UCLA study adds weight to ‘obesity paradox’ in surgery outcomes

A higher body mass index in older adults is associated with lower 30-day mortality rates after major elective surgery, according to research published Aug. 26 in JAMA. 

A BMI above 25 has been linked to postoperative outcomes in the general population, leading clinicians to recommend weight loss before patients undergo surgery, according to UCLA Health researchers. However, age-related physiological changes associated with frailty, including altered body composition and fat redistribution, can affect surgery outcomes in adults 65 and older. 

Researchers analyzed 414 cases of older adults undergoing major elective surgery at a large academic medical center in California between February 2019 and January 2022. 

The overall, all-cause, 30-day mortality rate was 11%. The study found a significant risk reduction in patients with an overweight BMI, with an 0.8% mortality rate. Patients with a normal BMI had an 18.8% mortality rate, and those with an underweight BMI had the highest rate at 75%. 

“This study adds to a growing body of evidence on the so-called ‘obesity paradox,’ where a higher BMI appears to be linked with better survival in certain older adult populations,” Catherine Sarkisian, MD, the study’s co-author and a professor at the University of California at Los Angeles’ School of Medicine, said in a news release. 

“It’s important to tailor preoperative evaluation to the physiology of older patients,” said Dr. Sarkisian, who is also director of UCLA’s Value-Based Care Research Consortium. 

An overweight BMI was also associated with fewer overall postoperative complications and more patient discharges to their homes.

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