Is Bariatric Surgery The Answer To Obesity?
By David Johnson, Thu Dec 8th

b>Introduction

Against a background of widespread obesity among all USage-groups, and the relative failure of conventional weight lossmethods, doctors are increasingly resorting to gastrointestinalsurgery in order to curb the rise of weight-related disease, andassociated costs. An estimated 170,000 weight loss surgerieswill be performed in 2005, and although the average bariatricsurgery patient is a woman in her late 30s who weighsapproximately 300 pounds, operations such as vertical bandedgastroplasty and roux-en-Y bypass are now being successfullyconducted on patients as young as 13 years.

But Does Bariatric Surgery Work?

While the increasing popularity of obesity surgery is a clearreflection of the inability of most obese patients to complywith conventional dietary treatments, the question remains: doesthis type of surgical treatment offer an effective solution forsevere clinical obesity? To understand the issues raised by thisquestion, let us examine the problem of obesity and how surgeryattempts to reduce it.

How Widespread is Obesity?

According to current statistics, 61.3 million American adults(30.5 percent) are obese. In addition, an estimated 10-15percent of children (ages 6?11) and 15 percent of teenagers areoverweight and at risk of developing weight-related disorders.Severe obesity is also on the rise. Six million American adultsare morbidly obese (BMI 40+), while another 9.6 million have aBMI of 35-40. (Source: US Census 2000; NHANES III dataestimates)

How Does Obesity Affect Health?

Excess body fat associated with high body mass index (BMI)carries an increased risk of premature death. Obese patients(BMI 30+) have a 50-100 percent increased risk of death from allcauses, compared with individuals of normal weight (BMI 20?25).Morbid obesity (BMI 40+) and super-obesity (BMI 50+) carries astill higher risk of dying younger. Most of the increased riskis due to co-morbid conditions like cardiovascular disease(atherosclerosis, heart attack or stroke). The effects of severeobesity on longevity are dramatic. Obese white males between 20and 30 years old (BMI > 45) can shorten their life expectancy by13 years. African-American men of similar age and BMI can loseup to 20 years of life. Obese white females between 20 and 30years old (BMI > 45) can shorten their life expectancy by 8years. African-American women of similar age and BMI can lose upto 5 years of life.

Research Into Obesity and Premature Death

A 12-year study of 330,000 obese men and 420,000 obese women,revealed that premature mortality rates for morbidly obese menwere twice the normal: 500 percent higher for diabetics and 400percent higher for those with digestive tract disease. Inseverely obese women, the mortality was also increased two fold,while in female diabetics the mortality risk increased eightfold and three fold in those with digestive tract disease.Another study of 200 men aged 23-70 years with severe clinicalobesity, showed a 1200 percent increase in mortality in the25-34 year age group and a 600 percent increase in the 35-44year age group. Average cancer mortality rates are 150-500percent higher in obese patients.

Other Obesity-Related Diseases

Aside from premature death, obesity is strongly associated witha wide range of health disorders. 80 percent of patients withtype 2 diabetes are obese, while almost 70 percent of diagnosedheart disease is obesity-related. Other obesity-relateddisorders include: high blood pressure, cancer, carpal tunnelsyndrome, depression, gallstones, gastroesophageal reflux(GERD), insulin resistance, low back pain, obstructive sleepapnea, musculoskeletal complaints and osteoarthritis,respiratory problems, stroke, and vein disorders.

Why is Surgical Treatment is Needed?

As the facts demonstrate, obesity is an independent risk factorfor a number of serious diseases. Severe obesity, if leftuntreated, leads to life-threatening disorders and possiblepremature death. It is against this background that theviability of bariatric surgery should be assessed. Three keyquestions are: (1) Does bariatric surgery lead to a significantloss of weight? (2) What are the health benefits of surgery? (3)What are health risks?

Does Bariatric Surgery Lead To A Significant Loss ofWeight?

Yes. According to most patient-surveys the health and weightreduction benefits of bariatric surgery exceed all othertreatment methods by a wide margin. Weight loss surgery isconsidered successful when excess weight is reduced by 50percent and the weight loss is sustained for five years. Atpresent, average excess weight reduction at five years is 45-75percent after gastric bypass and 40-60 percent after verticalbanded gastroplasty. In a statistical review of over 600bariatric patients following gastric bypass, with 96 percentfollow-up, mean excess weight loss still exceeded 50 percent ofinitial excess weight at fourteen years. Another 10 yearfollow-up study from the University of Virginia reports weightreduction of 60 percent of excess weight at 5 years and in themid 50's between years 6 and 10. A significant percentage ofless-committed patients do regain weight 2-5 years after havingsurgery, especially those who undergo the less drastic stomachbanding procedure, but if the patient is well motivated andgiven proper post-operative support, the weight loss is usuallypermanent. By comparison, according to one 4-year study ofnon-surgical weight loss programs involving obesity medication,behavior modification, diet and exercise, average weightreduction was 3 pounds in those subjects who were followed forthe four years of the study.

What Are The Health Benefits of Surgery?

According to the International Federation for the Surgery ofObesity (IFSO), weight reduction caused by gastric reductionsurgery improves longevity and reduces rates of premature death.In addition, hypertension is cured in about 50 percent ofpatients, while measurements of cholesterol and other blood fatsshow visible improvements, all leading to a reduction in therisk of heart disease. Type 2 diabetes is cured in 80 percent ofdiabetic patients while hyperglycemia and associated conditionssuch as hyperinsulimia and insulin resistance are even morelikely to benefit from gastric bypass. Obstructive sleep apneais cured in about 75 percent of patients, shortness of breath isrelieved in 75-80 percent of cases, while asthma attacks aresignificantly reduced, particularly when associated withgastroesophageal reflux disease. Obesity surgery also relieveslow back pain and arthritis, heartburn, urinary incontinence,and lower limb venous disorders.

What Are The Health Risks?

Generally speaking, the health complications of bariatricsurgery divide into three classes. First, during the operationitself, patients are subject to the normal health dangers of anyserious surgical procedure. Risk factors include: patientcondition, the expertise of the bariatric surgeon andanesthesiologist and the quality of operating room services.Premature death occurs in about 1-2.5 percent of bariatriccases. Second, there are well-documented post-operative healthrisks, which largely depend on the type of procedureperformed.

Post-Operative Health Problems of Gastric Banding

Restrictive procedures like gastric-banding and stomachstapling carry a number of short-term post-operative healthrisks, including: (1) Risk of hernia. About 10-20 percent ofpatients require additional surgery to fix problems likeabdominal hernias caused by excessive straining after surgerybefore the incision heals. Laparoscopic surgery reduces thisrisk. (2) Risk of blood clots. About 1 percent of patientscontract blood clots in the legs. (3) Risk of infection. Onaverage, there is a 5 percent risk of infection in the incisionarea. (4) Risk of gastric staple breakage. This occurs inbariatric operations like vertical banded gastroplasty, that usestaples to reduce stomach size. (5) Risk of band slippage andsaline leakage. A routine complication, this occurs after lapband or other forms of adjustable gastric banding. (6) Risk ofbowel obstruction. This rare complication may occur due toadhesions caused by scar tissue. (7) Risk of stomal stenosis andmarginal ulcers.

Post-Operative Health Problems of Gastric Bypass

Post-operative health dangers of bypass procedures likeroux-en-y or biliopancreatic diversion include: (1) Correctiveoperations. About 15-20 percent of bypass patients requirefollow-up gastrointestinal operations to correct complications(eg. hernias). These follow-up operations tend to carry higherrisk of complication and death. (2) Dumping Syndrome. Caused byovereating or over-rapid eating, dumping, is not a real healthdanger, but symptoms (nausea, faintness, sweating and diarrhea)can be distressing. (3) Risk of nutritional deficiency. Sincestomach bypass surgery involves bypassing the duodenum andpart/all of the jejunum, causing insufficient absorption ofvitamins and minerals, patients can develop deficiencies innutrients like: iron, calcium, vitamin D and B12 deficiency.This can be easily corrected by a program of nutritionalsupplementation. (4) Risk of gallstones. About one-third ofbypass patients develop gallstones. (5) Bowel Disorders. Afterall bypass operations, there is a period of intestinaladaptation during which bowel movements can be liquid andfrequent. Typically accompanied by bloating, gas and foulsmelling stools, this complaint may reduce with time, butoccasionally becomes a permanent condition.

Bariatric Surgery is No Easy Answer To Obesity

Even though surgical methods are becoming more and moresuccessful for the reduction of severe obesity, it would bemisleading to present surgery as an easy option. To begin with,its success depends entirely on patient compliance withpost-operative guidelines. And pressures to overeat do notdisappear after surgery. If patients adhere to instructions,they tend to lose weight without regain. If they "cheat", theytend to regain most of their weight loss and may end up in aworse condition than before. Second, due to cost andavailability issues, bariatric surgery can only ever treat atiny percentage of the population who are severely obese. Third,we lack long term feedback on the success of these operations.For these reasons, it seems that bariatric surgery is no easysolution to our obesity epidemic.

More Information

BariatricSurgery

Gastric Bypass

About the author:David Johnson, LLb., is the senior researcher atwww.bariatric-surgery.info which offers a range of informationabout gastric banding, stomach bypass and other weight-relatedsurgeries to more than 2 million unique visitors per year.

BariatricSurgery

Gastric Bypass