When scares become deadly - weighing the actual risks of dying of obesity

The claims have been repeated so often that many people believe them to be true. But are they? Fat people, especially women, have been told that their obesity will kill them and that bariatric surgery is their best option to save their lives. They’re assured, even by our most trusted health organizations, that the risks of bariatric surgery are far less than the risks from extreme obesity.

The incessant news about the deadliness of their fat have terrified countless people. The claims also help justify the federal government’s spending of more than $600 million annually “to fight obesity.”

But when it comes to bariatric surgery, these are lives at stake, mostly those of young women. In order for people to make a truly informed decision about whether to elect surgery, they deserve the most objective, credible data available, not death threats and statistical manipulations being made to sell them on these surgeries. A few simple facts can help to put their real risks into perspective. It’s an easy math problem: compare the risks of dying from the most “morbid obesity” to the risks of dying from the surgeries. Incredibly, no one has....

As one patient recently told the Salt Lake Tribune, he believes he will be dead soon without bariatric surgery. He said his doctor told him: “You’re going to die if you don’t lose weight.” A recent bill mandating insurance coverage for bariatric surgeries was described in that same news report, with president of a bariatric surgery lobbying group adding urgency to fat people’s peril by saying: “People are dying while fighting their insurance companies to get weight-loss surgery.”

A 29-year old mother in Brighouse UK also thought surgery was her only option to see her little boy grow up. Her last note to her son, left under his pillow before she went into the hospital, said she was doing it for him because she would do anything for him, “even get the stars form the sky if I could.” Stories such as her’s make the news much less frequently. This young woman died from what was called a “routine surgery” and in the Halifx Courier article reporting her death an obesity surgeon said that the risks of dying from the surgeries are still less than those of obesity, a claim the bariatric industry continues to lead many patients to believe.

Risks: bariatric surgery compared to other elective surgeries

The risks of these surgeries are never carefully explained in a surgical context. As was discussed in a recent post, the most objective mortality data available to date found that 4.6% of patients die after having bariatric surgeries just within the first year. Most bariatric patients are women of childbearing age and such high surgical risks are not found in any other elective procedure done on such young patients, regardless of their size.

Overall post-op deaths from a hysterectomy among American women, for instance, is a mere 0.19%. Coronary artery bypasses are one of the most dangerous surgeries performed and are typically done on older patients, 75 years of age, on an emergency basis after a heart attack or other life-threatening event. Bariatric patients are comparatively young and healthy. Yet, the risk of dying from coronary bypass for the most obese man (BMI >36) is 1.3%, according to Dr. Paul Ernsberger, Ph.D., at Case Western Reserve School of Medicine, Cleveland, Ohio. That's 3 1/2 times lower than for bariatric surgery.

Which cause of death is rising fastest in our country: bariatric surgery or obesity?

While obesity is claimed to be a skyrocketing cause of death in our country, the facts don’t support such dire claims.

U.S. Centers for Disease Control and Prevention researchers in the June 2004 issue of the Journal of the American Medical Association reported that since 1999, the prevalence of obesity and extreme obesity, and hence any deaths “associated” with obesity and extreme obesity in our country, have increased in actual percentages only 0.1% and 0.4%, respectively, over the entire period (going from 30.5 to 30.6% and 4.7 to 5.1%). Significantly less than most people and probably most medical professionals realize.

By comparison, between 1999 and 2005, American deaths from bariatric surgeries have increased 607% (from an estimated 1,334 deaths in 1999 to 8,096 deaths in 2005, when about 176,000 surgeries were performed).

Clearly, the skyrocketing rate of deaths from bariatric surgeries compare extremely unfavorably to those of obesity.

Numbers dying from obesity

According to the latest CDC estimates, obesity may be associated with 112,000 excessive deaths each year, although even they note that their figures don’t account for actual causative factors such as bariatric surgeries, yo-yo-dieting, diet drugs, discrimination in healthcare, activity levels and socioeconomic status, to name a few. But taken as face value, 30.6% of the population labeled “obese” translates into 92,133,000 Americans. That means each year only 0.12 percent are possibly “dying from their obesity.”

Risks of dying from obesity

Over recent years, claims of the risks associated with body weight have used statistical models, although their flaws have been the topic of intense criticism in the medical literature. In contrast, throughout history, legitimate epidemiological studies have used actual deaths. The majority of body-weight and mortality studies published over the last half century have found weight to be irrelevant to health or mortality, except at the most extremes. And the lack of support for any relationship remains even when factors such as smoking, preexisting illness and length of followup are taken into consideration.

“Certainly there is no steady increase in mortality with increasing overweight,” according to Dr. Ernsberger and Paul Haskew in a comprehensive review of more than 400 papers in the Journal of Obesity and Weight Regulation. In fact, most show fatness especially as we age, to be particularly favorable for longevity.

The risks for the very fattest people are commonly exaggerated, as are their actual numbers. While the very most extremes of obesity represent a tiny fraction of our population, they are the ones typically depicted without heads on the news, giving the public a much different impression of obesity than is reality.

Since the vast majority of bariatric surgeries are done on fat women and they are being most frightened about their risks of dying, let’s consider their mortality rates. As researchers at the CDC National Center for Health Statistics reported in their analysis of existing studies in the 1996 issue of International Journal of Obesity & Related Metabolic Disorders, among women “there is little relationship between BMI and mortality.” The studies consistently show an especially wide range of body weights among women similarly optimal for longevity. According to research by Dr. Edward Harry Livingston, M.D, at the University of Texas Southwestern, “based on obesity alone, a woman was no more likely to die at a body mass index of 50 (approximately 310 pounds) than at 35.”

Launched as the world’s largest epidemiological study of BMI and life expectancies, which followed 1.8 million Norwegians for four decades, the Norway Study found that the most morbidly obese women with BMIs of 40 or above reduce their life expectancy about as much as “ideal” weight women who are light smokers. “However even these extremely obese women still have a longer life expectancy than normal-weight men,” said Ernsberger. Yet, we are not being inundated with scares about the deadliness of being male, millions aren’t spent to eradicate maleness, and men make up a fraction of bariatric patients.

“For a 25 year old woman who’s at the very fattest 0.2 percent of women, her risk of dying is 0.1 percent (0.18 percent if she were 35 years old),” according to Ernsberger. [The corresponding mortality rates for women of “ideal body weight” are 0.05% and 0.13%.]

In other words, a woman at the very fattest 0.2% of women has a 99.9 percent chance of living another year.

So, by having bariatric surgery a woman increases her risk of dying 45-fold.

Meanwhile, women even just 100 pounds over “ideal” weights are lining up for these surgeries with no idea just how much they’re risking their lives. And parents are signing on the dotted line for their teenage daughters.

More than 8,000 Americans — mostly young women — lost their lives last year from a procedure they were told offers them their only hope for survival. Yet, all of these women would likely still be alive a year later had they not had the surgery.

These surgeries aren’t about saving lives. The facts prove that. If these were innocent babies dying similarly painful, unnecessary and costly deaths, everyone would be furious. But these are fat women (and men)...our mothers, sisters, daughters, friends and wives (and our fathers, brothers, sons and husbands). Why are we not outraged?

“Find out just what people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them.” — Frederick Douglass, 1818–1895

© 2007 Sandy Szwarc