The Baby Boomer generation is aging and people are living longer today than ever before, a combination that is rapidly changing the composition of the world’s population. While only 10% of people were over 60 years of age in 2000, the United Nations projects that this number will increase to 21% by 2050 [1]. But even as we enjoy increased longevity, a new health crisis is emerging: developed nations are seeing obesity become a leading cause of preventable death [2]. Medical science is making advances in the fight against obesity, with bariatric surgery one of the most powerful weapons in its arsenal. Unfortunately, the tendency has been to discourage older patients from addressing their obesity with surgical methods.
Noting the rapidly aging population, several researchers have taken a closer look at the safety and efficacy of bariatric surgery among patients over the age of 50. A 2006 study among elderly patients in the US concluded that, although “the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality” [3].
LAP-BAND® Adjustable Gastric Banding System In Older Patients
Two additional studies, whose results are presented below, have found compelling evidence that at least one form of bariatric surgery, laparoscopic adjustable gastric banding (LAGB), is safe and beneficial for older patients:
Craig John Taylor and Laurent Layani, of the Obesity Surgery Centre at John Flynn Hospital in Queensland, Australia, conducted a prospective review on patients aged 60 or older who underwent LAGB between February 2000 and September 2005 [4]. All patients had a BMI greater than 40 or a BMI greater than 33 plus significant co-morbidities.
Rishi Singhal and colleagues, of the Heart of England NHS Foundation Trust, conducted a study which compared the outcome of LAGB in patients aged 50 and older with patients younger than 50 [5]. All patients had a BMI of 40 or above, or a BMI of 35 or above plus comorbidities. The study consisted of 1,335 patients, 1,137 of which were female.
Complications
Complications were few among the older patients, and there were no in-hospital deaths resulting from the LAGB procedure. The patients in the Taylor study, all aged 60+ years, experienced no complications during the LAGB procedure and only three later complications—one band slippage and 2 access port infections—which were all successfully treated. Of the 3 band slippages, 6 pouch dilations, and one band erosion observed among patients in the Singhal study, all but one partial slippage occurred in patients younger than 50 years.
Weight Loss
Both studies found that older patients saw significant weight loss with LAGB surgery. Patients in the Taylor study, who averaged 65.8 years of age, went from an average pre-surgery BMI of 42.2 to an average BMI of 32.9 in the 48 months following the LAGB procedure. Their excess weight loss was 54% after 2 years.
In the Singhal study, patients 50 years or older began with an average preoperative BMI of 43.8 and saw a steady increase in excess percent BMI loss over the following 3 years, from 25.9% at 3 months to 47.3% at 36 months. This weight loss was not significantly different than that experienced by patients younger than 50.
Comorbidities
Although the majority of patients in the Taylor study reported an improvement in obesity-related comorbidities, many patients continued to use the same amount of medication to treat these conditions even after LAGB. This is a departure from the results of younger obese patients, who generally require significantly less medication after bariatric surgery.
Quality of Life
Perhaps the most interesting aspect of the Taylor study was the look at quality of life. Before surgery, all patients completed the Medical Outcomes Study Short Form-36 (SF-36), a detailed preoperative quality of life assessment known to give valid and accurate results [6]. As might be expected, quality of life as measured preoperatively was lower among the patients than among their peers in the general population. When assessed again a little over two years after undergoing LAGB, the patients had significantly improved scores related to physical functioning, general health, mental health, and energy levels. In particular, nearly half saw improved sleep, 70% experienced an increase in self-esteem, and 72% reported a better outlook on life. And patients’ quality of life wasn’t improved only in relation to their presurgery responses—their mental and physical well-being actually exceeded that of the general population in several respects.
Conclusion: LAGB Safe and Effective For Older Adults
As the percentage of adults over 60 increases in the coming decades, the need for bariatric procedures among this age group will also increase. Fortunately, recent examinations suggest that the effective weight loss, improvement in comorbidities, and increased quality of life known to result from LAGB hold true even among older patients. The patient experience appears to be largely positive as well, with 82% of older patients happy they had undergone LAGB and 91% indicating they would recommend LAGB to other older people. The consensus in the medical community is that age should not be the deciding factor when considering weight loss surgery. Moreover, there are indications that older people experience a significant improvement in quality of life after undergoing LAGB, making their golden years truly a time to enjoy.
Matt Papa
Matt Papa, PhD, is a research scientist at Washington University School of Medicine. Matt closely follows the current scientific findings related to obesity and weight loss, and is empathetic to those who struggle with their weight. He strives to present relevant scientific research in layman’s terms, in the hope that his articles will help to educate and inform the public. He often gives away a promotional coupon for Nutrisystem and a discount coupon code for BistroMD.
References:
1. United Nations. World population prospects: the 2000 revision highlights. New York: United Nations; 2001. p. 14–5.
2. Washington Post, March 10, 2004; Page A01.
3. Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72(10):865–9.
4. Taylor CJ, Layani L. Laparoscopic adjustable gastric banding in patients > or =60 years old: is it worthwhile? Obes Surg. 2006; 16(12):1579–83.
5. Singhal R et al. Age ≥50 Does Not Influence Outcome in Laparoscopic Gastric Banding. Obes Surg. 2009; 19:418-421.
6. Ware JE, Sherbourne CD. The MOS 36 item Short-Form Health Survey (SF-36): Conceptual framework and item selection. Medical Care 1992; 30: 473-83.
