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 Of Obesity
- 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 cancers.
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 Irregularities Reduced
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 surgery.
- 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 reflux disease.
- 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.
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 surgeon.
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 Surgery
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 realistic expectations.
- 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 Risks
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.