Despite Obesity Paradox, Intentional Weight Loss Following Bariatric Surgery Has Benefits

Although obesity increases the risk of heart failure (HF), results of a new study show that the obesity paradox is present for all-cause mortality. Still, the study authors note that intentional weight loss after bariatric surgery can improve indices of cardiac structure and myocardial function among individuals who are obese.

To reach these conclusions, the researchers reviewed 4959 citations from the MEDLINE, Embase, and Web of Science databases through April 3, 2018. After exclusions, the researchers analyzed 29 studies that reported on the association and prognostic impact of obesity in HF as well as the impact of intentional weight loss after bariatric surgery on cardiac structure and myocardial function in obesity.

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By analyzing the studies, the researchers determined that there was a J curve relationship between body mass index (BMI) and HF risk; individuals with morbid obesity had the maximum risk.

Furthermore, while the “obesity paradox” was demonstrated for all-cause mortality, individuals who were overweight had lower cardiovascular mortality compared with the other BMI groups. There were no significant differences between other BMI groups.

“Intentional weight loss induced by bariatric surgery in obese patients without established HF, atrial fibrillation, or known coronary artery disease was associated with a reduction in left ventricular mass index, improvement in left ventricular diastolic function, and a reduction in left atrial size,” the researchers concluded.

—Colleen Murphy

Reference:

Mahajan R, Stokes M, Elliott A, et al. Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis. Heart. 2020;106(1):58-68. http://dx.doi.org/10.1136/heartjnl-2019-314770.