Weight Loss Surgery Risky Only in Super Obese or Chronically Ill Patients

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Is Weight Loss Surgery Too Dangerous for Those Who Need it Most?

Bariatric surgery has offered renewed hope for thousands of people suffering from obesity and its many debilitating health consequences. In most cases it is a safe and effective procedure that can yield dramatic health benefits.

Reports indicate that 80 percent of patients who undergo gastric banding surgery succeed in losing weight, with 30 percent actually attaining a “normal” weight. Gastric bypass has even higher weight loss rates—patients are likely to drop 60 percent of their pre-surgery weight--and laparoscopic gastric bypass shows similar results. Weight loss is not the only benefit. These patients consistently experience improvement in a number of obesity-related conditions, including Type 2 diabetes, high cholesterol, hypertension, and obstructive sleep apnea.

There is growing concern, however, that bariatric surgery may be extra risky for the very patients who stand to benefit the most—the so-called “super obese.”

Super-obesity is defined as having a body mass index (BMI) of 50 or more. Exact statistics are not available on how many people are super-obese, but about 6 million American adults are considered morbidly obese—that is, their BMI is greater than 40.

A Study of Obese Veterans

Dr. David Arterburn of the Group Health Research Institute in Seattle, Washington, and research colleagues at the VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center undertook a study of 856 veterans who had bariatric surgery between 2000 and 2006 in Veterans Administration hospitals around the country. Their study, “Predictors of Long-term Mortality After Bariatric Surgery Performed in Veterans Affairs Medical Centers,” was published in the Archives of Surgery, 2009;144(10):914-920.*

Among the 856 subjects, average BMI was very high—48.7 (morbidly obese) and 36 percent (more than 300 individuals) were super obese. Eight percent (68 people) of the participants also suffered from chronic illnesses such as diabetes and heart problems.

Postsurgical Mortality

Fifty-four of the 856 veterans (6.3%) had died within a year after the surgery. Fully 25% of patients whose BMI exceeded 50 had died within 3.5 years. Half of those who died were identified as “super-obese.”
The conclusions are stark: “Super obese veterans and those with a greater burden of chronic disease had a greater risk of death after bariatric surgery from 2000 through 2006.”

The risk of death increased over the first year following surgery, particularly for patients with other health problems. At the one-year point, 10 percent of these individuals had died, compared with 3.4 percent of the group as a whole and 5.2 percent of the super-obese subjects.

Dr. Arteburn and his co-authors conclude that “These findings…suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes, and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits, in older male patients and those with super obesity.”

He goes on to underline the importance of doctors making sure that their patients are informed of and understand the full range of risks as well as the positive outcomes associated with weight loss surgery.

*Authors: David Arterburn, MD, MPH; Edward H. Livingston, MD, MS; Tracy Schifftner, MS; Leila C. Kahwati, MD, MPH; William G. Henderson, PhD; Matthew L. Maciejewski, PhD

An abstract of this study is available at: http://archsurg.ama-assn.org/cgi/content/abstract/144/10/914

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