Curbside Consults Podcast

Published January 13, 2021

Obesity is a major cause of morbidity in the United States and many other high-income countries. Its association with diabetes, hypertension, cardiovascular disease, and ultimately reduced life expectancy is well known. A healthy diet and regular exercise can prevent obesity as well as help achieve weight loss in obese individuals. However, for some individuals with severe obesity, these lifestyle changes alone are not enough. Bariatric surgery can be key in helping such patients lose weight and maintain weight loss, thereby reducing their risk of harmful obesity associated outcomes.

In this episode of Curbside Consults, I am joined by Dr. Clifford J. Rosen −− Associate Editor at the New England Journal of Medicine (NEJM) and Endocrinologist and Professor of Medicine at Tufts University School of Medicine −− to discuss a recent study published in NEJM entitled “Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study.”

0.07 – Introduction
3:10 – Benefits of bariatric surgery
3:50 – Patient selection and timing of bariatric surgery
5:03 – Effect of bariatric surgery on hypertension and diabetes
7:15 – Predicting patients who may benefit from bariatric surgery
7:48 – Swedish Obese Subjects Study description
10:40 – Life expectancy after bariatric surgery
12:47 – Bariatric surgery and public health policy
15:03 – Outro

Resources and articles discussed in this episode:

1. Schauer PR et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes. N Engl J Med 2017.
2. Inge TH et al. for the Teen–LABS Consortium. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med 2019.
3. Yoshino M et al. Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes. N Engl J Med 2020.
4. Heymsfield SB and Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med 2017.
5. The GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

Clifford J. Rosen, MD, is an endocrinologist. He is Director of Clinical and Translational Research and a Senior Scientist at Maine Medical Center's Research Institute, Adjunct Staff Scientist at the Jackson Laboratory, and Professor of Medicine at Tufts University School of Medicine. He is an Associate Editor at the New England Journal of Medicine.
James is a 2020-2021 NEJM Editorial Fellow and a graduate of the National University of Ireland, Galway. He has a Masters of Science in Evidence-Based Healthcare from University College London and completed Basic Specialist Training in general internal medicine with the Royal College of Physicians in Ireland.