Life expectancy after bariatric surgery in the Swedish obese subjects study
Open accessAbstract
BACKGROUND: Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear. METHODS: We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population. RESULTS: In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery. CONCLUSIONS: Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population. (Funded by the Swedish Research Council and others; SOS ClinicalTrials.gov number, NCT01479452.).
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Bariatric surgery and endoscopic procedures are important therapeutic options in people with type 2 diabetes and ABCD.
“Bariatric surgery and endoscopic procedures are important therapeutic options in persons with T2D and ABCD.777–781”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [781]
The Discussion (page not provided) reports longer life expectancy after bariatric surgery in middle-aged patients with severe obesity and notes trials examining type 2 diabetes remission. The Results—Participants section (page not provided) shows that the cohort included people with diabetes, but the paper does not address endoscopic procedures or establish the claim for all people with T2D and ABCD. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn clinical trials comparing bariatric surgery with medical treatment in people with type 2 diabetes, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of type 2 diabetes in some people.
“In clinical trials comparing bariatric surgery vs medical treatment in persons with T2D, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of T2D in some persons.777–783”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [781]
The Discussion (page unavailable) says randomized trials have examined remission of type 2 diabetes after bariatric surgery, and the References list trials comparing surgery with medical treatment. This paper does not report the claimed greater short- or long-term A1C lowering or establish that remission occurred in some participants; its own outcome is life expectancy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA particular advantage of bariatric surgery is successful long-term maintenance of large weight losses.
“A particular advantage of bariatric surgery is the successful long-term maintenance of large weight losses, with data showing a mean BMI reduction of approximately 11 kg/m 2 at 1 year post-surgery, followed by a gradual weight regain on average until year 8, where it stabilized at approximately 7 kg/ m 2 less than the baseline BMI until 20 years post-surgery.98”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [98]
Large and sustained weight loss after bariatric surgery is accompanied by 23% and 30% reductions in all-cause and cardiovascular mortality, respectively, and a 3 year increase in life expectancy.
“This large and sustained weight loss is accompanied by 23% and 30% reductions in all-cause and cardiovascular mortality, respectively, and a 3 year increase in life expectancy.98”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [98]
After bariatric surgery, cardiometabolic health, cancer risk, and life expectancy may improve dramatically even if BMI remains in the obesity range.
“Maintaining a so-called normal body weight or BMI is unnecessary after having bariatric surgery as cardiometabolic health, cancer risk, and life expectancy may improve dramatically even if BMI remains in the obesity range (104–106).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [105]
Procedures such as RYGB and VSG are associated with significant metabolic improvements and reductions in NAFLD severity, including reductions in liver fat, liver enzymes, and fibrosis.
“Procedures like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are associated with significant metabolic improvements and reductions in NAFLD severity [13,14,15], including reductions in liver fat, liver enzymes, and fibrosis [16,17,18].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [14]
The Results (Participants; page not provided) list gastric bypass, banding, and vertical banded gastroplasty—not vertical sleeve gastrectomy. The Discussion reports a survival benefit, but the passages found by searching for NAFLD, liver fat, liver enzymes, fibrosis, and metabolic improvements do not address the claimed liver or metabolic outcomes. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe hazard ratio was 0.70 (95% CI 0.57-0.85) for cardiovascular death and 0.77 (95% CI 0.61-0.96) for death from cancer.
“The corresponding HR was 0.70 (95% CI, 0.57-0.85)for CV death and 0.77 (95% CI, 0.61-0.96)for death from cancer.75,76”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [75]
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Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass
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Risk of Esophageal and Gastric Cancer After Bariatric Surgery
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Obesity pharmacotherapy in older adults: a narrative review of evidence
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Risk for hepatic and extra-hepatic outcomes in nonalcoholic fatty liver disease
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Incretin-based therapies for the treatment of obesity-related diseases
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Long‐term all‐cause and cause‐specific mortality for four bariatric surgery procedures
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Obesity: The Perfect Storm for Heart Failure
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Long-term risk of anaemia after bariatric surgery: results from the Swedish Obese Subjects study
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Weight Loss Prediction after Metabolic and Bariatric Surgery
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Definition, Mechanisms and Predictors of Weight Loss Failure After Bariatric Surgery
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Obstructive sleep apnea remission following bariatric surgery: a national registry cohort study
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Obesity management: sex-specific considerations
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Clinical outcomes of bariatric surgery — Updated evidence
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Halpern, B., Mancini, M. C., de Melo, M. E., Lamounier, R. N., Moreira, R. O., Carra, M. K., Kyle, T. K., Cercato, C., & Boguszewski, C. L. (2022) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000465 · Cited by 37 · see citing works
Summarizing Consensus Guidelines on Obesity Management
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Treating the Chronic Disease of Obesity
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Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index
Salte, O. B., Olbers, T., Risstad, H., Fagerland, M. W., Søvik, T. T., Blom-Høgestøl, I. K., Kristinsson, J. A., Engström, M., & Mala, T. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.14340 · Cited by 32 · see citing works
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Surgery for the treatment of obesity in children and adolescents
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Exploiting the obesity-associated immune microenvironment for cancer therapeutics
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The cardiovascular effects of novel weight loss therapies
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Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery
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Bone Response to Weight Loss Following Bariatric Surgery
Mele, C., Caputo, M., Ferrero, A., Daffara, T., Cavigiolo, B., Spadaccini, D., Nardone, A., Prodam, F., Aimaretti, G., & Marzullo, P. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.921353 · Cited by 30 · see citing works
Adipose tissue-targeting nanomedicines for obesity pharmacotherapy
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Self-citationThyroid Function Alteration in Obesity and the Effect of Bariatric Surgery
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Cui, B., Wang, G., Li, P., Li, W., Song, Z. J., Sun, X., Zhu, L., & Zhu, S. (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000066 · Cited by 26 · see citing works
Aminian, A., & Tu, C. (2021) · Obesity Surgery · doi:10.1007/s11695-020-05213-9 · Cited by 26 · see citing works
Karlas, T., Petroff, D., Feisthammel, J., Beer, S., Blüher, M., Schütz, T., Lichtinghagen, R., Hoffmeister, A., & Wiegand, J. (2022) · Obesity Surgery · doi:10.1007/s11695-022-06150-5 · Cited by 26 · see citing works
Andersson‐Assarsson, J. C., van Deuren, R. C., Kristensson, F. M., Steehouwer, M., Sjöholm, K., Svensson, P., Pieterse, M., Gilissen, C., Taube, M., Jacobson, P., et al. (2023) · EBioMedicine · doi:10.1016/j.ebiom.2023.104621 · Cited by 26 · see citing works
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Revisiting Resting Metabolic Rate: What is the Relation to Weight Fluctuations?
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Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels
Kristensson, F. M., Andersson‐Assarsson, J. C., Peltonen, M., Jacobson, P., Ahlin, S., Svensson, P., Sjöholm, K., Carlsson, L. M. S., & Taube, M. (2024) · JAMA Surgery · doi:10.1001/jamasurg.2024.1169 · Cited by 25 · see citing works
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The (dys)regulation of energy storage in obesity
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Standardized Assessment of Metabolic Bariatric Surgery Outcomes
Peterli, R., Hurme, S. A. M., Bueter, M., Grönroos, S., Helmiö, M., & Salminen, P. T. P. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2023.6254 · Cited by 24 · see citing works
Gastrointestinal pH, Motility Patterns, and Transit Times After Roux-en-Y Gastric Bypass
Ladebo, L., Pedersen, P., Pacyk, G., Kroustrup, J. P., Drewes, A., Brock, C., & Olesen, A. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05308-x · Cited by 18 · see citing works
Pharmacological targeting of glutamatergic neurons within the brainstem for weight reduction
Schneeberger, M., Brice, N., Pellegrino, K., Parolari, L., Shaked, J. T., Page, K. J., Marchildon, F., Barrows, D., Carroll, T. S., Topilko, T., et al. (2022) · Nature Metabolism · doi:10.1038/s42255-022-00677-8 · Cited by 23 · see citing works
- Authors
- Carlsson, L. M. S., Sjöholm, K., Jacobson, P., Andersson-Assarsson, J. C., Svensson, P.-A., Taube, M., Carlsson, B., & Peltonen, M.
- Affiliations
- Karolinska Institutet (SE)
- From the Institutes of Medicine (L.M.S.C., K.S., P.J., J.C.A.-A., P.-A.S., M.T., B.C.) and Health and Care Sciences (P.-A.S.), Sahlgrenska Academy at the University of Gothenburg, and Early Cardiovascular, Renal, and Metabolism (CVRM), Biopharmaceuticals Research and Development, AstraZeneca (B.C.), Gothenburg, and the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna (M.P.) — both in Sweden; and the Public Health Promotion Unit, National Institute for Health and...
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-10-15
- Volume
- 383
- Issue
- 16
- Pages
- 1535-1543
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7580786
- OpenAlex
- W3092759212
- Cited by
- 509
- References
- 29
- Citations by year
- 2026: 69 · 2025: 83 · 2024: 84 · 2023: 98 · 2022: 83 · 2021: 81 · 2020: 9
- FWCI
- 61.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- Swedish Research Council (2017-01707)
- The Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-717881 and ALFGBG-717891)
- The Swedish Diabetes Foundation (2019-417)
- The Swedish Heart-Lung Foundation (20180410)
- Novo Nordisk Fonden (NNF 19OC0057184)
- the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01DK105948)
- 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, life expectancy, mortality, cardiovascular mortality, cancer mortality, Swedish Obese Subjects study, postoperative mortality, reoperation, general population comparison
- MeSH terms
- Adult, Female, Humans, Life Expectancy, Longevity, Male, Middle Aged, Obesity, Prospective Studies, Reoperation, Sweden, Proportional Hazards Models, Case-Control Studies, Bariatric Surgery
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