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For Some, Weight-Loss Surgery Is More Effective Than Diet

Posted on: Tuesday, 25 January 2005, 03:00 CST

A report issued by the Agency for Healthcare Research and Quality (AHRQ) concludes that surgery may be more effective for weight reduction in patients who are extremely obese and who have tried and failed to lose weight with exercise and diet, according to an Oct 8, 2004, news release from AHRQ. Weight-loss surgery (ie, bariatric surgery) also can improve control of some obesity-related health problems, such as high blood pressure and diabetes. In addition, people who are extremely obese (ie, those who have a body mass index [BMI] of 40 or greater) often suffer from severe health problems (eg, heart disease, musculoskeletal disorders, sleep apnea) that limit daily activities and put their lives at greater risk. Body mass index is calculated by dividing one's weight in pounds by height in inches squared and multiplying the result by 703.

Approximately 60 million adults in the United States are obese, and nine million are extremely obese. A BMI of 40 or greater is not the sole criterion for identifying patients who might benefit from weight-loss surgery. Of the nine million extremely obese adults, only about 1.5% (ie, 140,000) undergo weight-loss surgery each year in the United States.

The scientific evidence review that was the basis for the AHRQ report found data suggesting that bariatric surgery may be more effective than medication for people with BMIs of 35 to 40. The evidence is not strong enough to draw firm conclusions for this group, however. In addition, the review found that Roux-en-Y gastric bypass surgery results in greater weight loss-an average of 20 lbs greater-than does vertical-banded gastroplasty.

The evidence review also found that some prescription medications- particularly orlistat and sibutramine, the most widely studied medications-promote moderate weight loss when prescribed with diet recommendations. The amount of weight loss directly attributable to these medications averages less than 11 lbs, but research shows that even such modest weight loss may decrease diabetes occurrence.

No weight-loss medication appears to be superior to others, and each has side effects. The medications have not been studied sufficiently to evaluate the risk of rare side effects, nor has there been enough research to determine the optimal time to treat obesity with medication or how this may vary by patient age, gender, or race. The evidence review found that very little research has been done on surgical or medical treatment of obesity in children and adolescents.

A summary of the report, Pharmacological and Surgical Treatment of Obesity, is available at http://www.ahrq.gov/dinic/epcsums/ obesphsum.htm. To download the full report, go to http:// www.ahrq.gov /dinic/evrptfiles.htmffobespharm.

New AHRQ Report on Treatment for Extremely Obese Americans Who Suffer tife-Threatening Illnesses Finds Weight-toss Surgery More Effective (news release, Rockville, Md: Agency for Healthcare Research and Quality, Oct 8, 2004) http://www.ahrq.gov/news/press/ pr2004 /obesphpr.htm (accessed 19 Oct 2004).

Copyright Association of Operating Room Nurses, Inc. Jan 2005

Source: Association of Operating Room Nurses. AORN Journal

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