Background
Obesity is increasing and, along with it, greater mortality resulting from the overweight
condition. Weight-reduction surgery is recommended for many obese patients based on
a perceived risk of greater obesity-related mortality. However, many of the studies
cited to justify this have aggregated patient groups together, making it difficult
to apply their findings to individual patients.
Methods
The combined National Health Interview Survey database from the years 1986-1994 that
has been linked to the National Death Index was analyzed. Patients were stratified
for their body mass index (BMI) category, the presence or absence of diabetes and
hypertension, gender, and race. The contribution of hypertension and diabetes to mortality
was determined by Cox proportional hazards modeling. The absolute magnitude that the
effect gender, race, BMI, hypertension, and diabetes had on mortality was determined
by examination of stratified age-adjusted death rates.
Results
We analyzed 662,443 records from individuals interviewed between 1986 and 1994. Of
these, 49,391 had died in the follow-up period (mean follow-up, 7.2 years; range,
1-14 years). Cox proportional hazards modeling—adjusting for age, race, and gender—revealed
that hypertension (hazard ratio = 1.35 [95% CI 1.34-1.35], P < .0001) and diabetes (hazard ratio = 2.29 [95% CI 2.28-2.29], P < .0001) increased mortality independent of body weight. Serious obesity was associated
with an increased mortality by Cox modeling (hazard ratio = 1.72 [95% CI 1.71-1.73], P < .0001); however, when assessed by stratified age-adjusted mortality rates, this
increase was numerically small because of the relatively low mortality rate for those
without hypertension or diabetes. The presence of hypertension or diabetes substantially
increased age-adjusted mortality rates. Much of the increased mortality observed in
diabetic patients was attributable to complications of diabetes and not necessarily
from atherosclerosis.
Conclusion
Because weight-loss surgery successfully cures hypertension or diabetes in most obese
patients, it should be considered for obese patients having these diseases. Based
on the greatly elevated mortality associated with diabetes, surgery may be justified
for obese diabetic patients with BMIs lower than the currently accepted criteria.
In contrast, for the morbidly obese without diabetes or hypertension, mortality is
only slightly increased from obesity alone. In terms of mortality, the benefits of
weight reduction resulting from weight-loss surgery are less clear if there is no
coexistent diabetes or hypertension.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Varying body mass index cutoff points to describe overweight prevalence among US Adults: NHANES III (1988 to 1994).Obes Res. 1997; 5: 542-548
- Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.Ann Intern Med. 1991; 115: 956-961
Methods for Voluntary Weight Loss and Control. Proceedings of NIH Technology Assessment Conference. Bethesda, Maryland, 30 March-1 April 1992. Ann Intern Med 1993;119:641-770.
- Body-mass index and mortality in a prospective cohort of US adults.N Engl J Med. 1999; 341: 1097-1105
- Years of life lost due to obesity.JAMA. 2003; 289: 187-193
- Coronary mortality and its prediction in samples of US and Italian railroad employees in 25 years within the Seven Countries Study of cardiovascular diseases.Int J Epidemiol. 1995; 24: 515-521
- The effect of age on the association between body-mass index and mortality.N Engl J Med. 1998; 338: 1-7
- Body weight and mortality among women.N Engl J Med. 1995; 333: 677-685
- The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies.Int J Obes. 1996; 20: 63-75
- The direct health care costs of obesity in the United States.Am J Public Health. 1999; 89: 1194-1199
- Annual deaths attributable to obesity in the United States.JAMA. 1999; 282: 1530-1538
- An overview of body-weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I—Epidemiologic Follow-up Study.J Clin Epidemiol. 1991; 44: 743-753
- Relative weight and mortality in US blacks and whites: findings from representative national population samples.Ann Epidemiol. 1997; 7: 383-395
- Body-fat distribution and 5-year risk of death in older women.JAMA. 1993; 269: 1254
- Overweight and mortality.Cancer. 1986; 58: 1826-1829
- Body-mass index and mortality among nonsmoking older persons: the Framingham Heart Study.JAMA. 1988; 259: 1520-1524
- Variations in mortality by weight among 750,000 men and women.J Chronic Dis. 1979; 32: 563-576
- Body-mass index and patterns of mortality among 7th-day-adventist men.Int J Obes. 1991; 15: 397-406
- Body mass and 26-year risk of mortality among women who never smoked: findings from the Adventist mortality study.Am J Epidemiol. 1997; 146: 1-11
- Body mass and 26-year risk of mortality from specific diseases among women who never smoked.Epidemiology. 1998; 9: 246-254
- The effect of age on the association between body-mass index and mortality.N Engl J Med. 1998; 338: 1-7
- Annual deaths attributable to obesity in the United States.JAMA. 1999; 282: 1530-1538
- The influence of obesity on health.N Engl J Med. 1974; 291: 178-185
- Obesity: adverse effects on health and longevity.Am J Clin Nutr. 1979; 32: 2723-2733
- A prospective study of obesity and risk of coronary heart disease in women.N Engl J Med. 1990; 322: 882-889
- Body weight and longevity: a reassessment.JAMA. 1987; 257: 353-358
- Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants.Am J Epidemiol. 1993; 137: 235-241
DOCUMENTATION: National Health Interview Survey Multiple Cause of Death Public Use Data Files 1986-1994, Survey Years 2000.
- Contribution of major diseases to disparities in mortality.N Engl J Med. 2002; 347: 1585-1592
- Combining National Health Interview Survey datasets: issues and approaches.Stat Med. 1995; 14: 669-677
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. National Heart, Lung, and Blood Institute, Bethesda, Md1998 (NIH publication 98-4083)
- Obesity: preventing and managing the global epidemic: report of a WHO consultation presented at the World Health Organization June 3-5, 1997.WHO, Geneva, Switzerland1997 (Publication WHO/NUT/NCD 98.1)
- Epidemiology and consequences of obesity.J Gastrointest Surg. 2003; 7: 438-442
- Obesity and its surgical management.Am J Surg. 2002; 184: 103-113
- Technical review on obesity.Gastroenterology. 2002; 123: 1752
- National trends in utilization and in-hospital outcomes of bariatric surgery.J Gastrointest Surg. 2002; 6: 855-861
- The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus.J Gastrointest Surg. 1997; 1: 213-220
- Who would have thought it? an operation proves to be the most effective therapy for adult-onset diabetes mellitus.Ann Surg. 1995; 222: 339-350
- Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss.Ann Surg. 2003; 237: 751-756
- Body weight, blood pressure, and mortality in a cohort of obese patients.Am J Epidemiol. 2002; 156: 239-245
- Body weight, pre-existing disease, and all-cause mortality in a cohort of male employees in the German construction industry.J Clin Epidemiol. 1997; 50: 1099-1106
- Is the relationship between blood pressure and cardiovascular risk dependent on body-mass index?.Am J Epidemiol. 1985; 122: 434-442
- Higher risk of cardiovascular mortality among lean hypertensive individuals in Tecumseh, Michigan.Circulation. 1994; 89: 703-711
- Enhanced risk of coronary heart disease mortality in lean hypertensive men.Hypertension. 1987; 10: 22-28
- Body-mass index and cardiovascular mortality at different levels of blood pressure: a prospective study of Norwegian men and women.J Epidemiol Community Health. 1995; 49: 265-270
- Why do lean hypertensives have higher mortality rates than other hypertensives: findings of the Hypertension Detection and Follow-Up Program.Hypertension. 1991; 17: 553-564
- Relation of low body mass to death and stroke in the systolic hypertension in the elderly program.Arch Intern Med. 2000; 160: 494-500
- Obesity in adulthood and its consequences for life expectancy: a life-table analysis.Ann Intern Med. 2003; 138: 24-32
- The Swedish Obese Subjects (SOS) study: rationale and results.Int J Obes. 2001; 25: S2-S4
- Relation of body fat distribution to ischemic heart disease: the National Health and Nutrition Examination Survey I (Nhanes-I) Epidemiologic Follow-Up Study.Am J Epidemiol. 1995; 142: 53-63
- Cardiovascular disease risk factors and mortality among black women and white women aged 40-64 years in Evans County, Georgia.Am J Epidemiol. 1986; 123: 209-220
- Body mass index and fat patterning as correlates of lipids and hypertension in an elderly, biracial population.J Gerontol. 1993; 48: M249-M254
- The body mass index-mortality relationship in white and African American women.Obes Res. 1998; 6: 268-277
- Body mass index and 15-year mortality in a cohort of black men and women.J Clin Epidemiol. 1990; 43: 949-960
- Underestimation of relative weight by use of self-reported height and weight.Am J Epidemiol. 1987; 125: 122-126
Article info
Publication history
Accepted:
May 15,
2004
Dallas, Tex, and Los Angeles, CalifIdentification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
