Studies support expanded use of gastric bypass, banding, experts say
WEDNESDAY, Aug. 22 (HealthDay News) -- Confirming what surgeons say they've known for years, two major studies find that weight-loss surgeries reduce patients' risk for early death.
A U.S. study of almost 16,000 obese people found long-term mortality dropped 40 percent for those who opted for gastric bypass. And a Swedish study of more than 4,000 obese people found that death rates fell by 29 percent for those who had gastric bypass or lap band surgeries versus those who did not.
"This comes as no surprise at all -- it's one of the reasons that I have been doing these procedures for so long, because I've seen the real benefit that this has had for people," said Dr. George Fielding, a pioneering bariatric surgeon in New York City.
Fielding, an associate professor of surgery at the New York University School of Medicine, was not involved in the studies, which are published in the Aug. 23 issue of the New England Journal of Medicine.
More than 120,000 weight-loss surgeries were performed in the United States in 2003 alone. These procedures essentially shrink the size of the stomach, using either a bypass technique or an adjustable band to squeeze off the gastric pouch. The safety of these operations has greatly improved since the advent of minimally invasive laparoscopic techniques, experts say.
Still, even though massive weight loss might be expected to make patients live longer, there has been no hard evidence that it actually does so.
That's been a real problem for Americans seeking coverage for the expensive procedures, one bariatric surgeon said.
"In the last five years, there's been a movement in this country to erect obstacles to [prevent] patients from gaining access to bariatric surgery," said Dr. Anita Courcoulas, chief of the section of minimally invasive bariatric and general surgery at the University of Pittsburgh School of Medicine.
As it stands, expert guidelines drawn up at a 1991 U.S. National Institutes of Health meeting relegate weight-loss surgery to only the morbidly obese (people with a body mass index of 40 or above, with a BMI of 30 being the threshold for obesity), and even then only after patients had exhausted all other weight-loss options.
"However, the problem is for people who have more than 80 pounds to lose, diets are not going to work in the long term," said Courcoulas. "Most of these patients do diet for years and years -- as is often now required by insurance."
But without hard evidence that bariatric surgery boosts health and extends life, experts say it has often been a struggle to convincing health insurers to cover the procedure.
That might now change, the experts added.
In the Swedish trial, researchers at Gothenburg University and elsewhere tracked almost 6,100 very obese adults (BMIs over 34) for an average of 11 years. About two-thirds of the participants had undergone some form of weight-loss surgery, while others had tried non-surgical methods.
Death rates fell by 29 percent in the group that got surgery vs. those who hadn't, the team said. Most of the deaths were linked to heart disease.
Results were even more dramatic in the multi-center American study, which followed 16,000 adults with BMIs of 33 or above for seven years. The American team estimated that 136 lives were saved for every 10,000 surgeries performed. And the statistics were fairly impressive: Death from any cause fell 40 percent for those who underwent gastric bypass surgery versus those who did not. And death rates from specific diseases fell even lower.
"Diabetes mortality was improved by 92 percent, coronary artery disease by 56 percent, and cancer by 60 percent," said lead researcher Ted Adams, an adjunct associate professor in the division of cardiovascular genetics at the University of Utah School of Medicine in Salt Lake City.
The surgery itself appeared to carry little short-term risk. The death rate in the year after surgery (0.53 percent) was nearly identical to that of people who did not get gastric bypass, the researchers said.
Still, there were some longer-term risks associated with the rapid weight loss, including a slight hike in the odds of death by injury, and an increase in psychological illnesses. "There are some studies showing that a number of folks after bariatric surgery go on to develop certain chemical dependencies," Adams noted.
That means that in-depth consultation with a doctor is crucial to make sure that weight-loss surgery is right for you, Adams added.
For many severely obese people, weight-loss surgery will be the correct choice -- and earlier is often better, the other experts said.
"It virtually eliminates your risk of getting diabetes if you haven't already got it -- and if you are morbidly obese, eventually you will get diabetes," said Fielding.
Fielding speaks from personal experience: Besides being a bariatric surgeon, he also underwent the procedure eight years ago.
"I was about 310 to 315 pounds at the time, and I'm now 210," he said.
Before the surgery, he added, "I was on 11 different drugs, I had all of these diseases except diabetes" -- and diabetes was not far away.
Fielding noted that the recent disclosure of weight-loss surgeries by such celebrities as Today show weatherman Al Roker and singer Carnie Wilson is helping ease the stigma surrounding the operation.
And just last Friday, lawyer and TV talk-show host Star Jones disclosed that she had undergone weight-loss surgery four years ago, although she was reticent to say so at the time. She told CNN's Larry King that she has dropped half of her weight post-surgery and maintained that weight loss.
Fielding said he understood Jones' reticence.
"I think that it's normal not to talk about it until you are confident that you have done well with it," he said. "I think that a lot of us fat people expect everything to fail, because nothing else has ever worked."
All of the experts agreed that eating sensibly and exercising after surgery is the real key to long-term success.
"Bariatric surgery is a tool, and the patients who are most successful -- who are able to keep their weight off for the long term and keep their health problems at bay -- are those who marry that tool with lifestyle change," Courcoulas said.
There's more on bariatric surgeries at the U.S. National Institutes of Health.
SOURCES: Anita Courcoulas, M.D., M.P.H., associate professor, surgery, and chief, section of minimally invasive bariatric and general surgery, University of Pittsburgh School of Medicine; George Fielding, M.D., associate professor, surgery, New York University School of Medicine, New York City; Ted Adams, Ph.D., M.P.H., adjunct associate professor, division of cardiovascular genetics, University of Utah School of Medicine, Salt Lake City; Aug. 23, 2007, New England Journal of Medicine
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