Obesity Surgery Sharply Improves Related Problems
By Amanda Gardner, HealthDay Reporter
TUESDAY, Oct. 12 (HealthDayNews) -- Most people who have obesity surgery not only lose a lot of weight but also experience marked improvements in health problems that are part and parcel of being extremely overweight.
A new review of studies on the procedure finds that "a substantial majority" of obese people who had it recuperated from diabetes, high cholesterol, hypertension and obstructive sleep apnea. Moreover, many "experienced complete resolution," said the review, which appears in the Oct. 13 issue of the Journal of the American Medical Association.
According to the article, about 1.7 billion people globally are overweight or obese, a condition that substantially raises the risk of the above-mentioned health problems as well as asthma, back pain and depression. In the United States, about two-thirds of the population is overweight, and half of those people are obese.
One solution is bariatric surgery, which has been available since the 1970s but has expanded rapidly in the last few years. Currently, only about 1 percent of patients who are qualified by National Institutes of Health standards are getting the procedure.
With the popular media devoting extensive coverage to several deaths resulting from bariatric surgery, it has been unclear how viable a solution it is.
The deaths prompted the Massachusetts Department of Public Health to convene an expert panel on how best to approach the risk of death and other complications (such as infection) from the surgery. While the panel insisted that it is "major surgery," it added: "It is important to remember that obesity itself carries a high risk of mortality due to obesity-related illnesses. For many patients the potential risks from not having the surgery may be greater than the risks from possible complications of having the procedure."
The authors of this journal article reviewed 136 existing studies on bariatric surgery, looking specifically for its impact on diabetes, high cholesterol, high blood pressure and obstructive sleep apnea. The surgical procedures included gastric banding, gastric bypass, gastroplasty (so-called "stomach stapling"), duodenal switch and others. The operations are intended to limit either the amount of food a person can ingest -- say, by making their stomachs smaller -- or the amount their bodies can metabolize.
All together, the studies looked at 22,094 obese patients, 72.6 percent of whom were women. All had at least one of the conditions cited above.
For all the procedures, the average percentage of excess weight loss was 61.2 percent. This ranged from 70.1 percent for biliopancreatic diversion (which allows food to bypass part of the small intestine) to 47.5 percent for gastric banding.
"There was a tremendous amount of loss of excess body weight -- much, much more than one could ever achieve by dieting," said Dr. Henry Buchwald, lead author of the article and professor of surgery at the University of Minnesota School of Medicine in Minneapolis. "Not only did it cause weight loss, but it caused 70 to 80 percent complete resolution and even higher percentage of improvement in these four terrible diseases."
Buchwald has performed more than 2,500 such operations in the last 30 years. The study was funded by Ethicon Endo-Surgery Inc., a subsidiary of Johnson and Johnson Co., which makes products for various types of operations, including obesity-reducing ones. The sponsor had no role in collecting or interpreting the data, according to the review. Buchwald is a consultant to the company.
Diabetes was completely resolved in more than three-quarters (76.8 percent) and improved or resolved in 86 percent of patients.
Cholesterol levels improved in at least 70 percent, according to the review. High blood pressure was lowered in 78.5 percent, and improved or was completely resolved in 61.7 percent. Obstructive sleep apnea was improved in 85.7 percent.
Death as a result of surgery within 30 days of a procedure ranged from 0.1 percent to 1.1 percent.
"The death rate from obesity surgery and the complication rate is lower than comparable operations for cancer or for heart disease," Buchwald said. "For people who are morbidly obese, bariatric surgery today is the treatment of choice."
Existing treatments for diabetes, hypertension, obstructive sleep apnea and high cholesterol are expensive and do not affect the underlying disease, he added. "If the same patient has bariatric surgery, you're attacking the primary disease and the obesity goes away -- plus, you're eliminating all those other diseases," Buchwald said. "We're not only achieving weight loss. We're eliminating major diseases."
Others are not so sure.
"We have no long-term follow-up on these people. What happens five to 10 years from now? What's the mortality rate? Are they healthy? Are they able to maintain a nutritional lifestyle that's reasonable?" asked Dr. Fred Pescatore, a New York City internist and author of four books, including Thin for Good and The Hamptons Diet. "This can't be seen as a quick fix for the obesity problem. We can't afford for 60 percent of the population to undergo surgery, and you can't ever tackle an obesity problem and still allow people to eat what they've been eating."
More information
The Massachusetts Department of Public Health (www.mass.gov#what ) has more on weight-loss surgery. 
SOURCES: Henry Buchwald, M.D., Ph.D., professor, surgery, University of Minnesota School of Medicine, Minneapolis; Fred Pescatore, M.D., author, Thin for Good and The Hamptons Diet; Massachusetts Department of Public Health statement; Oct. 13, 2004, Journal of the American Medical Association
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