it is a significant problem. Dr. Irgau explains, “obesity “is not really a question of willpower, it’s a question of biology. Our body, essentially, has been engineered to prefer a higher weight because, for the vast majority of our existence, we had not had enough food, so conserving food as long as possible is part of our genetic makeup.” He continues by saying, “when we live in a society that offers plenty of food, then obesity comes up”. There are other cultural factors that lead to an increase of weight as well such as the association of food with pleasure, social activities, and lack of mobility. Dr. Irgau noted that as health workers, they have to view obesity as a health threat because it can result in severe diseases like hypertension, stroke, diabetes, or cancer.

Bariatric surgery is not solely for individuals to lose weight and live a comfortable life; it is about improving an individual’s health. As more data is collected, it is noted that those who have had bariatric surgery are not only losing weight, but they are becoming healthier by having resolution of hypertension, less strokes, less cardiovascular diseases, and now more and more we are understanding cancer as well. Due to the resolution of these diseases people are living longer. Dr. Irgau shared, “and then we saw studies… the Swedish Obesity Subject Study… from 1987, they followed up with 2,000 patients who were morbidly obese who underwent bariatric surgery and about 2,000 patients who were morbidly obese but did not undergo bariatric surgery. On average, they were able to demonstrate that the ones who did have bariatric surgery lived longer.” In other words, Dr. Irgau explained, “there was excess mortality among the ones who did not have bariatric surgery, so there was data showing us that we what knew was absolutely true”. Up to 13 types of cancers are related to obesity. Being morbidly obese makes someone even more likely to develop life-threatening cancers. Accumulation of fat creates opportunity for disease. Unfortunately, only one percent of patients who are eligible for bariatric surgery seize the opportunity. “That’s what bariatric surgery is, a passport to a longer life for people who are suffering from morbid obesity,” Dr. Irgau stated. “A longer life, but also a better quality life,” Erkan adds. “It is important to take care of morbid obesity, not only because it is going to be

shortening life expectancy, but also even if you live longer, the quality of life with morbid obesity is going to be terrible because you are always going to be after medication, and after doctors and your mobility is going to be limited as well.” Dr. Irgau adds, “you don't have to do it all by yourself… there is a treatment that is available right now, and this treatment has been made as safe as it has ever been; it is important that people explore this.” Bariatric surgery has not reached a stage where it is prescribed. Dr. Irgau emphasizes, “we’re not saying you must have it, we’re saying consider it, be aware of it, don’t suffer in silence, explore those options.”

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