DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Bariatric surgery

In Obesity Epidemic, Many Now Turn to Surgery. I harp on fitness and diet. Fortunately, I have a body habitus that allows success towards my goals. Some people have major weight problems. I watched a moving interview which Tim Russert conducted with Al Roker, discussing Roker’s weight loss surgery. Al Roker has a web page and has several discussions of his surgery, the most poignant – Here’s The Story!. Jane Brody has done a wonderful job of synthesizing information on bariatric surgery.

 

This nation is in the midst of an expanding epidemic of excess weight, the consequence of overconsumption and underactivity that has resulted in a chronic net increase in caloric intake over expenditure. About 60 percent of American adults are overweight or obese, including about 3 percent of adults who are morbidly obese, weighing 100 pounds or more above their ideal weights.

Despite a false start with an intestinal bypass operation that initially gave weight-loss surgery a bad name, modern versions of so-called bariatric surgery are safer and more effective, and they are becoming increasingly popular among the largest Americans.

The American Society for Bariatric Surgery estimates that in the year now ending, 63,100 weight-reduction operations will have been performed, up from 23,100 five years ago.

Surgery is a final option. It is a last resort. Surgery has significant risks.

Surgical weight reduction is now limited to those who are extremely obese, with a body mass index, or B.M.I., of 40 or more, or 35 for those with medical complications caused by obesity. The B.M.I. can be calculated in several ways: in one, a person’s weight in pounds is divided by height in inches squared, then multiplied by 703.

 

You can calculate your own BMI – Body Mass Index Web Calculator. I have run a few numbers to bring a BMI of 40 into perspective. At 6 feet I would have to weigh 295 to reach morbid obesity (BMI of 40). At 5’6″ the weight is 248. At 5′ the weight is 205. We are discussing the morbidly obese. Note that patients with serious medical complications are eligible at lower weights.

Again I must emphasize the risks of surgery.

The operation, even though sometimes done through a laparoscope, is hardly a minor procedure. Like all operations, it has risks and complications, including blood clots, wound problems and death. About 15 percent of patients experience complications, and 0.5 percent to 1 percent die because of the surgery.

For many patients the risks are worth the benefits. Patients must make a careful and informed decision with a full understanding of those risks.

 

But the benefits are profound. In addition to durable weight loss, bariatric surgery can rapidly reverse Type 2 diabetes, improve cardiac function and blood lipid levels, correct breathing problems like sleep apnea, reduce blood pressure, improve the quality of life and lower health care costs, disability and the risk of premature death.

Many patients whose weight had kept them from working or taking part in physical and other activities are able to go back to their jobs, exercise regularly and maintain active social lives.

Sexual interest is often restored and women who were infertile because of hormonal problems are able to conceive. In addition, there are the emotional benefits of extreme weight loss: an improvement in self-image and self-esteem and lifting of depression.

I have cared for a number of patients who have had successful bariatric surgery. This is a major decision for patients. It requires careful physician counseling and support. It is the right treatment for some patients. This review is worth saving for interested patients.

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