A study of Cleveland Clinic patients found that adults with obesity who had undergone bariatric … [+]
This study was SPLENDID. And the results were pretty good too.
As described in a recent publication in the medical journal JAMA, the SPLENDID study showed that adults with obesity who had undergone bariatric surgery ended up being 32% less likely to have subsequently developed obesity-related cancer and 48% less likely to have died from obesity-related cancer than those who hadn’t undergo such surgery.
Here’s a tweet from Ali Aminian, MD, the lead author of the study and director of Cleveland Clinic’s Bariatric & Metabolic Institute, about the study:
In this case, SPLENDID isn’t just someone yelling the word “splendid” in ALL CAPS. It’s an acronym for Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death, which would otherwise be a mouthful. As many medical researchers may tell you, one of the keys to a good study is coming up with a good acronym for the study. And what works better than telling folks that you came up with a SPLENDID acronym?
The SPLENDID study was what’s called a matched-cohort study. A matched cohort study is when you select a group of people who got some type of intervention to follow and then select a control group for comparison that is similar to the intervention group in every way except for not getting the intervention.
This involved first identifying a cohort of 5,053 adults who had started off with obesity and then undergone bariatric surgery at the Cleveland Clinic sometime in the 2004 to 2017 time period. Next came the matching time. For every one of these adults, the research team from the Cleveland Clinic (Aminian, Rickesha Wilson, MD, Abbas Al-Kurd, MD, Chao Tu, MS, Alex Milinovich, Matthew Kroh, MD, Raul J. Rosenthal, MD, Michael W. Kattan, PhD, Jame Abraham, MD, and Steven E. Nissen, MD), Ohio State University Wexner Medical Center (Stacy A. Brethauer, MD), Louisiana State University (Philip R. Schauer, MD, and Justin C. Brown, PhD) and Case Western Reserve University (Nathan A. Berger, MD) identified five adults who were similar in demographics and clinical history but hadn’t undergone bariatric surgery as the control group. That one-to=five ratio made the study a 1:5 matched cohort study. This control group amounted to 25,265 patients. Of the 30,318 total patients the study, 77% were female, and 73% were White. Their median age was 46 years, and the median length of follow-up was 6.1 years.
The research team defined obesity-related cancer as the 13 types of malignant cancer that the International Agency for Research on Cancer Handbook Working Group has deemed associated with obesity based on available studies. These cancers included esophageal adenocarcinoma, renal cell carcinoma, postmenopausal breast cancer that was either diagnosed at 55 years of age or older or occurred in those who had had both of their ovaries removed, a certain type of stomach cancer, colon cancer, rectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, ovarian cancer, uterine cancer, thyroid cancer, and multiple myeloma.
There were significant differences between what happened to the post-bariatric group and the control group in the ensuing years. After a decade, the post-bariatric surgery group had an average of 19.2% greater weight loss, amounting to an average of 24.8 kg more lost body weight, than the control group. Significantly smaller percentages of the patients had developed obesity-related cancer (2.9% vs. 4.9%) and died from an obesity-related cancer (0.8% vs. 1.4%) in the post-bariatric surgery group compared to the control group.
Of course, just getting bariatric surgery is not enough. The surgery can help people lose weight when accompanied by appropriate lifestyle modifications. Aminian emphasized that “Our data suggest that patients need to lose a large amount of weight, over 20-25%. to see a beneficial change in the cancer risk.” He added, “That is much higher than the 5-10% weight loss threshold that is usually required to observe a reduction in risk of cardiovascular disease or mortality in patients with obesity.”
Of course, no matter how SPLENDID the study may have been, it did have its limitations. Such a cohort study can only identify associations and correlations and not demonstrate cause and effect. Could those who have undergone bariatric surgery be on average be different from those who have not? Maybe they are more motivated and thus more likely to have lived healthier lifestyles in general and reduced other cancer risks.
Nevertheless, the results from this study weren’t super surprising. Labelling the 13 cancers as obesity-related means that they are obesity-related. Thus, properly treating obesity such as reducing body weight should help decrease the risk of such cancers. “For the purpose of cancer risk reduction, the current guidelines recommend weight loss,” Aminian explained. “Our findings support these guidelines. However, instead of focusing on lifestyle modification only, treating obesity with effective and durable medications and interventions such as bariatric surgery are required for cancer prevention.” In other words, lifestyle modifications are simply not enough for certain patients. And bariatric surgery can provide that extra assistance.
A surgical team at The Hospital Of Meaux 77, France. prepares for a sleeve gastrectomy under … [+]
Plus, this certainly wasn’t the first study to demonstrate potential links between bariatric surgery and better health outcomes. For example, members of this research team, including Schauer, Aminian, Brethauer, and Nissen, had also published a study in the New England Journal of Medicine back in February 2017 that showed how those with obesity who underwent bariatric surgery had better control of their type 2 diabetes than those who had intensive medical therapy alone. And as I covered for Forbes back in January, Aminian led another study that showed how bariatric surgery was associated with around a 60% lower risk of severe Covid-19.
This latest study does add to the growing body of evidence that bariatric surgery can make a big difference in a person’s life. Again, bariatric surgery is not for everyone. The American Society for Metabolic and Bariatric Surgery (ASMBS) has very clear guidelines on who should be a potential candidate for bariatric surgery:
- Body Mass Index (BMI) ≥ 40, or more than 100 pounds overweight.
- BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
- Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
And potential candidate doesn’t automatically equate to should definitely get bariatric surgery. It simply means that it may be worthwhile discussing the possibility with a real, experienced bariatric and metabolic surgeon. “Obviously, we can’t offer bariatric surgery to 100 million people with obesity who live in the United States,” said Aminian. “However, patients with obesity who have pre-cancerous lesions should be strongly considered for effective weight loss therapies including bariatric surgery.” Cancer-prevention surgery could be a SPLENDID way to think about bariatric surgery.
