Is bariatric surgery justified for the super-obese elderly?
Ample evidence supports the safety and effectiveness of bariatric surgery in the general adult population, but more information is needed in patients age 60 years and older (elderly). In England, in 2012/13, the annual Health and Social Care Information Centre (HSCIC) statistics show over 8,000 bariatric surgery procedures were performed. Many more surgical procedures were carried out on women than men (in 2012/13, 6,080 for women and 1,944 for men).
There has been no data until now on the efficacy of bariatric surgery in the super-obese elderly. A new study from combined hospitals in London identified 50 consecutive patients undergoing bariatric surgery aged 60 years or over, and compared the outcomes of the super-obese (BMI≥50; n=26) with those of BMI<50. Mean follow-up was 33 months. It was found there were no significant differences between the groups in terms of comorbidities, operation-type or peri-operative complications.
Since life expectancy is naturally limited in elderly patients, quality of life is an important outcome measure. The study found quality of life outcomes were as good, if not better, for super-obese elderly patients as compared to morbidly obese. This trend is potentially counter intuitive since the super-obese patients were heavier at the end of the study period, with a greater proportion remaining obese.
Therefore, although super obese elderly patients may not lose as much weight during bariatric surgery compared to their lighter counterparts, their quality of life is enhanced, thus bariatric surgery may be justified more psychologically then physically in this group. This leads to the super obese elderly having a more positive attitude that may help them control their weight and exercise more frequently.