This research was AMAZING. The outcomes were also quite good.
The SPLENDID study, which was recently published in the medical journal JAMA, found that persons with obesity who had undergone bariatric surgery were 32 percent less likely to develop obesity-related cancer and 48 percent less likely to die from obesity-related cancer than those who had not.
SPLENDID isn't just someone yelling the word "splendid" in ALL CAPS in this situation. Surgical Procedures and Long-Term Effectiveness in Neoplastic Disease Incidence and Death is an acronym that would otherwise be a mouthful. One of the keys to a good study, as many medical researchers will tell you, is coming up with a catchy acronym for the study. And what works better than bragging about how you came up with the acronym SPLENDID?
A matched-cohort study is what the SPLENDID trial was. A matched cohort study is when you follow a group of people who received some form of intervention and then compare them to a control group that is identical to the intervention group but for the fact that they did not get the intervention.
This required first identifying a group of 5,053 adults who had been diagnosed with obesity and subsequently had bariatric surgery at the Cleveland Clinic between 2004 and 2017. Then it was matchmaking time. The Cleveland Clinic's research team (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). The study was classified as a 1:5 matched cohort study because of the one-to-five ratio. There were 25,265 patients in the control group. 77 percent of the 30,318 patients in the research were female, and 73 percent were White. Their median age was 46, and their average follow-up period was 6.1 years.
Obesity-related cancer was defined by the research team as the 13 forms of malignant cancers that the International Agency for Research on Cancer Handbook Working Group has identified as being linked to obesity based on existing evidence. Esophageal adenocarcinoma, renal cell carcinoma, postmenopausal breast cancer diagnosed at 55 years of age or after both ovaries were removed, a type of stomach cancer, colon cancer, rectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, ovarian cancer, uterine cancer, thyroid cancer, and multiple myeloma were among the cancers that were found.
So, in the years that followed, were there any disparities between what happened to the post-bariatric group and what happened to the control group? In a nutshell, yes. After a decade, the post-bariatric surgery group had a 19.2 percent larger weight loss than the control group, resulting in an average of 24.8 kg more decreased body weight. In the post-bariatric surgery group, significantly fewer patients acquired obesity-related cancer (2.9 percent vs. 4.9 percent) and died from obesity-related cancer (0.8 percent vs. 1.4 percent) than in the control group.
Of course, having bariatric surgery isn't the same as wearing a shacket. It's not something you can just put on and forget about. The procedure must be performed by a surgeon who is sufficiently qualified and competent. Furthermore, after the operation, the patient must put in a lot of effort and make proper lifestyle changes in order to lose enough weight to potentially benefit from cancer preventive benefits. "Our data imply that individuals need to shed a significant amount of weight, around 20-25 percent," Aminian said, "to see a good shift in cancer risk." "That is substantially greater than the 5-10% weight loss threshold that is normally required to demonstrate a reduction in the risk of cardiovascular disease or mortality in obese people," he continued.
Of course, no matter how AMAZING the research was, it was not without flaws. A cohort study like this can only find links and correlations, not prove cause and effect. Is there a difference between people who have had bariatric surgery and those who have not? Perhaps they are more motivated, and as a result are more likely to have led healthier lifestyles in general, lowering their cancer risks. Furthermore, what occurred at the Cleveland Clinic may not be applicable to all health-care settings and organizations.
Nonetheless, the findings of this study were not very surprising. The 13 malignancies that have been labeled as obesity-related are, in fact, obesity-related. As a result, effectively treating obesity, such as losing weight, could help reduce the risk of certain malignancies. "The current standards promote weight loss for cancer risk reduction," Aminian explained. "These guidelines are supported by our findings." Instead of relying solely on lifestyle changes, cancer prevention requires the use of effective and long-lasting drugs and procedures, such as bariatric surgery." To put it another way, for many people, lifestyle changes alone may not be enough to reduce weight. And, in the correct conditions, bariatric surgery may be able to provide the extra help required.
Furthermore, this isn't the first study to show a link between bariatric surgery and improved health outcomes. Members of this research team, such as Schauer, Aminian, Brethauer, and Nissen, published a study in the New England Journal of Medicine in February 2017 that showed that people with obesity who underwent bariatric surgery had better control of their type 2 diabetes than those who relied solely on intensive medical therapy. Aminian also led another study, which indicated that bariatric surgery was linked to a 60 percent lower incidence of severe Covid-19, as I reported for Forbes in January.
This new study adds to the growing body of data that bariatric surgery can significantly improve a person's life. Bariatric surgery is not for everyone, to be sure. Who should be considered possible candidates for bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery (ASMBS):
"BMI 40, or more than 100 pounds overweight."
Type II diabetes (T2DM), hypertension, sleep apnea and other respiratory illnesses, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease are all obesity-related co-morbidities.
Prior weight loss initiatives failed to achieve a healthy weight decrease that lasted for a long time."
And just because you're a possible candidate doesn't mean you should receive bariatric surgery right away. It simply implies that you should talk to a real, qualified bariatric and metabolic surgeon about the option. "Obviously, we can't provide bariatric surgery to the United States' 100 million obese people," Aminian explained. "However, obese patients with precancerous lesions should be strongly examined for effective weight loss procedures, such as bariatric surgery." In other words, describing bariatric surgery as cancer-prevention surgery could be a GENIUS idea.
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