Study: Weight loss surgery patients with diabetes 40% less likely to suffer heart attack, stroke

Obesity and diabetes often go hand-in-hand and share many of the same comorbidities, an additional disorder that is found accompanying a primary disorder.

While lifestyle changes can help reduce these symptoms, they are not always enough to solve the problem. However, certain bariatric surgeries and procedures have been found to help reduce some of these comorbidities in patients who are obese or diabetic, and even reduce the possibilities of heart attacks, stroke and death.

These findings confirm what doctors have seen anecdotally for years.

"It's well established that diabetes by itself increases chances for stroke, heart attack or death," said Dr. Ijeoma Acholonu Ejeh, a surgeon with Ferncreek General Surgery. "Add obesity, and they've added to the risk. The bariatric surgery to get the weight off would help."

Bariatric surgery is another name for weight-loss surgeries such as gastric bypass, gastric sleeve and lap band surgeries.

The JAMA study included 5,054 Kaiser Permanente, 247 HealthPartners patients and 15,000 patients in a control group that all suffered from diabetes, had a body mass index of at least 35 or very similar characteristics. Those that received bariatric surgery had 67 percent fewer deaths and 40 percent fewer heart attacks and strokes within a five-year window than those that didn't receive bariatric surgery.

The bariatric surgery itself is beneficial, but patients are encouraged to continue with a healthy lifestyle after the fact to promote positive results.

"If you want to be successful with the operation, it's sort of a three-tier attack," said Dr. James Classen with Cape Fear Valley General Surgery Village Surgical. "One is eating less. Eating the right foods, and you've got to have the right exercise program. After the surgery, if you're going to eat mashed potatoes, grits and cheese, you're not going to lose a lot of weight."

For many patients, those lifestyle changes are part and parcel with pursuing bariatric surgery. The procedures are classified as elective — or optional — and insurance providers are looking for patients to be successful and retain positive results instead of backsliding into the bad habits that led to the initial surgery.

"I tell my patients you're with me for life," Ejeh said. "I see them two weeks after surgery, a month after surgery, then three months, then six months. After a year, I see them yearly."

These frequent checkups begin even before surgery, with both insurance providers and doctors looking for lifestyle changes and occasionally assisting with coaching and providing advice.

After surgery, patients are encouraged to meet with nutritionists, and doctors also recommended support groups. These support groups could be through the hospital where the surgery took place itself, through existing social organizations like church or work, or through a group like Weight Watchers or Nutrisystem. Support groups encourage continued positive lifestyle choices.

Those that aren't successful post-surgery are those that return to old habits or don't attend their follow-up sessions. Old habits are notoriously difficult to break, and the changes that come along with bariatric surgery can be significant.

Many potential patients for bariatric surgery are referred through a family physician or an orthopedic surgeon. It's not uncommon for someone exploring a knee replacement or back surgery due to weight to also be candidates for bariatric surgery.

For those who have done their own research and are curious if bariatric surgery is appropriate for them, hospitals and doctors will occasionally host educational seminars for interested individuals.

Ejeh's monthly seminar is free of charge and includes information about the cultural issues that have led to the current global rise in obesity. These informational seminars may help clear up any concerns patients have surrounding the surgeries, but after the fact, the consensus is clear.

"It's sort of a big decision," Classen said. "It's sort of like jumping into the swimming pool off the diving board — some people don't want to make that leap. Pretty much everybody that has it done says they should've done this earlier."

The study was not a randomized clinical trial, just an observational one, so its results are not definitive, but both Ejeh and Classen were not surprised by the results and were encouraged by the numerical data provided.

"It's not surprising to those of us in the medical background," Ejeh said. "We're a country of documentation and research. I know in my brain, 'Well, yeah!' Having a study to put a number to a stroke — that's extra strong proof that weight loss surgery can eliminate something that's debilitating."