Dr. Rickesha Wilson, general and bariatric surgeon at Cleveland Clinic, talks about how bariatric surgery for people with obesity could possibly prevent cancer from developing.
Interview conducted by Ivanhoe Broadcast News in 2023.
Your studies show that obesity is a risk factor for cancer, can you speak more about these findings?
WILSON: We’ve learned over the years that obesity is related to a lot of different medical conditions, such as diabetes, high blood pressure, heart disease, and sleep apnea. Cancer in the last several years has come to light as a risk factor as well. Obesity is related not to all cancers, but a specific number of cancers. We’re learning about the changes that obesity causes in the body and how some of those changes related to inflammation or insulin resistance and hormone changes also impact cancer development. There are a number of obesity-related cancers, which are 13 different kinds that obesity has been linked to, but we’re still certainly trying to learn more about why and what cancers are specifically related.
You mentioned those types of cancer, what are the types of cancer that are impacted by obesity?
WILSON: For people with obesity, we found that several common cancers that we’ve all heard of are related. These are cancers of the stomach, liver, gallbladder, pancreas, colon and rectum, ovaries, uterus, and even breast cancer, specifically for those who have undergone menopause or who have had their ovaries removed. Also, multiple myeloma. A number of cancers that many of us are familiar with are impacted by obesity.
How does bariatric surgery come to play when it comes to cancer risk?
WILSON: Bariatric surgery is also known as weight loss surgery and metabolic surgery. These are procedures that induce weight loss and change metabolism by altering the GI tract and the anatomy. For the most common procedure, that means we make the stomach smaller. For another common procedure like the bypass, we make the stomach smaller, but we also reroute the intestine. Bariatric surgery really helps people lose a significant amount of weight. Really it’s the key to losing a significant amount of weight that induces a lower risk of cancer. We’re not saying necessarily that bariatric surgery is the answer for everyone, but it’s a really strong tool to allow people to lose enough weight to reduce their risk of cancer. That’s something we found in the SPLENDID study, that the amount of weight lost actually impacts the risk of cancer.
When it comes to numbers, how successful was bariatric surgery to lower the risk of cancer?
WILSON: In our study, the SPLENDID study that we published last year, we looked at 30 thousand patients. Five thousand of those patients underwent weight-loss surgery, and all 30 thousand had a diagnosis of obesity. Five thousand underwent the most common two weight loss procedures, which are the sleeve gastrectomy and the Roux-en-Y gastric bypass. The other 25 thousand patients with obesity underwent usual care: diets, medications, and nonsurgical interventions for weight loss. We found that in the group that underwent bariatric surgery, there was a 32 percent lower incidence of developing obesity-related cancers in our follow-up of about 17 years. Also, death related to cancers was also around a 48 percent risk decrease in the bariatric surgery group compared to the non-surgical group. We found that our patients who underwent bariatric surgery in the study also lost a significant amount of weight.
You mentioned what cancers this can help avoid in that question, would it work for all patients would you say?
WILSON: We certainly would not prescribe bariatric surgery for all patients, because everyone is unique so their needs and their health conditions are unique. In this study, we matched those who underwent surgery and those who didn’t, based on their weight, their medical conditions, their health status overall, and their age. The people who would qualify and benefit from weight-loss surgery are those who have obesity. First of all, that calculation is based on your height and your weight, and we get a body mass index from that. But those with obesity and those who already have medical conditions related to obesity, those people are the ones that we at least encourage to investigate and do more research about weight-loss surgery. On Cleveland Clinic’s website, there is a weight-loss surgery seminar that you can watch for free on your own time and learn more about the benefits. You can register for our program. This doesn’t commit you to surgery, but it helps you talk to professionals and experts and get further evaluated for treatments that are right for you – surgery is one option, but there are other treatments for obesity that are available.
What cancers does bariatric surgery help people avoid?
WILSON: Bariatric surgery, from our SPLENDID study findings, can help lower the risk of obesity-related cancers specifically. We’re not saying all cancers, but these are common cancers related to obesity. There are 13 different kinds. Those that affect the esophagus, the stomach, the liver, the gallbladder, the pancreas, breast cancer, cancer of the uterus, the ovaries, colon, and rectum, the thyroid, and multiple myeloma.. From our research and from other studies too, it seems like bariatric surgery can reduce that risk significantly.
When it comes to bariatric surgery, who would benefit the most, would you say?
WILSON: I think those who would have the most benefit are those who are in the highest weight quartiles or percentages. The higher your weight is, the more likely you are to benefit. Also, those who have significant co-morbidities or medical conditions due to obesity. Those who struggle with getting their diabetes under control, who may be on insulin and whose sugars are still high, those with high blood pressure, and those experiencing sleep apnea. We’ve found that people who have a high-risk profile and obesity are those who would benefit significantly, and individuals who have heart disease and fatty liver disease, which is a cause of needing a liver transplant down the road. These individuals with obesity may be able to avoid obesity-related conditions down the road by undergoing weight loss surgery if they’re the right fit.
Are there risks to having bariatric surgery?
WILSON: Certainly. There are risks to having any surgery and specifically with bariatric surgery, there are risks in the short-term that are general to all surgeries like bleeding risks, risks of infection at the incisions, risk of infection in the urine – those are examples of general surgery risks. Also specific to weight-loss surgery, we make anastomoses, or connections, between different parts of the intestine and the stomach. There could be risks that those connections are too tight or too loose, but we found in our research and by improving our techniques over the years and over the past couple of decades, that weight-loss surgery is just as safe as a lot of the common surgeries that we’ve heard of like gallbladder surgery, a knee replacement, or a hysterectomy. Our research has shown that weight-loss surgery is just as safe as many of these common procedures.
Do the benefits outweigh the risks, could you say?
WILSON: I It depends on the individual. Our program at Cleveland Clinic conducts a full evaluation of each patient, including their medical history and their surgery history to make sure that they are a good candidate for surgery. We treat sick patients. A lot of people may be in need of an organ transplant, but in order to be put on the waiting list, they have to meet a certain weight criteria. We treat many patients with heart failure, liver failure, in renal failure on dialysis. Many people are good candidates for surgery, and the health benefits that they get following weight-loss surgery outweigh the risks of undergoing surgery.
Are there other effective ways that are assumed to be just as effective in lowering cancer, instead of having surgery?
WILSON: There are many treatments, of course, or testing that can be done for preventing or lowering the risk of cancer. Nothing is going to replace, for instance, cancer screening. I mentioned colon and rectal cancer and breast cancer screening, those are screenings that are recommended for all individuals, whether or not they have obesity. Nothing replaces the benefit of getting screened. Our studies have shown, and other studies have too, that individuals with obesity have a likelihood to get screened less for cancers because of the stigma, maybe the shame, maybe the difficulty with dealing with obesity. Once an individual has cancer, the standard of care for cancer treatments can’t be replaced, but when we talk about preventing cancer risk over the long term, significant weight loss is certainly a way to lower the risk and we’ve found that for weight loss strategies, bariatric surgery is the most effective. It’s been found to be more effective than lifestyle interventions, diets, and medications.
Are there weight-loss techniques people should avoid?
WILSON: Before undergoing weight-loss procedures and interventions, it’s important to take into consideration all of your risk factors, your health, and your specific needs. Every individual is different so we encourage our patients to make sure they ask all the questions they can and really get a full evaluation. Our program at Cleveland Clinic offers a multi-disciplinary team, with bariatric surgeons, dieticians, psychologists, obesity medicine providers, and advanced practitioners. We refer to heart doctors, and lung doctors, or other specialties depending on the patient’s needs. Avoid hasty or trendy weight-loss therapies and interventions that you may not understand or that really don’t have a proven track record. Get a second opinion if you’d like to get additional perspective on a recommended treatment.
Anything else you want to add that maybe I didn’t ask you? Anything about the study?
WILSON: Our SPLENDID study was really a large sample size, 30 thousand patients. When we compared the outcomes of lowering the cancer risk, we made sure that the patients in the surgery group and the non-surgery group were well-matched, including their smoking status, medical conditions, their age, and their weight. I would like to point out two interesting findings. First, the study findings were were significant for the African-American population. A lot of research studies are criticized because there’s not a diversity in the patients who are studied so we really don’t know how these impact all populations, but our study showed that African-Americans had an even better chance of lowering risk of obesity-related cancer after bariatric surgery. Also, we found that there was a dose-related response for people who underwent surgery. The more weight that individuals lost, the lower their risk of cancer. We broke down the weight-loss results from those who underwent bariatric surgery into quartiles. Those who lost less than 24 percent of their weight, those between 24 and 31 percent, those who lost up to 39 percent, and those greater than 39 percent weight loss. We found that between these groups, the more weight you lost, the lower your risk of cancer was over time. We think these results are powerful, and we are excited to share them.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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