Bariatrics: Summary Of Risks And Benefits
Surgical treatment of obesity, involving
procedures such as vertical banded gastroplasty (stomach stapling), adjustable
gastric banding (eg. lap band), and gastric bypass (eg. Roux-en-Y), is
the only proven way to achieve lasting weight loss and reduce the co-morbidities
of extreme overweight. It's true that we lack definitive statistics on
the precise level of health risks for bariatric patients,
and also that a significant proportion of bariatric procedures fail to
achieve the 50 percent reduction in excess weight required for the operation
to be deemed successful, but these concerns are dwarfed by the well-documented
adverse health effects of obesity. Furthermore,
even when bypass surgery 'fails' to induce patients to achieve (and maintain)
sufficient weight loss, it is typically due to lack of patient compliance
with post-op dietary and exercise guidelines. In short, despite the proven
health benefits of bariatric surgery, not
even this can compel people to control their calorie intake and expenditure.
Medical Health Effects
- An estimated 112,000 deaths per year
are caused by obesity.
- People who are obese (BMI > 30) incur
a 50-100 percent increased risk of premature death from all causes,
compared to people with a healthy weight. Risk of early death increases
significantly among patients with morbid obesity (BMI > 40) and those
with super-obesity (BMI 50+).
- High blood pressure is twice as common
in obese adults compared to those with a healthy weight.
- Women who gain more than 20 pounds of
fat, double their risk of postmenopausal breast cancer, compared to
women whose weight remains stable. Over half of all breast cancers are
diagnosed in obese women.
- Excess weight is strongly associated
with diabetes - hence the new word 'diabesity'. Almost 90 percent of
all type 2 diabetics are obese.
- The American Heart Association classifies
obesity as a major risk factor for heart disease. Almost 70 per cent
of diagnosed heart disease is related to obesity.
- Severe clinical obesity is associated
with many other adverse health conditions including: Arthritis, Breathing
Problems, Carpal Tunnel Syndrome, Deep Vein Thrombosis, Fatty Liver
Disease, Gastroesophageal Reflux, Insulin Resistance, Lower Limb Ischemia,
Low Back Pain, Metabolic Syndrome X, Osteoarthritis, Sleep Apnea, Stroke,
Urinary Stress Incontinence, Vein Problems.
Obesity is a significant cause of ill-health. Morbid obesity carries
a significant risk of premature death, and is a causal factor in many
life-threatening diseases, like cardiovascular heart disease and some
Of Weight Loss Surgery
Bariatric surgery has been documented as
reducing premature death rates and improving a range of obesity-related
comorbid conditions such as glucose intolerance and type 2 diabetes, sleep
apnea and hypoventilation, heart function, elevated blood pressure and
raised blood fats.
- Type 2 Diabetes Improved
Type 2 diabetes is cured in 80 percent of patients after bariatric surgery.
A recent medical study showed that type 2 diabetics treated medically
had a mortality rate three times higher than that of a comparable group
who underwent stomach bypass surgery.
- Glucose Abnormalities and Metabolic
According to the American Society For Bariatric Surgery and the International
Federation for the Surgery of Obesity (IFSO), hyperinsulimia and insulin
resistance are significantly improved after stomach bypass.
- Risk of Cardiovascular Disease Reduced
High blood pressure (hypertension) is cured in about 50 percent of patients
who successfully undergo weight loss surgery. Cholesterol levels and
other heart risk factors also typically improve.
- Sleep Apnea Cured
Obstructive sleep apnea is cured in about 3 out of 4 patients after
- Shortness of Breath Improved
Hypoventilation is significantly improved in 75-80 percent of patients
after weight loss surgery.
- Asthma Improved
Successful bariatric surgery significantly reduces the number and severity
of asthma attacks, especially where such attacks are linked to gastroesophageal
- Other Health Benefits of Obesity Surgery
Gastric reduction surgery also improves back pain and arthritis, heartburn,
urinary incontinence, and vein function in the legs.
- Social Benefits
Successful bariatric surgery has been shown to increase self-esteem,
improve socialization and (in relationships which were harmonious pre-op)
improve marital relations.
Health Risks Of Obesity
Taking into account patient condition and
life expectancy, the overall health risk of obesity surgery is low. Hospital
deaths resulting from bariatric operations range between 0.2 and 1 percent
of patients operated on. The health risks of stomach bypass include: surgical
complications (10-15 percent), serious, life-threatening complications
(2-3 percent), and even death (less than 1%). Corrective surgery is needed
in up to 1 in 5 cases, and poses extra health risks, but in general, bariatric
operations are becoming safer with fewer health complications, as surgeons
become more experienced. When evaluating the risks and benefits, one should
note that the long term success of bariatric treatment depends upon the
amount of weight lost - something which is outside the control of the
Comparison Of Surgical Versus Non-Surgical
Treatment Of Obesity
A recent study conducted by researchers
at McGill University Health Centre, Montreal, compared 1,035 morbidly
obese patients (BMI > 40) who underwent obesity surgery (mostly stomach
bypass) with 5,746 equally overweight patients who did not have the operation.
The study found that six bariatric patients died, compared with 350 who
died in the larger group. On a strict comparative basis, bariatric patients
reduced their risk of premature death by 89 percent.
In another recent study of 66,000 obese
patients, by the University of Washington, weight loss surgery led to
noticeable improvements in premature mortality. Roughly 3 percent of gastric-bypass
patients (under 40) died in the 13.6 years after the surgery, compared
with 14 percent of obese patients who were not treated surgically. Roughly
12 percent of gastric-bypass patients of all ages died after 15 years,
compared with 16 percent who didn't have surgery.
What these studies and statistics seem
to show, is that while there is a risk of dying during or after gastric
bypass, the majority of patients obtain improvements in diabetes, heart
disease, lung function as well as other medical problems and seem to live
longer. In short, weight loss surgery improves long-term survival in severely
obese patients, but there is an increased risk upfront.
Understanding The Risks Of Weight Loss
If you are thinking of having a stomach
bypass or other bariatric procedure to lose weight, here are a few basic
tips to help you understand and hopefully reduce the risk of surgery.
- Find out about all aspects of the bariatric
operation you are considering. Pay special attention to the risks involved,
the length of recovery, the post-op dietary regime and try to develop
- Check the credentials and qualifications
of all bariatric surgeons you are considering. Talk to patients the
surgeon has operated on, about how they were treated and supported.
- Choose a surgeon who is communicative
and candid about the risks and benefits of surgery, and whose program
is based on long-term management and lifelong follow-up.
Bariatric Surgery: Greater Benefits, Fewer
To obtain the greatest benefit and the
least risk from your gastric surgery, you need to be aware of the pitfalls
that lie ahead, and react accordingly.
Initial Results of Surgery
The weight loss results of obesity surgery (both roux-en-y bypass and
lap band) are generally good. Typically, the most rapid rate of weight
loss occurs immediately after surgery, when you are still on a liquid
diet. Thereafter, patients typically lose an average of 10 pounds per
month and reach a stable weight 18-24 months after their operation.
Medium Term Results
However, during the period 2-5 years after the bariatric bypass or banding
operation, patients typically experience a degree of weight gain, as they
adjust metabolically and psychologically to their new eating habits. Some
patients lose their motivation to maintain a healthy diet and lifestyle.
To avoid this trap, before booking surgery ensure that your bariatric
clinic and surgeon provide a program of post-op support, and take full
advantage after the operation.
Long Term Results
Bariatric surgery will not help you to maintain your weight loss in the
long term unless you maintain your personal commitment to the healthy
guidelines that your doctor and nutritionist will teach you. Statistics
show that patients who have access to support services which allow them
to interact with other patients, have a higher chance of long term success.
Related Weight Loss Surgery Links: