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40-year Utah study: deaths after weight-loss surgery

Long-term all-cause and cause-specific mortality for four bariatric surgery procedures.

Overview

Adams et al.. Obesity (Silver Spring) 2023 · PMID 36695060 · DOI 10.1002/oby.23646

Overall deaths were 16% lower after surgery, but suicide was about 2.4 times more frequent, mostly in young patients.

Does the study support the specific claim? Partly · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Long-term mortality by procedure and age
How was the study done?: Matched cohort
How many people, animals or samples were studied?: 21,837 pairs
What was actually found?: Lower all-cause, CVD, cancer, diabetes deaths; more suicide
How large was the observed effect?: HR 0.84; suicide HR 2.4
What do the results mean in everyday life?: Benefit overall, specific mental-health risk
What are the study's limitations?: Self-reported control BMI
What does it say about Elawady's specific claim?: Confirms suicide risk; contradicts general life-shortening
Do the results apply to Germany and Europe?: Transferable
What can explicitly not be concluded from this study?: Causation

Authors: Adams et al.
Journal: Obesity (Silver Spring)
Year: 2023
Identifier: PMID 36695060 DOI 10.1002/oby.23646
Verification: verified – PubMed efetch 2026-10-26 + Crossref API
Retracted: no
Corrections: none
Extent checked: full text
Conflicts of interest and funding: Funding: Ethicon Endo-Surgery (Johnson & Johnson), NIH/NIDDK, NCRR, Intermountain foundation (full text).

What are long-term all-cause and cause-specific mortality after four bariatric procedures by age at surgery?

Study design: Cohort study – Retrospective matched cohort (Utah Population Database), surgery vs driver-licence controls, up to 40 y
Population: Utah bariatric patients 1982-2021 and matched non-surgical persons
Country: USA
Period: 1982-2021
Sample size: 21,837 matched pairs (RYGB 69.2%, sleeve 14.0%, band 12.0%, duodenal switch 4.8%)
Inclusion and exclusion criteria: 1:1 matching on age, sex, BMI and date

Exposure / intervention: Bariatric surgery (4 procedures)
Comparator: Non-surgical persons from driver licence records
Endpoints: All-cause and cause-specific mortality
Statistical methods: Cox regression stratified by sex, procedure and age at surgery

Results: All-cause mortality 16% lower (HR 0.84, 0.79-0.90); CVD -29%, cancer -43%, diabetes -72%. Suicide HR 2.4 (1.57-3.68), mainly in those aged 18-34 at surgery. Deaths in first year 111 (0.5%) vs 89 (0.4%), P=0.14 (full text).
Absolute risks: Over a median 10.8 y: deaths 13.5% (surgery) vs 14.6% (non-surgery) (full text).
Authors' conclusion: Reduced all-cause mortality was durable for decades and multiple procedures; suicide death rate higher after surgery, mainly in the youngest age group.

HR 0.84 is a modest relative reduction; suicide HR 2.4 with low absolute numbers.

Balanced long-term evidence: overall survival benefit and a real suicide excess in young patients.

Mostly RYGB.

US data; transferable.

Supports lower overall mortality and confirms excess suicide.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	some concerns
Precision of results	high
Directness	direct
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable

Sleeve-specific suicide risk.