Sick leave and disability pension before and after treatment for obesity: A report from the Swedish Obese Subjects (SOS) study

Narbro, Kristina; Ågren, Göran I.; Jonsson, Egon; Larsson, Bo; Näslund, Ingmar; Wedel, Hans; Sjöström, Lars

doi:10.1038/sj.ijo.0800890

Cited by 118 publications

(117 citation statements)

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“…In the first postoperative year, the number of lost days was twice as high in the surgical group, while over years two to four after inclusion, the number of lost days was significantly reduced in the surgical group. 14 Cross-sectional data showed that subjects in the SOS registry study had a health-related quality of life (HRQL) that was much worse than in an age-matched reference population. The HRQL was in fact worse than in patients with rheumatoid arthritis or spinal cord injuries and comparable to patients with generalised malignant melanoma.…”

Section: Results From the Sos Studymentioning

confidence: 99%

The Swedish Obese Subjects (SOS) study—rationale and results

2001

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OBJECTIVE: Obesity is associated with increased morbidity and mortality. Several observational epidemiological studies have indicated that weight gain and weight loss, even in the obese, is also related to an increased mortality. The Swedish Obese Subjects (SOS) study was initiated in 1987 as an attempt to elucidate this paradox. Design: Two thousand matched patient pairs will be followed for 10 y each. One pair member is surgically treated, while the other receives conventional obesity treatment. By February 2000, 1879 patient pairs have been recruited. RESULTS: The two-y weight reduction was 28 AE 15 kg among the operated patients and 0.5 AE 8.9 kg among the obese controls. After eight years the weight loss was 20 AE 16 kg in the surgical group, while the controls had gained 0.7 AE 12 kg. Weight reductions achieved in the surgical group reduced the two-y incidence of diabetes 32 times as compared to the controls. After eight years there was still a 5-fold reduction in diabetes incidence. The two-y incidence of hypertension was similarly reduced 2.6 times in the surgical group. After eight years the incidence of hypertension was almost equal in the two study groups. CONCLUSION: Compared to weight stability, large intentional weight loss results in substantial reductions in the two-y incidence of several cardiovascular risk factors. After eight years there is still a reduced risk of developing diabetes in the surgical group, while the incidence of hypertension is equal in the two treatment groups. Whether intentional weight loss will reduce mortality is still too early to tell. International Journal of Obesity (2001) 25, Suppl 1, S2 -S4 Keywords: obesity; weight reduction; surgery; risk factors; health-related quality of lifeThe rationale behind the SOS study Obesity is associated with elevated cardiovascular risk factors, increased morbidity and mortality. 1,2 Short-term weight loss improves all risk factors. 3 However, several observational epidemiological studies have found an association between weight loss and increased, rather than decreased, mortality, even in subjects that were obese at baseline. 4 This paradox might be related to an inability to distinguish between intentional and unintentional weight loss. 5 Furthermore, some long-term trials have shown a rebound in risk factors in spite of maintained weight reduction, pointing at the need for adequate observation times. 6 Inadequate nutrient intake might make weight reduction hazardous 7 and it could also be that loss of body fat decreases, while loss of lean body mass increases mortality. 8 The SOS study was initiated in 1987 as an attempt to elucidate this apparently enigmatic situation. Long-term observation of a large cohort of well characterised obese subjects that either lose a substantial amount of weight or remain weight stable would have the ability to sort out several of these problems.Design of the SOS study SOS consists of a cross-sectional registry study and a longitudinal intervention study. 9 Obese subjects are eligible for the SOS inte...

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Section: Results From the Sos Studymentioning

confidence: 99%

The Swedish Obese Subjects (SOS) study—rationale and results

2001

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“…The endocrinological disturbances associated with obesity also appear to be involved in carcinogenesis, 23 explaining the increased risk of disability pension from tumors observed in this study. In addition to the biological plausibility, data from studies of large and permanent weight loss induced by surgical methods have shown that weight reduction results in lower incidence of disability pension 24 as well as increases in gainful employment. [25][26][27] These findings indicate that BMI is indeed a causal factor at least in the upper end of the BMI spectrum.…”

Section: Bmi Status and Disability Pension M Neovius Et Almentioning

confidence: 99%

“…He found no evidence of body weight causing employment disability, and raised the question whether other adverse health outcomes really are caused by high body weight. Strong evidence from intervention studies, for example, Swedish Obese Subjects, suggests that weight loss not only reduces the occurrence of disability pension, 24 but also mortality, 30 diabetes and hyperlipidemia. 31 This supports the theory that excess weight is hazardous and causes adverse health and economic effects.…”

Section: Bmi Status and Disability Pension M Neovius Et Almentioning

confidence: 99%

“…Intervention studies of morbidly obese subjects support that a high BMI causes lower productive potential. [24][25][26][27] Fourth, other less severe measures of disability, as have been used in other studies, would have been interesting to complement the analyses with. 38 Finally, BMI is an imperfect measure of adiposity.…”

Section: Bmi Status and Disability Pension M Neovius Et Almentioning

confidence: 99%

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Association between obesity status in young adulthood and disability pension

2008

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“…124 The SOS noted a significant decrease in sick leave and disability pension in patients following the surgical treatment of obesity, particularly in subjects aged 47-60 y. 11 There were significant reductions in medication for T2DM and cardiovascular disease, but increases in other medication resulted in similar total costs for surgically and conventionally treated patients in the SOS trial due to higher costs for gastrointestinal tract disorder, anemia and prevention of vitamin deficiencies. 125,126 Average weight reduction of 16.7% in the surgically treated patients did not reduce hospitalization costs in the SOS trial over 6 y.…”

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

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Sick leave and disability pension before and after treatment for obesity: A report from the Swedish Obese Subjects (SOS) study

Abstract: Surgical treatment of obesity results in a reduction of sick leave and disability pension, compared to controls, particularly in subjects aged 47-60 y.

Cited by 118 publications

References 13 publications

The Swedish Obese Subjects (SOS) study—rationale and results

The Swedish Obese Subjects (SOS) study—rationale and results

Association between obesity status in young adulthood and disability pension

Evidence-based medicine reports on obesity surgery: a critique

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