Stop the presses! Bariatric surgeons admit obesity does not increase risk of dying or risks for heart disease

Today brought another unbelievable example of ad-hoc reasoning, as well as a remarkable admission that the war on obesity is without scientific merit. It appeared in a paper published in the journal for the American Society for Bariatric Surgery (now called the American Society for Metabolic and Bariatric Surgery), which is edited by the Society’s president, Dr. Harvey Sugerman, M.D. FACS.

The article, “Do current body mass index criteria for obesity surgery reflect cardiovascular risk?” was “work presented at the 2005 American Society for Bariatric Surgery Meeting in poster form.” The authors, led by Edward H. Livingston M.D. at the University of Texas Southwestern School of Medicine, reported that many of the conventional risk factors for cardiovascular disease “decreased with increasing degrees of obesity.”

Yes, you read that correctly, decreased.

“Massively obese individuals might have better CVD risk profiles than less obese individuals,” they concluded. “Therefore, the criteria for obesity surgery should be changed to lower BMIs than are currently used.”

This twist of logic is reminiscent of the new American Heart Association’s Guidelines for Cardiovascular Disease Prevention in Women which admitted that virtually all heart disease occurs in women without “risk factors,” so rather than admit the risk factors themselves are problematic, they argued that therefore, all women of lower “risk” should be treated for these “risk factors.”

As JFS has repeatedly emphasized, fears about extreme obesity are greatly exaggerated. While fat women are most targeted for bariatric surgeries, as Dr. Livington reported in 2004: “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.” And we can't forget that the most extremely "morbidly obese" woman still has a longer life expectancy than a normal weight man. This is so not about fat or health.

So a press release went out today from U.T. Southwestern School of Medicine***, entitled “BMI Criteria for Obesity Surgery Should be Lowered,” describing this paper:

U.T. Southwestern Medical Center researchers have found that the existing body mass index criteria for obesity surgery often excludes a group of obese patients at risk of cardiovascular disease. The study, appearing in the December issue of the journal Surgery for Obesity and Related Diseases... “Our results show that cardiovascular risk factors do not necessarily worsen with increasing obesity,” Dr. Livingston said. “They also support the concept that obesity, by itself, doesn’t trigger an adverse cardiovascular risk profile or increased risk of death.”

Stop the presses! The bariatric surgeons admitted that obesity is not the cause for cardiovascular risk factors, nor that obesity increases the risk of death. How many mainstream media outlets will report this? If obesity itself is not the cause, treatment focused on weight, rather than actual causes and health issues, is without merit. The press release goes on to describe their paper:

The researchers examined patient data from the Third National Health and Nutrition Examination Survey (NHANES) database for the presence of known cardiovascular risk factors as a function of obesity....findings show that some morbidly obese patients have better cardiovascular disease risk profiles than those who are less obese. In particular, the researchers found that cardiovascular risk factors can be much worse in many individuals with a BMI as low as 30 than they are for some surgical candidates with higher BMIs.

This suggests that some patients who are obese but not morbidly obese could benefit from bariatric surgery, which can help reduce cardiovascular disease, said Dr. Livingston.

How might these patients benefit? They hypothesize that fussing with cardiovascular risk factor profiles (lab numbers) that haven’t proven relevant among the more obese, will somehow benefit people less obese. Of course, this was not a clinical trial providing any supportive evidence for any potential benefits of improved lifespan or reduced heart disease mortality.

What they are proposing is to lower the BMI criteria for bariatric surgery to include BMIs of 30 to <35 — yet those are precisely the BMIs associated with lower risks of premature death than even those of “normal” weight, according to the CDC National Center for Health Statistics. As reported, nonsmokers with ‘class I obesity’ (BMI 30 to <35) had 23% lower risks than ‘normal’ weight people. [NOTE: This is an example of why it is important to accurately report findings. The obesity paradox is not just for those “overweight,” as reported in the popular press.]

If these bariatric researchers are concerned about heart disease deaths, they only have to look at the body of evidence showing a protective effect of obesity among heart patients, even those with the highest rates of diabetes, high cholesterol and high blood pressure. The huge randomized INVEST trial of people with heart disease and hypertension, for example, demonstrated that the obese, BMIs 30 - <35, had the lowest risks for all-cause mortality, heart attacks and strokes — nearly half that of “normal” weight patients. Only at the very highest BMIs did the risks begin to creep up but they were still less than the underweight and most notably less than the ‘normal’ weight patients.

To sum up, they want to treat those with the lowest actual chances of dying, using a treatment so risky it’s been shown to increase the risks of dying by nearly 400% among those at the highest risks? This is a risk-benefit ratio that goes against all medical practice ethics and integrity.

It is just as Dr. Livingston had written in the October issue of Archives of Surgery, after reviewing the two largest and most objective studies on mortalities following bariatric surgery. The high mortality rates “called into question the risk-benefit ratio for operations.”

© 2007 Sandy Szwarc. All rights reserved