Get the Facts on Surgery for Obesity

Summarized by Robert W. Griffith, MD
October 29, 2004

Introduction

About two-thirds of people in the USA are overweight, and of these, almost half are obese. And the groups showing the most rapid increase in numbers are the very obese (those with a BMI over 35) and the morbidly obese
(BMI over 40)¹. In fact, the morbidly obese encompass 8 million people in the USA.

Morbid obesity is accompanied by an increased likelihood of type 2 diabetes, high cholesterol, high blood pressure, heart disease, stroke, and several other serious conditions. Morbidly obese men and women aged 22 have a reduced life span of 12 and 8 years, respectively.

Diet and medication are unsuccessful in morbid obesity. However, over the last 10 years bariatric surgery² (morbid obesity surgery) has offered new hope for the management of this condition. A report in the Journal of the American Medical Association has analyzed the results of over 22,000 individual surgeries to assess the benefits and risks of this approach. Here's a summary of the main findings.

The analyzed patients

The data from 136 published studies were pooled for analysis (i.e. this was a meta-analysis). About 4 out of 5 of the patients were women; their average age was 39, and their average BMI was 47. There were 4 kinds of bariatric surgery: gastric banding, gastric bypass, stomach stapling (gastroplasty), and other procedures involving diversion of the bile duct, etc.

The results of the meta-analysis are given in this table:

	All Patients	Stomach Banding	Gastric Bypass Surgery	Stomach Stapling	Bile Duct Diversion
Avg. wt. loss	39.7 kg	28.6 kg	43.5 kg	39.8 kg	46.4 kg
% wt. loss	61.2%	47.5%	61.6%	68.2%	70.1%
BMI decrease	14.2	10.4	16.7	14.2	18.0
Mortality		0.1%	0.5%	0.1%	1.1%
Diabetes 'cure'	77%	48%	84%	68%	98%

(by diabetes 'cure' was meant ability to discontinue all medications, maintain blood glucose at normal levels, and normalization of HbA1c levels)

Other beneficial results of morbid obesity surgery included improvement of high blood cholesterol in 70% of patients, normalization of high blood pressure in 62%, and resolution of sleep apnea in 84% of patients. There is no doubt that such improvements in these and other related conditions will result in longer lives for these patients.

What this analysis means

It's clear that morbid obesity surgery results in effective weight loss, coupled with improvements or resolution of diabetes as well as a number of serious conditions. And it seems to be relatively safe, with postoperative mortality ranging from 0.1% for the simpler procedures (stomach banding and stapling), with 0.5% for gastric bypass surgery, to as high as 1.1% for the more complicated procedures.

Obviously it would be best if nobody developed morbid obesity in the first place. Correct nutrition and plenty of physical activity should begin in childhood, hopefully becoming habitual. But obesity in adolescents and young adults can be reversed in a proportion of cases, given sufficient support and resources. For those who have progressed to morbid obesity, with all the complications that follow, gastric bypass surgery or stomach banding offers real hope of a longer and more comfortable life.

Source

• Bariatric surgery: a systematic review and meta-analysis. H. Buchwald, Y. Avidor, E. Braunwald,  et al., JAMA, 2004, vol. 292, pp. 1724--1737
  
  

Footnotes
1. The BMI is a way of measuring body weight in relation to height - it's the weight in kilograms divided by the square of the height in meters. You can find your BMI very easily by using our calculator: http://www.healthandage.org/Home/gid4=99
2. Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity.

Related Links
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