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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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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“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]
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“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]
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“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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Metadata
- 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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