Advertisement

Obesity Surgery

, Volume 28, Issue 4, pp 900–906 | Cite as

Bariatric Surgery to Reduce Mortality in US Adults. A Public Health Perspective from the Analysis of the American National Health and Nutrition Examination Survey Linked to the US Mortality Register

  • Maddalena Gaeta
  • Emanuele Rausa
  • Alexis E. Malavazos
  • Luigi Bonavina
  • Cornelius M. Smuts
  • Cristian Ricci
Original Contributions

Abstract

Background

Type II obesity represents a major pandemic and public health threat in high-income countries. Type II obesity increases the risk of all-cause and specific-cause mortality, and it is widely acknowledged that bariatric surgery represents the only effective therapeutic option in these patients. The aim of the present study was to estimate US population attributable risk for all-cause and cause-specific mortality in type II obese subjects undergoing weight loss as resulting from bariatric surgery alone and supplemented with behavioral intervention.

Methods

The American National Health and Nutrition Examination Survey linked to the US death registry updated to 2011 was used to estimate type II obesity prevalence and all-cause and specific cause of death for type II obese adults undergoing weight loss. Multivariate adjusted proportional hazard Cox models were used to estimate mortality risks. Statistical analyses were performed on the most updated version of the database (June 2017).

Results

A monotone positive trend for type II obesity was observed during the period 1999–2014 (p < 0.001). According to trend analysis, the rate of type II obesity in US adults is expected to rise up to 8.5%. Two- to sevenfold increased risk of all-cause and specific-cause mortality was observed for type II obese participants when compared to type I obese and overweight participants. Population attributable risk for all-cause and specific-cause mortality for type II obese subjects undergoing weight loss was ranging between 6 and 34%.

Conclusions

Bariatric surgery supplemented with behavioral intervention can result in a relevant reduction of mortality if extensively applied to the US population.

Keywords

Obesity surgery Mortality Population attributable risk USA 

Notes

Author Contribution

All authors participated in the final version of the manuscript and agreed on the current version.

Compliance with Ethical Standards

Ethical Considerations

The NHANES study has been approved by the NHANES Ethics Review Board (ERB) and received ethical approval by internal institutional review board and all participants signed informed consent (https://www.cdc.gov/nchs/nhanes/irba98.htm). NHANES data are collected anonymously and probabilistic linkage to the US death registry was performed (https://www.cdc.gov/nchs/nhanes/about_nhanes.htm).

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;2003(348):1625–38.CrossRefGoogle Scholar
  2. 2.
    Calle EE, Teras LR, Thun MJ. Obesity and mortality. N Engl J Med. 2005;353(20):2197–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Van Gaal LF, Mertens IL, Christophe E. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Segal-Lieberman G, Segal P, Dicker D. Revisiting the role of BMI in the guidelines for bariatric surgery. Diabetes Care. 2016;39(Supplement 2):S268–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.CrossRefGoogle Scholar
  8. 8.
    Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25(3):397.CrossRefPubMedGoogle Scholar
  9. 9.
    Ricci C, Gaeta M, Rausa E, et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients. Obes Surg. 2014;24(4):522.CrossRefPubMedGoogle Scholar
  10. 10.
    Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Rausa E, Bonavina L, Asti E, et al. Rate of death and complications in laparoscopic and open Roux-en-Y gastric bypass. A meta-analysis and meta-regression analysis on 69,494 patients. Obes Surg. 2016;26(8):1956–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Bond DS, Phelan S, Wolfe LG, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009;17(1):78–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Kinzl JF, Schrattenecker M, Mattesich M, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609.CrossRefPubMedGoogle Scholar
  14. 14.
    Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Buck land G, González C A, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M. Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol 2009; 170(12):1518–29.Google Scholar
  16. 16.
    Wareham NJ, Jakes RW, Rennie KL, et al. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2003;6(04):407–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim H-J, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health. 2007;121(7):492–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hsu LG, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60(3):338–46.CrossRefPubMedGoogle Scholar
  20. 20.
    Jacobi D, Ciangura C, Couet C, et al. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–77.CrossRefPubMedGoogle Scholar
  21. 21.
    Josbeno DA, Kalarchian M, Sparto PJ, et al. Physical activity and physical function in individuals post-bariatric surgery. Obes Surg. 2011;21(8):1243–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg. 2006;16(6):787–94.CrossRefPubMedGoogle Scholar
  23. 23.
    Livingston EH. The incidence of bariatric surgery has plateaued in the US. Am J Surg. 2010;200(3):378–85.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of HygieneUniversity of PaviaPaviaItaly
  2. 2.Division of General Surgery, Papa Giovanni XXIII HospitalUniversity of MilanBergamoItaly
  3. 3.Clinical Nutrition and Cardiovascular Prevention UnitIRCCS Policlinico San DonatoSan DonatoItaly
  4. 4.Department of Biochemical Sciences for Health, Division of General Surgery, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
  5. 5.Centre of Excellence for Nutrition (CEN)North-West UniversityPotchefstroomSouth Africa

Personalised recommendations