While weight-loss surgeries are not usually performed in people above the age of 65, a new study shows that these procedures can lead to successful weight loss and better diabetes control in older adults. The study, presented at the Society for Endocrinology annual conference in Brighton, UK, indicates that elderly patients treated with bariatric surgery (gastric bypass or gastric sleeve) can recover well and have a reduced risk of obesity-related complications, including heart disease and diabetes.
Obesity is a growing, global health epidemic that needs more effective intervention strategies to avoid debilitating complications including heart disease, kidney failure and type 2 diabetes. Weight loss surgery is rarely recommended for obese adults over 65, due to perceived increased risk, yet the health and quality of life in this patient group can be severely affected for many years. As a consequence, very little data are available on the potential benefits or risks of weight loss surgery in elderly patients.
Dr Nader Lessan and study co-author Dr Saradalekshmi Radha, both from the Imperial College London Diabetes Centre in Abu Dhabi in the UAE, assessed the results of 22 patients who had attended their medical centre and who had undergone weight loss surgery after the age of 65. Two years after weight-loss surgery, the patients had, on average, lost 24% of their original body weight. In addition, of the 11 patients who had been on insulin to control their type 2 diabetes, four no longer needed it, while for others, the total insulin dose required had significantly decreased. The only adverse effects reported during the two year period were iron and vitamin D deficiencies, which happen in younger patients too.
Dr Lessan states, "Although based on a small number of patients, our data suggest that successful weight loss and improved diabetes control can be safely achieved with surgery in older patients, which could have real benefits for their longevity and quality of life."
As this study was retrospective using the limited data available, the next step would be to conduct a prospective, observational study among the older population. Then we could more effectively compare outcomes of surgery with other interventions such as medication or lifestyle modifications.
Dr Lessan comments, "Management of obesity and diabetes in old age is challenging. There is a lot of scepticism around conducting weight-loss surgery in patients over 65. Our study suggests these procedures could be considered in older adults as an effective intervention to aid weight loss and associated complications."
Conference abstract, observational study, human
Bariatric surgery outcomes amongst older obese patients: data from an Emirati cohort
Saradalekshmi Koramannil Radha, Maha T Barakat, Nader Lessan
Imperial College London Diabetes Centre, Abu Dhabi, UAE
Obesity is highly prevalent in the Middle East. Treatment is a challenge and with an aging population, therapy in the elderly poses new problems. Published data on efficacy of bariatric surgery in the older age groups are scant.
The objective of this study was to assess the outcomes of bariatric surgery (BS) in the elderly (?65years) in the UAE population.
ICLDC patient database was accessed to identify all patients with a history of BS after the age of 65. Anthropometric measurements, medications, diabetes status and HbA1c were extracted. Data are presented as median (interquartile range).
22 Emirati patients [12 females, age 66.9 (66.2- 67.8) years, BMI 43.6 (40.4 - 46.8) kg/m2, 19 with type 2 diabetes with a duration of 6.75 (2.94 - 13.21) years] who had sleeve gastrectomy (LSG, n=15) or Roux-en-Y gastric bypass (RYGB, n=7) were identified.
At two years after surgery there was significant weight loss of 23.9 (15.4 - 28.5) % (p< 0.001) with a BMI reduction of 10.8 (6.7 - 13.9) kg/m2. Total weight loss was comparable between LSG and RYGB (p= 0.238).
Median reduction in HbA1c was 0.9 (0.6 - 1.3) % at two years after surgery. Two patients who had impaired fasting glucose had normal glucose tolerance within six months after surgery. There was a significant dose reduction amongst insulin treated patients [n=11; 120 (70 - 165) versus 25 (20 - 35) units, p= 0.08)] with 4/11 patients completely off insulin. Duration of diabetes had no effect on weight loss or HbA1c reduction post BS. Reported adverse effects included iron and vitamin D deficiency (n=14).
Our data suggest 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.