ReviewBypassMortality - The n e w e ng l a n d j o u r na l...

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edi t or i a l s n engl j med 357;8 august 23, 2007 818 T h e new england journal o f medicine The Missing Link — Lose Weight, Live Longer George A. Bray, M.D. In this issue of the Journal, two articles — by Sjöström et al. 1 and Adams et al. 2 — may provide the missing link between intentional weight loss and lives saved for obese patients. For the past two decades, we have been living through an epidemic of obesity. 3,4 The prevalence of obe- sity has more than doubled in adults and has risen by a factor of more than 3 in children. This escalation in obesity is a time bomb for the fu- ture risk of diabetes and other illnesses and for the attendant costs. 5 With the increasing use of surgery to treat massively overweight patients in the 1980s, the National Institutes of Health (NIH) convened a Consensus Conference, which proposed that bar- iatric surgery should be considered for persons with a body-mass index (BMI, the weight in kilo- grams divided by the square of the height in meters) of more than 40 or of more than 35 in patients with coexisting illnesses. 6 The confer- ence group also concluded that bariatric surgery was appropriate only if other forms of treatment had failed. These opinions have been the primary guidelines for surgical intervention since they were published in 1991. 6 The results of the stud- ies by Sjöström et al. and Adams et al. may be taken to suggest that these criteria need to be reexamined. The National Heart, Lung, and Blood Insti- tute 3 and the World Health Organization 4 docu- ment that weight loss reduces many of the risk factors for increased death and disease that so often accompany obesity. After weight loss, inci- dent type 2 diabetes in persons with prediabetic conditions is reduced, hypertension and dyslip- idemia can be treated or controlled more easily, the quantity of visceral fat decreases, and the quality of life improves. What has been missing from the equation is a demonstration that im- provement in these risk factors translates into a longer life. Although we know that being over- weight shortens life expectancy, some epidemio- logic studies have suggested that weight loss may even worsen life expectancy. However, these stud- ies are confounded by an inability to determine whether weight loss was intentional or uninten- tional — and we have known for more than 2500 years that unintentional weight loss is often ominous. Therefore, the studies by Sjöström et al. and Adams et al. showing that weight loss lowers the rate of death are most welcome. Two earlier studies by Flum and Dellinger 7 and by Christou et al. 8 using cross-sectional methods suggested that bariatric surgery improved long-term survival. Sjöström and Adams and their colleagues address
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This note was uploaded on 03/01/2010 for the course NPB 97952 taught by Professor ? during the Fall '09 term at UC Davis.

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ReviewBypassMortality - The n e w e ng l a n d j o u r na l...

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