NUTRITION
July 30, 2006

Obesity Surgery: Yes or Maybe Not

Obesity Surgery: Yes
Sisters Lorena Garcia and Alma Garcia of Los Angeles were prime candidates for an increasingly popular way of treating extreme obesity — gastric bypass surgery. Alma was suffering from high blood pressure, diabetes and thyroid disease and Lorena had developed degenerative bone disease.

The Garcia sisters' surgeon, Ted Khalili, M.D., director of the Center for Weight Loss Surgery at L.A.'s Cedars-Sinai Medical Center, sees similar cases every day.

"Within the next 50 years, life expectancy in the United States is predicted to drop due to obesity. That implies that all the public health measures that were put into effect in the last two decades that contributed to the rise in the expected life span - including antibiotics, refrigeration, clean water and vaccines - are being reversed because of obesity."

Both Garcia sisters were normal weight while growing up, but began to gain weight in their teens. By the time they were in their 30s, both women were carrying more than 100 extra pounds on their 5 foot-plus frames. They scheduled their gastric bypass surgeries with Khalili for the same day in February 2006.

The Garcia sisters underwent what is known as Roux-en-Y surgery, the most common type of gastric bypass, in which a thumb-sized pouch is created from which the rest of the stomach is permanently divided and separated. The small intestine is cut about 18 inches below the stomach and rerouted to the second part of the small bowel. Because the patient cannot eat as much and the food is not absorbed as well as before the surgery, many patients will usually lose about 60 to 70 percent of their excess weight within a year.

Like any procedure, weight-loss surgery can have complications and needs to be carefully considered, cautions Khalili.

Doing nothing, on the other hand, carries risks as well. Obesity triples the risk of heart disease and causes a ten-fold increase in a person's chances of developing diabetes. Other illnesses caused by obesity include stroke, hypertension, gallbladder disease, osteoarthritis and some forms of cancer.

For the Garcias, the surgery has been a success. Both have lost more than 40 pounds. They are also exercising more.

"I don't want to go back to being the person I used to be," said Lorena. We had the surgery for our health, for our families and for the people who care for us. We needed to have this change in our lives, and we're happy we did it."

Obesity Surgery: Maybe Not
Unable to lose weight through diet or exercise, more and more Americans are turning to the surgeon's knife. According to a new study, however, gastric bypass surgery may be much riskier than they realize.

Four of every 10 obesity surgery patients develop a complication, such as a hernia, within 6 months of leaving the hospital, according to HHS' Agency for Healthcare Research and Quality.

HHS researchers found that the complication rate among non-elderly obesity surgery patients with private insurance increased dramatically following hospital discharge — from 21.9 percent while they were still hospitalized to 39.6 percent by the end of the 180-day study period.

The most common complications were dumping syndrome, which includes vomiting, reflux, and diarrhea (nearly 20 percent); anastomosis complications (complications resulting from the surgical joining of the intestine and stomach), including leaks or strictures (12 percent); abdominal hernias (7 percent); infections (6 percent); and pneumonia (4 percent).

Most previous studies of complications from obesity surgery, also known as bariatric or weight-loss surgery, have only looked at those that occur before hospital discharge or at the most, up to 30 days post-discharge. The new study followed patients for as long as 180 days after discharge.

The researchers also studied conditions that can occur in patients following any major surgery, such as complications of surgical procedure, intestinal obstruction, gastrointestinal disorders, abdominal pain, chest pain and nutritional disorders.

"Obesity surgery is helping thousands of Americans who have not succeeded at losing weight reduce their risk of diabetes and other life-threatening diseases, but this study shows how important it is for patients to consider the potential complications when they make the decision to undergo the procedure," said AHRQ Director Carolyn M. Clancy, M.D.
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