Obesity Surgery Kept the Weight Off and Patients Lived Longer
Posted on: Thursday, 23 August 2007, 09:14 CDT
From wire reports
The first long-term studies of stomach stapling and other radical obesity treatments show that they not only lead to lasting weight loss but also dramatically improve survival. The results are expected to lead to more such operations, possibly for less severely obese people, too.
Researchers in Sweden and the United States separately found that obese people who underwent drastic surgery had a 30 to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.
The research, published in today's New England Journal of Medicine , should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.
Researchers already knew that bariatric surgery sharply reduced diabetes, hypertension and high cholesterol in addition to improving appearance and quality of life. But the new studies are the first to document a long-suspected link between weight loss and survival.
"It is now absolutely clear that losing weight and keeping the weight off adds years to your life," said Dr. Edward H. Phillips, a bariatric surgeon at Cedars-Sinai Medical Center in Los Angeles , who was not involved in the studies.
Obesity surgeries have surged in recent years along with global waistlines. In the United States , 177,600 operations were performed last year, according to the American Society for Metabolic & Bariatric Surgery . But that is less than 1 percent of those who would be eligible for the surgery under the current criteria, the society said.
Several local hospitals have started weight-loss surgery programs in recent years that not only provide the surgery but also nutritional, psychological and educational services for patients.
More than 700 weight-loss surgeries were done at bariatric centers at Sentara Norfolk General Hospital and Sentara Care Plex in Hampton in 2006.
The Bon Secours Surgical Weight Loss Center, which opened in 2003, does about 350 surgeries a year at Maryview Medical Center in Portsmouth .
Chesapeake General Hospita l performed 81 such surgeries in the fiscal year ending in July. That's an increase of 25 from the previous year.
National guidelines call for a prospective patient to have a body mass index of 40, or a BMI of 35 with one or more other conditions, such as diabetes or hypertension . For a 5-foot-10-inch person, a weight of 245 pounds would translate to a BMI of 35 , and a weight of 275 pounds would translate to a BMI of 40 .
In light of the studies and other results over the past decade, those guidelines should be eased to make even more people eligible for the surgery, Dr. George A. Bray of Louisiana State University said in an editorial accompanying the studies.
The National Institutes of Health will convene a panel this fall to consider whether the guidelines should be relaxed.
There are two main types of bariatric surgery. The simplest is banding, in which an inflatable silicone band is placed around the stomach to reduce its capacity, allowing the patient to feel full after consuming much less food.
In a gastric bypass, the stomach is sewed shut to reduce its capacity to 3 or 4 ounces, and the intestines are connected directly to the newly created pouch, bypassing part of the area where food absorption occurs. This is generally a more invasive surgery but produces greater weight loss .
In the first study, Dr. Lars Sjostrom of Goteborg University in Sweden studied 2,010 obese patients who underwent bariatric surgery and 2,037 patients who received conventional medical treatment for their obesity. A third underwent gastric bypass, while the rest had a form of banding.
After 10 years, the patients who had a bypass had lost 25 percent of their weight, while those who underwent banding had lost about 15 percent . Those receiving conventional medical treatment did not lose or gain more than 2 percent of their starting weight.
There were 129 deaths in the control group over the 10-year period and 101 in the surgery group. Taking into account age, sex and risk factors, that amounted to a 29 percent reduction in the number of deaths, they said.
The study was supported by the Swedish Medical Research Council and several pharmaceutical companies.
In the second study, Dr. Ted D. Adams of the University of Utah School of Medicine and his colleagues compared 7,925 obese patients who underwent gastric bypass surgery with an equal number of patients who did not. The study did not examine weight loss.
Over the average seven years of follow-up, Adams and his colleagues observed a 56 percent decrease in deaths from cardiovascular disease, a 92 percent drop in deaths from diabetes and a 60 percent decline in deaths from cancer.
Those declines were partially offset by an increase in deaths from suicide, accidents and poisoning, but overall the number of deaths dropped by 40 percent in the surgery group - 213 deaths in the surgery group and 321 in the control group.
Adams attributed the increased deaths from suicides to some severely obese people suffering from mood disorders or post- traumatic stress disorders who might be more likely to seek surgery to improve their body image.
The increased number of accidents might indicate that those who lost weight were taking part in more normal activities.
The study was paid for by the National Institutes of Health, the Utah Department of Health and the University of Utah.
"The interesting thing about gastric bypass is that there appear to be effects of the surgery other than weight loss," Phillips said. " It changes gut hormones, changes how lipids are handled by the body, and there may be other things we don't even know about."
He noted, for example, that the symptoms of diabetes declined sharply well before significant weight loss occurred.
Both studies were done before surgery advances that have led to smaller incisions and faster recovery time. Experts say future long- term survival rates from obesity surgery should be even better.
More than 400 million people worldwide are obese and surgery is the only proven method to shed significant pounds in a short time.
In the United States, it costs $17,000 to $35,000 and insurance coverage varies.
Weight-loss surgery is considered relatively safe, with the risk of death from the surgery at less than 1 percent. Common complications include nutritional deficiency, gallstones and hernia .
This story was compiled from reports by the Los Angeles Times, The Associated Press and staff writer Elizabeth Simpson.
(c) 2007 Virginian - Pilot. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Virginian - Pilot
User Comments (0)
RSS Feeds