Weighing-up bariatric surgery for older patients

Are the potential benefits of weight-loss surgery for older patients being overhyped?

Among over 65-year olds, bariatric surgery can be very effective in facilitating significant weight loss, despite this age group generally being considered unsuitable for the procedure,  new research suggests.

According to a small observational study, bariatric surgery resulted in an average 24% weight loss among a cohort of morbidly obese older people, which was sustained at two years’ post-surgery.

In addition, the study found the health benefits of this weight loss were similar in this older population as with younger bariatric surgery patients. Namely dramatic improvements were seen in patients with type 2 diabetes, with half of those who were on insulin prior to surgery no longer requiring the injections two years post-procedure.

The study, recently presented at the Society for Endocrinology conference in the UK, involved 22 patients, all with a BMI greater than 40 and an average age of 67 who underwent either a sleeve  gastrectomy or Roux-en-Y bypass. At baseline,  half the patients were identified as having insulin-dependent type 2 diabetes. 

 “Our data suggests that successful weight loss and better glycaemic control can be achieved in the elderly and that age alone should not be considered a contraindication to bariatric surgery,” the Emerati authors said. 

 But Professor John Dixon, GP academic and the head of clinical obesity research at the Baker Heart and Diabetes Institute in Melbourne, said the study was unable to demonstrate that weight loss or diabetic remission, had any benefits for quality or longevity of life in older patients. 

 “It doesn’t focus on the specificities of age and it pretends that people in their late 60s, 70s and 80s are the same as people in their 20s, 30s and 40s and have the same concerns and problems,” he told The Medical Republic. 

 Older patients are often more concerned about function, muscle strength and frailty compared with younger patients undertaking bariatric surgery. However, to date the research into bariatric surgery, particularly in older patients is yet to study these factors.

 “What we do know is that bariatric surgery in an older population is likely to lead to a loss of muscle and bone mass when they lose weight,” Professor Dixon said.

 In addition, there is an increased risk of developing nutritional deficiencies in this age group.

 Professor Dixon conceded that, very occasionally bariatric surgery might be appropriate for someone older than 65, with a BMI greater than 40 and major functional problems related to their weight. 

 “But for most patients in their 60s and 70s, encouraging exercise and a healthy diet is the most important thing we can do to improve functionality – but we need to do this without the expectation of having them lose weight,” Professor Dixon said. 

 Professor Dixon said currently there were no Australian or international guidelines which suggested weight management in people over 70 was beneficial for cognitive function or quality of life. 

 In addition, given that the severity and likelihood of complications of type 2 diabetes was generally dependent on the duration of the disease, patients who were diagnosed after the age of 65 could commonly be well managed clinically without developing complications.  

 “That’s why I’m very proactive for young people in their late teens and 20s to have bariatric surgery because when they have diabetes as a young person, they’re in desperate trouble and many of these people won’t make it to 50 in the first place,” he said.