Older adults fighting obesity with bariatric surgery: Benefits, side effects, and outcomes

Cost of Surgical Treatment of Obesity and Its Impact on Healthcare Expense-Nationwide Data from a Polish Registry

Weight loss surgery is linked to health benefits and may reduce the cost to the public healthcare systems. The aim of this study was to assess the cost and cost-structure in the one-year periods before and after a bariatric surgery in the Polish nationwide registry. The study included 2390 obese adults which underwent surgical treatment for obesity in 2017. The cost structure and the total costs per patient for one year before bariatric surgery, preoperatively, and for one year after surgery were analyzed. The total cost of the postoperative period was about PLN 3 million lower than during the preoperative period. After bariatric surgery, a reduction of approximately 59% in costs associated with hospital treatment was observed. The costs of outpatient specialist services, hospital treatment, psychiatric care, and addiction treatment also significantly decreased. There was a negative correlation between the changes in the cost of treatment of patients undergoing obesity surgery and their age. The health care cost during the period of one year after bariatric surgery is lower than in the year preceding the surgery (a greater cost difference is observed in younger people). This is mainly influenced by the reduction in costs associated with hospital treatment.

Long-term Impact of Laparoscopic Sleeve Gastrectomy on Drug Costs of Japanese Patients with Obesity and Type 2 Diabetes Mellitus

PURPOSE

Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases.

RESULTS

The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115 kg and 40.6 kg/m², respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5 years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75 years of median drug costs to treat T2DM and hypertension.

CONCLUSION

In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.

Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: Fact or Fiction?

Although type 2 diabetes mellitus (T2DM) has been traditionally viewed as an intractable chronic medical condition, accumulating evidence points towards the notion that a complete remission of T2DM is feasible following a choice of medical and/or surgical interventions. This has been paralleled by increasing interest in the establishment of a universal definition for T2DM remission which, under given circumstances, could be considered equivalent to a “cure”. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for T2DM. Herein, available evidence regarding available surgical modalities and the mechanisms that drive metabolic amelioration after bariatric surgery are reviewed. Furthermore, reports from observational and randomized studies with regard to T2DM remission are reviewed, along with concepts relevant to the variety of definitions used for T2DM remission and other potential sources of discrepancy in success rates among different studies.

What's Age Got to Do With It? A Comparison of Bariatric Surgical Outcomes Among Young, Midlife, Older and Oldest Adults

Bariatric surgery has become an accepted method to treat obesity and its related diseases in adults; nevertheless, few bariatric surgery follow-up studies compare changes in body mass index (BMI), disease outcomes, and side effects among age groups. This study compares bariatric surgery outcomes across four adult age groups by comparing changes in milestone BMIs such as highest and lowest BMI, perceived existing disease outcomes, and symptoms related to those diseases. Data were obtained using a 40-item questionnaire that was mailed to 2,520 patients of a Midwestern weight management center who were at least 18 months post-bariatric surgical procedure. The 534 respondents were divided into four age groups in years: 18 to 49 (n = 171), 50-59 (n = 148), 60-69 (n = 138), and ≥ 70 (n = 77). There were no differences among the age groups for lowest (p = .93) and current BMI (p = .51). Significant improvement in eight chronic diseases occurred across all age groups. There were no differences between age groups in reported occurrence of incontinence (p = .65), diarrhea (p = .22), flatulence (p = .46), heartburn (p = .73), and indigestion (p = .22). Constipation rarely occurred among the oldest adults (p < .001). Bariatric surgery should be considered an option for weight loss and disease management for older adults as much as it is for younger adults.