Surgical Options for the Treatment of Obesity -

What's All the Controversy?

For cases of extreme obesity and among patients for whom other weight loss treatment options have failed, obesity surgery presents a possible option to achieve weight loss. Obesity surgery is recommended as an option in the treatment of obesity only for patients with either a BMI (body mass index)> 40 or a BMI (body mass index) of 35 to 39.9 combined with other serious obesity-related medical conditions⁵².

What Does the Typical Surgical Candidate Look Like?
The International Bariatric Surgery Registry (IBSR) has put together a database with information on more than 14,500 people who have had obesity surgery.

The patients having obesity surgery had the following weight and body mass index (BMI) characteristics:⁵³

• Average Weight at Time of Operation: 279.4 pounds (+/- 60.3 pounds)
• Average BMI (body mass index) at Time of Operation: 46 (+/- 8.3)
• A body mass index between 35 and 39.9: 19.7 percent
• A body mass index of 40 or more: 76.1 percent

What are Some of the Weight Loss Benefits of Obesity Surgery?⁵⁴

• Most patients experience rapid weight loss and continue to do so for 12 to 18 months following obesity surgery.
• Patients may experience weight loss of up to 50 percent of their excess weight in the first six months and 77 percent of excess weight within one year⁵⁵ of obesity surgery.
• Patients may maintain 50 to 60 percent of their weight loss 10 to 14 years after obesity surgery.

What are Some of the Risks Associated with Obesity Surgery?⁵⁶

• Complications caused by the obesity surgery may be as high as 10 percent or more.
• Complications requiring a hospital stay of seven or more days were reported in 1.35 percent of patients from the IBSR database. Some of the obesity surgery complications involve the heart or liver, rupture of blood vessels in the lungs, infection surrounding the diaphragm area, leaking and bleeding of the stomach and intestines, blood clotting in veins and blockage of the small intestine.
• Obesity surgery complications requiring a hospital stay of less than seven days were reported in 5.28 percent of patients from the IBSR database. These complications include breathing difficulties, wound infections and injury to the spleen.
• Ten to 20 percent of patients needed follow-up operations to correct obesity surgery complications such as abdominal hernias.
• Gallstones develop in more than one-third of patients as a result of significant weight loss or from losing weight quickly. Taking medication can prevent gallstones. The condition is irrelevant if the gallbladder is removed during surgery.
• Anemia, osteoporosis and other bone disease are nutritional deficiencies that develop after the obesity surgery due to long-term loss of absorptive function. Nutritional deficiencies, which occur in almost 30 percent of patients, can be prevented with proper attention to vitamin and mineral intake, especially vitamins B12 and D, calcium, folate and iron.
• Women of childbearing age should be aware that quick weight loss and nutritional deficiencies can harm a developing fetus.
• The Vertical-banded Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (RGB) death rate is relatively low. Within 30 days of obesity surgery, death occurred in less than a quarter of one percent (0.17 percent) of patients in the IBSR database. Pulmonary embolism was the most frequent cause of death.
• Possible death (1 out of 200 cases).

The Controversy

Despite much progress in developing safer and more effective surgical techniques, obesity surgery remains a last option for patients attempting weight loss. Before considering obesity surgery, it is important that patients understand all of the risks and benefits associated with obesity surgery. The full team of medical professionals involved in the weight loss planning process – which may include a general practitioner, an endocrinologist, an ob/gyn, a nutritionist, a psychologist, and others – should be available to offer their expertise and guidance. If the patient has an underlying endocrine or other serious health condition such as cardiovascular disease or risk for stroke, obesity surgery may not be the best option. In addition, surgical candidates must be willing to alter their diet and physical lifestyle following the surgery in order to achieve long-term weight loss success.

The following chart outlines the most common surgical treatments for obesity, and their associated risks and benefits.

What Should We Expect for Treatments in the Future?

The underlying causes of obesity continue to be hot topics of investigation among clinical and basic endocrine researchers. Endocrinologists are working hard to determine the root causes of obesity, including the factors regulating food intake, energy expenditure, body weight and complications associated with the condition.

Research is also currently being conducted with obesity to examine the potential efficacy of agents derived from gastrointestinal or gastrointestinal-related hormones that affect hunger and satiety⁶⁰. Such research is important as the prevalence of obesity increases and the demand for additional obesity treatment options and alternatives continues to rise.