"Get The Skinny."   by Caroline J. Cederquist, M.D.

Bariatric Surgery: Drastic Measures for Drastic Measurements

   It used to be that "stomach stapling" was a rare and extreme response to dangerous cases of obesity. 

   But as more long-term data become available about 
the generally positive outcomes for bariatric 
surgeries, more consumers are opting for these 
procedures than for any other non-cosmetic elective 
surgery. 

   With most of us normally so reluctant to go under 
the knife, what's driving the popularity of bariatric 
procedures? Quite simply, as an investment in 
health, they offer a very high return. 

   Follow-up research on patients of earlier bariatric 
surgeries is showing that the prospects for long-term 
weight loss are better than with any other mode of 
treatment for seriously overweight people, those 
classified as "morbidly obese." 

   The data also show that post-operative health 
outcomes for patients of bariatric surgery are 
remarkably good, with major improvements in 
diabetes, cardio-vascular health, musculoskeletal 
conditions and sleep disorders. 

   But perhaps the most important outcome shown is 
that these health improvements are lasting, 
specifically because patients of bariatric surgery 
have excellent chances of maintaining a much lower, 
much healthier weight for years to come. 

   According to the Journal of the American Medical 
Association, "bariatric surgery offers the best 
treatment to produce sustained weight loss in 
patients who are morbidly obese." 

   That assessment has been borne out by the 
statistics. The maximum weight loss is usually 
reached between 18 and 24 months after their 
surgery. The amount of weight lost tends to vary a 
little between the various procedures, but on an 
average, a loss of 60 percent of the excess weight 
was still maintained at five years after the surgery. 

   One study of over 600 patients reported that an 
average of 50 percent of the excess weight lost was 
still maintained at 14 years after the surgery. The 
numbers for weight loss maintenance in other 
treatment approaches come nowhere near these 
rates. 

   Roughly speaking, the "morbidly obese" are those 
defined as being 100 pounds overweight, or with a 
body mass index (BMI) of 39 or more. A score of 35 
or more is used for those who already have 
associated health problems, such as diabetes or 
heart disease. 

   Also referred to as "clinically severe obesity," it's a 
condition that presently affects about six million 
Americans. And for these people, the risks 
associated with remaining overweight are simply 
much greater than the risks of going under the knife. 

   People at lower BMIs typically are not considered as 
candidates for bariatric surgery without extenuating 
circumstances. 

   And sometimes people above a BMI of 40 are not 
considered because of other factors. Certain 
psychological conditions might preclude an 
individual's candidacy, or an inability to commit to 
lifestyle changes necessary for weight maintenance. 

   For instance, people who consume lots of sweets 
and high-fat junk foods and who don't really plan to 
give them up, won't get the lasting improvements 
they want from the surgery. 

   And there are some patients who have delicate 
health complications such that they may have to 
lose weight in a supervised program before 
undergoing the surgery. 

   With rates for complications below 2 percent and 
mortality of less than one-half a percent, bariatrics 
surgeries have proven, safety-wise, to be 
comparable to other elective procedures, and far less 
risky than the heart bypass operations that are so 
common today. 

   That's a remarkably low incidence of post-operative 
complications, particularly considering that the 
general health in this patient population is highly 
compromised by their excess weight to begin with. 

   Yet even as new techniques are developed that 
improve the safety and efficacy of bariatric 
procedures, and minimize some of their unpleasant 
side effects, experts worry that the public will get 
the idea that these are routine surgeries that offer a 
silver bullet solution to the problems of the gravely 
obese. 

   Surgery is a complex and demanding procedure for 
both the doctor and the patient, and like any 
surgery, it shouldn't be taken lightly. Most bariatric 
surgery specialists will not agree to perform a 
bariatric procedure on a patient who hasn't already 
demonstrated a concerted effort to get rid of some 
of their excess through more conventional weight-
loss methods. 

   Surgical preparation usually includes weight loss and 
conditioning for the patient immediately before the 
operation, and then there is a lot of lifestyle and 
maintenance work afterwards. 

   That's the investment. The return? Early death 
related to weight decreases markedly, and aside from 
the other specific medical improvements, studies also 
show that bariatric surgery patients get improved 
mobility and stamina, better mood and self-esteem, 
improvements in social interactivity and interpersonal 
effectiveness. And for overall quality of life, that 
means a real long-term gain. 

Through Thick & Thin 

   Bariatric surgery is remarkably effective, but it's no 
silver bullet. Before seeking a bariatric surgeon, 
consider getting counseling to help establish whether 
you have the commitment and the support system in 
place to make the lifestyle changes you'll need to 
make the surgery successful over the long haul. 

022106

Archive

Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physician (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice. You can also get more information about Dr Cederquist and her 
weight management plan by visiting www.DietToYourDoor.com