| IntroductionAgainst a background of widespread | | | | procedure, but if the patient is well motivated and |
| obesity among all US age-groups, and the relative | | | | given proper post-operative support, the weight |
| failure of conventional weight loss methods, | | | | loss is usually permanent. By comparison, |
| doctors are increasingly resorting to | | | | according to one 4-year study of non-surgical |
| gastrointestinal surgery in order to curb the rise | | | | weight loss programs involving obesity medication, |
| of weight-related disease, and associated costs. | | | | behavior modification, diet and exercise, average |
| An estimated 170,000 weight loss surgeries will be | | | | weight reduction was 3 pounds in those subjects |
| performed in 2005, and although the average | | | | who were followed for the four years of the |
| bariatric surgery patient is a woman in her late | | | | study.What Are The Health Benefits of |
| 30s who weighs approximately 300 pounds, | | | | Surgery?According to the International Federation |
| operations such as vertical banded gastroplasty | | | | for the Surgery of Obesity (IFSO), weight |
| and roux-en-Y bypass are now being successfully | | | | reduction caused by gastric reduction surgery |
| conducted on patients as young as 13 years.But | | | | improves longevity and reduces rates of |
| Does Bariatric Surgery Work?While the increasing | | | | premature death. In addition, hypertension is cured |
| popularity of obesity surgery is a clear reflection | | | | in about 50 percent of patients, while |
| of the inability of most obese patients to comply | | | | measurements of cholesterol and other blood fats |
| with conventional dietary treatments, the question | | | | show visible improvements, all leading to a |
| remains: does this type of surgical treatment | | | | reduction in the risk of heart disease. Type 2 |
| offer an effective solution for severe clinical | | | | diabetes is cured in 80 percent of diabetic patients |
| obesity? To understand the issues raised by this | | | | while hyperglycemia and associated conditions |
| question, let us examine the problem of obesity | | | | such as hyperinsulimia and insulin resistance are |
| and how surgery attempts to reduce it.How | | | | even more likely to benefit from gastric bypass. |
| Widespread is Obesity?According to current | | | | Obstructive sleep apnea is cured in about 75 |
| statistics, 61.3 million American adults (30.5 | | | | percent of patients, shortness of breath is |
| percent) are obese. In addition, an estimated | | | | relieved in 75-80 percent of cases, while asthma |
| 10-15 percent of children (ages 6?11) and 15 | | | | attacks are significantly reduced, particularly when |
| percent of teenagers are overweight and at risk | | | | associated with gastroesophageal reflux disease. |
| of developing weight-related disorders. Severe | | | | Obesity surgery also relieves low back pain and |
| obesity is also on the rise. Six million American | | | | arthritis, heartburn, urinary incontinence, and lower |
| adults are morbidly obese (BMI 40+), while | | | | limb venous disorders.What Are The Health |
| another 9.6 million have a BMI of 35-40. (Source: | | | | Risks?Generally speaking, the health complications |
| US Census 2000; NHANES III data estimates)How | | | | of bariatric surgery divide into three classes. First, |
| Does Obesity Affect Health?Excess body fat | | | | during the operation itself, patients are subject to |
| associated with high body mass index (BMI) | | | | the normal health dangers of any serious surgical |
| carries an increased risk of premature death. | | | | procedure. Risk factors include: patient condition, |
| Obese patients (BMI 30+) have a 50-100 percent | | | | the expertise of the bariatric surgeon and |
| increased risk of death from all causes, compared | | | | anesthesiologist and the quality of operating room |
| with individuals of normal weight (BMI 20?25). | | | | services. Premature death occurs in about 1-2.5 |
| Morbid obesity (BMI 40+) and super-obesity (BMI | | | | percent of bariatric cases. Second, there are |
| 50+) carries a still higher risk of dying younger. | | | | well-documented post-operative health risks, which |
| Most of the increased risk is due to co-morbid | | | | largely depend on the type of procedure |
| conditions like cardiovascular disease | | | | performed.Post-Operative Health Problems of |
| (atherosclerosis, heart attack or stroke). The | | | | Gastric BandingRestrictive procedures like |
| effects of severe obesity on longevity are | | | | gastric-banding and stomach stapling carry a |
| dramatic. Obese white males between 20 and 30 | | | | number of short-term post-operative health risks, |
| years old (BMI > 45) can shorten their life | | | | including: (1) Risk of hernia. About 10-20 percent |
| expectancy by 13 years. African-American men | | | | of patients require additional surgery to fix |
| of similar age and BMI can lose up to 20 years of | | | | problems like abdominal hernias caused by |
| life. Obese white females between 20 and 30 | | | | excessive straining after surgery before the |
| years old (BMI > 45) can shorten their life | | | | incision heals. Laparoscopic surgery reduces this |
| expectancy by 8 years. African-American women | | | | risk. (2) Risk of blood clots. About 1 percent of |
| of similar age and BMI can lose up to 5 years of | | | | patients contract blood clots in the legs. (3) Risk |
| life.Research Into Obesity and Premature DeathA | | | | of infection. On average, there is a 5 percent risk |
| 12-year study of 330,000 obese men and | | | | of infection in the incision area. (4) Risk of gastric |
| 420,000 obese women, revealed that premature | | | | staple breakage. This occurs in bariatric operations |
| mortality rates for morbidly obese men were | | | | like vertical banded gastroplasty, that use staples |
| twice the normal: 500 percent higher for diabetics | | | | to reduce stomach size. (5) Risk of band slippage |
| and 400 percent higher for those with digestive | | | | and saline leakage. A routine complication, this |
| tract disease. In severely obese women, the | | | | occurs after lap band or other forms of |
| mortality was also increased two fold, while in | | | | adjustable gastric banding. (6) Risk of bowel |
| female diabetics the mortality risk increased eight | | | | obstruction. This rare complication may occur due |
| fold and three fold in those with digestive tract | | | | to adhesions caused by scar tissue. (7) Risk of |
| disease. Another study of 200 men aged 23-70 | | | | stomal stenosis and marginal ulcers.Post-Operative |
| years with severe clinical obesity, showed a 1200 | | | | Health Problems of Gastric BypassPost-operative |
| percent increase in mortality in the 25-34 year | | | | health dangers of bypass procedures like |
| age group and a 600 percent increase in the | | | | roux-en-y or biliopancreatic diversion include: (1) |
| 35-44 year age group. Average cancer mortality | | | | Corrective operations. About 15-20 percent of |
| rates are 150-500 percent higher in obese | | | | bypass patients require follow-up gastrointestinal |
| patients.Other Obesity-Related DiseasesAside | | | | operations to correct complications (eg. hernias). |
| from premature death, obesity is strongly | | | | These follow-up operations tend to carry higher |
| associated with a wide range of health disorders. | | | | risk of complication and death. (2) Dumping |
| 80 percent of patients with type 2 diabetes are | | | | Syndrome. Caused by overeating or over-rapid |
| obese, while almost 70 percent of diagnosed | | | | eating, dumping, is not a real health danger, but |
| heart disease is obesity-related. Other | | | | symptoms (nausea, faintness, sweating and |
| obesity-related disorders include: high blood | | | | diarrhea) can be distressing. (3) Risk of nutritional |
| pressure, cancer, carpal tunnel syndrome, | | | | deficiency. Since stomach bypass surgery involves |
| depression, gallstones, gastroesophageal reflux | | | | bypassing the duodenum and part/all of the |
| (GERD), insulin resistance, low back pain, | | | | jejunum, causing insufficient absorption of vitamins |
| obstructive sleep apnea, musculoskeletal | | | | and minerals, patients can develop deficiencies in |
| complaints and osteoarthritis, respiratory | | | | nutrients like: iron, calcium, vitamin D and B12 |
| problems, stroke, and vein disorders.Why is | | | | deficiency. This can be easily corrected by a |
| Surgical Treatment is Needed?As the facts | | | | program of nutritional supplementation. (4) Risk of |
| demonstrate, obesity is an independent risk factor | | | | gallstones. About one-third of bypass patients |
| for a number of serious diseases. Severe obesity, | | | | develop gallstones. (5) Bowel Disorders. After all |
| if left untreated, leads to life-threatening disorders | | | | bypass operations, there is a period of intestinal |
| and possible premature death. It is against this | | | | adaptation during which bowel movements can be |
| background that the viability of bariatric surgery | | | | liquid and frequent. Typically accompanied by |
| should be assessed. Three key questions are: (1) | | | | bloating, gas and foul smelling stools, this complaint |
| Does bariatric surgery lead to a significant loss of | | | | may reduce with time, but occasionally becomes |
| weight? (2) What are the health benefits of | | | | a permanent condition.Bariatric Surgery is No Easy |
| surgery? (3) What are health risks?Does Bariatric | | | | Answer To ObesityEven though surgical methods |
| Surgery Lead To A Significant Loss of | | | | are becoming more and more successful for the |
| Weight?Yes. According to most patient-surveys | | | | reduction of severe obesity, it would be |
| the health and weight reduction benefits of | | | | misleading to present surgery as an easy option. |
| bariatric surgery exceed all other treatment | | | | To begin with, its success depends entirely on |
| methods by a wide margin. Weight loss surgery is | | | | patient compliance with post-operative guidelines. |
| considered successful when excess weight is | | | | And pressures to overeat do not disappear after |
| reduced by 50 percent and the weight loss is | | | | surgery. If patients adhere to instructions, they |
| sustained for five years. At present, average | | | | tend to lose weight without regain. If they |
| excess weight reduction at five years is 45-75 | | | | "cheat", they tend to regain most of their weight |
| percent after gastric bypass and 40-60 percent | | | | loss and may end up in a worse condition than |
| after vertical banded gastroplasty. In a statistical | | | | before. Second, due to cost and availability issues, |
| review of over 600 bariatric patients following | | | | bariatric surgery can only ever treat a tiny |
| gastric bypass, with 96 percent follow-up, mean | | | | percentage of the population who are severely |
| excess weight loss still exceeded 50 percent of | | | | obese. Third, we lack long term feedback on the |
| initial excess weight at fourteen years. Another 10 | | | | success of these operations. For these reasons, it |
| year follow-up study from the University of | | | | seems that bariatric surgery is no easy solution to |
| Virginia reports weight reduction of 60 percent of | | | | our obesity epidemic.David Johnson, LLb., is the |
| excess weight at 5 years and in the mid 50's | | | | senior researcher at which offers a range of |
| between years 6 and 10. A significant percentage | | | | information about gastric banding, stomach bypass |
| of less-committed patients do regain weight 2-5 | | | | and other weight-related surgeries to more than 2 |
| years after having surgery, especially those who | | | | million unique visitors per year. |
| undergo the less drastic stomach banding | | | | |