Surgery for Obesity:
Psychosocial and Medical Outcomes
JARL S:SON TORGERSON
With surgery, unlike other strategies for treating obesity, large and long-standing weight losses can be achieved in a majority of eligible patients (see Chapter 101). There are also substantial improvements in cardiovascular risk factors and health-related quality of life. Perioperative mortality associated with surgical treatment is less than 0.5%. Against this background, obesity surgery as a therapeutic approach is justified in its own right.
A fundamental problem in all obesity treatment is the lack of unequivocal scientific evidence showing beneficial effects of weight loss on mortality. On the contrary, several observational epidemiological studies indicate that weight reduction is related to increased mortality, even in subjects who are obese at baseline. A detailed analysis of this apparent paradox is beyond the scope of this chapter. However, since surgically induced weight loss is maintained long-term, it can serve as a model for the effects of voluntary weight reduction on obesity-related mortality. This is in fact the scientific credo of the ongoing intervention, Swedish Obese Subjects (SOS) study, in which the effects of surgery (substantial weight loss) or conventional treatment (weight-stable control group) on mortality in 2,000 matched patient pairs will be followed over 20 years.
Health-related quality of life (HRQL) is a broad concept that includes aspects of functional limitations in daily life as well as mental well-being (see Chapter 70). Both diseasespecific and generic instruments are used to measure different HRQL dimensions. Compared to normal-weight subjects, obese individuals suffer from a reduced HRQL. In fact, it is as poor as in patients with cancer recurrence. Many obese persons who seek