Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Open accessAbstract
BACKGROUND: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. METHODS: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). RESULTS: The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
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Bariatric surgery is the most effective treatment for severe obesity, resulting in 25-30% weight loss after the first postoperative year and around 20-25% weight loss long-term.
“For decades, bariatric surgery (BS) has been the most effective treatment for severe obesity, resulting in 25–30% WL after the first postoperative year and around 20–25% WL long-term [3].”
From Triple Agonism Based Therapies for Obesity (2025) · cites this paper as [3]
The introductory passage describes bariatric surgery as the only available technique with established long-term effects on weight loss, supporting the treatment comparison. But Weight Change (page not provided) reports peak losses after 1–2 years of 32%, 25%, and 20% by procedure, and 10-year losses of 25%, 16%, and 14%; it does not support the claimed ranges as general results after the first year and long-term. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe Swedish Obese Subjects study demonstrated an adjusted decreased overall mortality by 30.7% in the group of 2010 surgical patients compared with nonsurgical controls, at an average of 10 years after surgery.
“Representative studies include the Swedish Obese Subjects study demonstrated an adjusted decreased overall mortality by 30.7% in the group of 2010 surgical patients compared with nonsurgical controls, at an average of 10 years after surgery [17].”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [17]
The Abstract reports 2,010 surgical patients, 2,037 controls, and a mean follow-up of 10.9 years. The Overall Mortality section reports lower mortality after surgery, but its adjusted hazard ratio of 0.71 corresponds to an approximately 29% reduction in mortality hazard, not the claimed 30.7%. (LLM, conf=0.90)
Experimental — accuracy not yet measuredLong-term results of metabolic and bariatric surgery consistently demonstrate safety and efficacy.
“Long-term results of MBS consistently demonstrate safety and efficacy.”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [17]
The Overall Mortality and Weight Change sections report lower mortality and sustained weight loss after bariatric surgery, supporting long-term efficacy in this cohort. The Adverse Events section reports early deaths and substantial reoperation or conversion rates; the paper does not establish that MBS is consistently safe across procedures or settings. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAfter MBS, there is a decrease in overall mortality.
“After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality [15–19].”
After MBS, there is significant improvement of metabolic disease.
“After surgery, the significant improvement of metabolic disease, as well as the decrease in overall mortality, has been reported in multiple studies further supporting the importance of this treatment modality [15–19].”
A total of 8 articles were used across more than 1 component.
“A total of 8 articles were used across more than 1 component.141,142,144,148,156,159,168,169”
From 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2014) · cites this paper as [169]
Bariatric surgery is associated with short- and long-term improvements in major morbidity and all-cause mortality, particularly from cancers, diabetes, and cardiovascular diseases.
“more studies are now showing that these surgical procedures are associated with short-and long-term improvements in major morbidity and all-cause mortality, particularly related with cancers, DM, and CV diseases”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [82]
Bariatric surgery predicts long-term decreases in cardiovascular risk in obese patients.
“and also predict long-term decreases in CV risk in obese patients (81)(82)(83)(84)(85).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [82]
Obesity surgery can lower arterial pressure in the short term, over 2 to 3 years.
“Obesity surgery may reduce arterial pressure over the short term (2 to 3 years), but may not have a long-term (e.g., 6 to 8 years) effect to reduce HTN (82,86).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [82]
Obesity surgery may not reduce hypertension over the long term (6 to 8 years).
“Obesity surgery may reduce arterial pressure over the short term (2 to 3 years), but may not have a long-term (e.g., 6 to 8 years) effect to reduce HTN (82,86).”
From Obesity and Cardiovascular Disease (2009) · cites this paper as [82]
In the Swedish Obese Subjects (SOS) study, 10% of RYGB patients did not maintain ≥5% weight loss at 10-year follow-up.
“In the Swedish Obese Subjects (SOS) study, the first long-term prospective trial to provide information on the effects of BS, 10% of RYGB patients did not maintain ≥ 5% weight loss at 10-year follow-up [1, 5, 6].”
RYGB is considered one of the most effective bariatric surgery procedures, promoting both weight reduction and improvement of metabolism.
“There are a number of bariatric surgery procedures, of which Roux-en-Y gastric bypass (RYGB) is considered one of the most effective, promoting both weight reduction and improvement of metabolism (Sjöström et al., 2007; Werling et al., 2013a).”
From Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation (2015) · cites this paper as Sjöström et al., 2007
Partial or total remission rates in type 2 diabetes as high as 80% to 90% occur following bariatric surgery.
“Partial or total remission rates in type 2 diabetes as high as 80% to 90% have been observed to occur following bariatric surgery [40-45].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [41]
A prospective surgical intervention trial in 4047 obese patients with follow-up 4 to 18 years revealed significantly higher long-term weight loss in the bariatric surgical group led to marked overall reductions in mortality compared with controls.
“A prospective surgical intervention trial in 4047 obese patients with a follow-up period ranging from 4 to 18 years revealed that significantly higher long-term weight loss in the bariatric surgical intervention group led to marked, overall reductions in mortality compared with controls [41].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [41]
Compelling studies show both short- and long-term mortality are reduced in morbidly obese patients who undergo bariatric surgery.
“Compelling studies show that both short- and long-term mortality are reduced in morbidly obese patients who undergo bariatric surgery.”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [41]
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- Authors
- Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., Lystig, T., Sullivan, M., Bouchard, C., Carlsson, B., Bengtsson, C., Dahlgren, S., Gummesson, A., Jacobson, P., Karlsson, J., Lindroos, A.-K., Lönroth, H., Näslund, I., Olbers, T., Stenlöf, K., Torgerson, J., Ågren, G., & Carlsson, L. M. S.
- Affiliations
- Pennington Biomedical Research Center (US)
- University of Gothenburg (SE)
- Nordic School of Public Health (SE)
- MRC Elsie Widdowson Laboratory (GB)
- Örebro University Hospital (SE)
- Norra Älvsborgs Länssjukhus (SE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2007-08-23
- Volume
- 357
- Issue
- 8
- Pages
- 741-752
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2104183837
- Cited by
- 4,668
- References
- 57
- Citations by year
- 2026: 106 · 2025: 128 · 2024: 157 · 2023: 150 · 2022: 189 · 2021: 213 · 2020: 239 · 2019: 216 · 2018: 231 · 2017: 258 · 2016: 259 · 2015: 330 · 2014: 351 · 2013: 321 · 2012: 334
- FWCI
- 280.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Novo Nordisk
- Servier
- Medical Research Council
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- bariatric surgery, obesity, mortality, weight loss, gastric bypass, vertical banded gastroplasty, gastric banding, myocardial infarction, cancer mortality, Swedish Obese Subjects study
- MeSH terms
- Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Risk Factors, Sweden, Weight Loss, Body Mass Index, Multivariate Analysis, Case-Control Studies, Bariatric Surgery
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