Association of bariatric surgery with indicated and unintended outcomes: An umbrella review and meta‐analysis for risk–benefit assessment

Abstract

SummaryBariatric surgery can cause numerous functional changes to recipients, some of which are unintended. However, a systematic evaluation of wide‐angled health benefits and risks following bariatric surgery has not been conducted. We systematically evaluated published systematic reviews of randomized controlled trials and observational studies reporting the association between bariatric surgery and health outcomes. We performed subgroup analyses by surgery type and sensitivity analysis, excluding gastric band. Thirty systematic reviews and 82 meta‐analyzed health outcomes were included in this review. A total of 66 (80%) health outcomes were significantly associated with bariatric surgery, of which 10 were adverse outcomes, including suicide, fracture, gastroesophageal reflux after sleeve gastrectomy, and neonatal morbidities. The other 56 outcomes were health benefits including new‐onset diabetes mellitus (DM) (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.19–0.79), hypertension (OR = 0.36; 95% CI = 0.33–0.40), dyslipidemia (OR = 0.33; 95% CI = 0.14–0.81), cancers (OR = 0.65; 95% CI = 0.53–0.80), cardiovascular diseases (CVDs), and women's health. Surgery is associated with reductions in all‐cause mortality and death due to cancer, DM, and CVD. Bariatric surgery has both beneficial and harmful effects on a broader than expected array of patients' health outcomes. An expansion of the indication for bariatric surgery could be discussed to include a broader population with metabolic vulnerabilities.

The relationship between weight-adjusted-waist index and suicidal ideation: evidence from NHANES

“…Several studies documented that the prevalence of suicidal ideation or depressive symptoms increases with BMI [ 34 , 35 , 38 , 39 ]. However, due to BMI's limitations, including its inability to differentiate between excess fat, muscle, or bone mass, and its failure to discern body fat distribution across different locations, some studies are beginning to experiment with other indicators.…”

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits

“…The current data indicate that the perioperative mortality rates of BST range from 0.03% to 0.2%, which has substantially improved since the early 2000s [8,9]. A recent review of 66 health outcomes of bariatric surgery has shown that 56 outcomes were health benefits, including new-onset of diabetes, dyslipidemia, cardiovascular diseases, hypertension, cancers, women's health, and reductions in all-cause mortality and 10 were adverse outcomes, including suicide, fracture, gastroesophageal reflux after sleeve gastrectomy, and neonatal morbidities, but none of the adverse outcomes reached a high level of evidence, warranting the need for further investigation.…”

“…However, Nutrients 2024, 16, 1466 2 of 13 emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Different types of bariatric surgery have distinct auxiliary and adverse effects, emphasizing the importance of individualized selection of procedures and risk-benefit conversations for each patient considering bariatric surgery [8,9].…”