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Patients who undergo weight-loss stomach surgery have a higher death rate than is true for the general population, including more suicides, perhaps linked to depression, researchers say.

The higher risk of death generally is due not to the surgery itself but to the health problems that accompany obesity, and the damage that the condition does to the body before and after surgery, the researchers said.

Dr. Bennet Omalu and colleagues at the University of Pittsburgh said a review of more than 16,000 bariatric operations done in Pennsylvania over a nine-year period found a "substantial excess of deaths owing to suicide and coronary artery disease" compared to normal death rates found in the population at large.

"It is very likely that the suicide deaths were ... underestimated because some of the deaths were listed as drug overdoses rather than suicide on the death certificate," Dr. Omalu's team wrote in their report, published in the Archives of Surgery.

"The large number of deaths due to suicide and drug overdose, in excess of what we expected, is also a cause for concern. Most of them occurred at least one year after surgery, suggesting that careful follow-up, especially the need to recognize and treat depression, should be provided," they added.

There were 440 deaths among the patients, who had an average age of 48 when the operations were performed. About 1 per cent of the patients in the study died within a year of the procedures and 6 per cent died within five years.

Heart disease was listed as the cause of death in 76 patients – about 20 per cent of the group – greater than would be common in the general population, the researchers found.

There were 14 suicides, compared with two that would be likely to occur in the population at large in a group of people that size, said the study

Dr. Omalu's team said surgery is an effective treatment for severe obesity, with heavily overweight patients often losing 80 per cent of their excess body weight within one or two years.

The higher death rates found in the study were likely due to complications caused by obesity itself, from both before and after the surgery, they said.

In a second study, Dr. Christopher Still and colleagues at the Geisinger Health System in Danville, Pennsylvania, found that bariatric surgery patients who lost some weight beforehand get out of the hospital quicker.

The study of more than 800 patients who underwent open or laparoscopic gastric bypass surgery between 2002 and 2006 found that those who lost more than 5 per cent of their excess body weight before the operation were less likely to stay in the hospital longer than four days compared to those who did not lose weight beforehand.

It also found that those who shed 10 per cent of the excess weight ahead of time were more than twice as likely to have lost 70 per cent of their excess weight a year later, compared with those who lost none at all.

The researchers said the effect has to do with the beneficial effects of weight loss on high blood pressure, diabetes and other problems.