Bariatric Surgery Helps with Weight Reduction
Persons who had surgery for obesity found they lost more weight and experienced fewer obesity-related complications, including diabetes, than individuals who did not have the operation, according to a study reported in the New England Journal of Medicine.
"It's certainly an endorsement relative to what else is available," says Dr. Caren G. Solomon, deputy editor of the journal and co-author of an accompanying editorial. "Other things don't take weight off as well, and it doesn't stay off well."
Dr. Marc Bessler, director of the New York Presbyterian Center for Obesity Surgery at Columbia University Medical Center, says "The weight loss seems to be very effective in controlling diabetes, in the development of new diabetes, at controlling hypertension, and the development of new hypertension."
Obesity Is a Risk Factor for Diabetes
According to the journal editorial, almost one-third of the US population is obese (meaning they have a body mass index of 30 or greater), while close to 5 percent are morbidly obese (with a body mass index of 40 or higher).
Given the lack of effective alternatives, there has been an increasing interest in bariatric surgery, or surgery to combat obesity. In the past seven years, the number of such surgeries performed in the US has increased fivefold, to 100,000 in 2003, the editorial states.
While other studies have been done, long-term data has been needed.
For this study, based in Sweden, researchers looked at 1,703 individuals who had undergone one of several types of bariatric surgery two years prior and 4,047 individuals who had undergone surgery a decade before.
Both of these groups were compared to a group of people who had not undergone surgery. All participants in the subject were obese, with a mean body mass index of 41.
After two years, the weight of people in the control group had increased by 0.1 percent, while, in the surgery group, it had decreased by 23.4 percent.
After 10 years, the weight of those in the control group had increased by 1.6 percent. Those in the surgery group saw their weight decrease to an overall total of 16.1 percent, meaning that individuals did gain some weight back.
Persons in the surgery group also consumed fewer calories and were more physically active than those in the control group.
At both two and 10 years, persons who had undergone surgery had higher rates of recovery from diabetes, lower triglyceride levels, blood pressure, glucose, and insulin levels, as well as higher "good" cholesterol levels than the control group.
Persons in the surgery group were also less likely to develop diabetes.
On the other hand, members of the surgery group did not experience a decrease in "bad" cholesterol levels.
"The only thing they didn't find was cholesterol improvement, but that may be because they didn't use gastric bypass surgery," Dr. Bessler says.
Some of the specific procedures used in the study are less commonly used today, although overall the information is applicable to current methods, Dr. Solomon says.
"Those who had surgery clearly had weight loss. The other group didn't lose," Dr. Solomon notes. "If they had diabetes or one of several other health conditions, they were much more likely than those who didn't have surgery to show no signs of the disease, and were also less likely to develop it."
One piece of information that is still missing, however, is whether these improvements also translate into reduced rates of heart disease and other cardiovascular complications, Dr. Solomon says.
In this particular study, the surgeries were also very safe, with a mortality rate of only 0.25 percent.
"What's very clear is that the surgeons at these centers are good at what they do," Dr. Solomon says. "The surgeon is obviously going to have a good bit to do with subsequent outcomes. These are very encouraging outcomes among a group that had experienced surgeons."
What would be even better, Dr. Solomon points out in her editorial, is the expertise for better preventive approaches so that surgery is not necessary in the first place.
Always consult your physician for more information.
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Gastric bypass surgery, a type of bariatric surgery (weight loss surgery), is a surgical procedure that alters the process of digestion.
Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.
There are several types of gastric bypass procedures, but all of them involve bypassing part of the small bowel by greater or lesser degrees.
For this reason, procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small intestine that absorbs nutrients.
Some of these procedures also involve stapling the stomach to create a small pouch that serves as the “new” stomach or surgically removing part of the stomach.
Although a gastric bypass procedure is malabsorptive, it may also be restrictive because the size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach.
While malabsorptive procedures are more effective in causing excess weight to be lost than procedures that are solely restrictive, they also carry more risk for nutritional deficiencies.
Gastric stapling surgery, also called gastric banding surgery, is a type of bariatric surgery (weight loss surgery) procedure performed to limit the amount of food a person can eat.
In gastric banding surgery, no part of the stomach is removed and the digestive process remains intact.
Either staples or a band are used to separate the stomach into two parts, one of which is a very small pouch that can hold about one ounce of food.
The food from this “new” stomach empties into the closed-off portion of the stomach and then resumes the normal digestive process.
Over time, the pouch can expand to hold two to three ounces of food. Because the size of the stomach is reduced so dramatically, this type of procedure is referred to as a restrictive procedure.
After gastric stapling or banding, a person can eat only about three-quarters to one cup of food.
The food must be well-chewed. Eating more than the stomach pouch can hold may result in nausea and vomiting.
Restrictive procedures pose fewer risks than gastric bypass procedures, but they are also less successful because continuous overeating can stretch the pouch so that it accommodates more food.
Always consult your physician for more information.
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