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Obesity Surgery More Effective for Weight Reduction
A new report issued today by HHS’ Agency for Healthcare Research
and Quality concludes that surgery for extremely obese patients who have
tried and failed to lose weight with exercise and diet may be more effective
for weight reduction. Obesity Surgery Improves Health
It can also improve control of some obesity-related health problems such
as high blood pressure and diabetes. In addition, extremely obese persons—those
who have a Body Mass Index (BMI) of 40 or greater—often suffer from
severe health problems such as heart disease, musculoskeletal disorders,
and sleep apnea that limit daily activities and put their lives at greater
risk.
Complications of Obesity Surgery
Approximately 20 percent of those who have weight-loss surgery experience
complications; although most are minor, some can be serious, according
to the study authors. These include nutritional deficiencies, leaks from
staple line breakdown, and deep vein thrombosis. Laparoscopic procedures
result in fewer wound complications and incision hernias than traditional
abdominal surgery.
Other Findings
- Roughly 60 million adults in the United States are obese, and 9 million
are extremely obese. A BMI of 40 or greater is not the sole criterion
for selecting patients who might benefit from weight-loss surgery. Of
the 9 million extremely obese adults, only a small fraction, about 1.5
percent or 140,000, undergo weight-loss surgery each year in the
United States.
- The scientific evidence review that was used as the basis for the
new AHRQ report found data suggesting that weight-loss surgery, also
known as bariatric surgery, may be more effective than drugs for people
with BMIs of 35 to 40; however, the evidence is not strong enough to
draw firm conclusions for this group.
- In addition, the review found that Roux-en-Y gastric bypass surgery
results in greater weight loss—an average of 20 pounds—than
does vertical-banded gastroplasty.
- The AHRQ review did not find enough evidence to draw conclusions about
differences in the safety of different types of weight-loss surgery,
which include adjustable gastric banding, vertical-banded gastroplasty,
and biliopancreatic diversion procedures. Less than than 1 percent of
patients operated on by experienced bariatric surgeons die as a result
of the surgery or from complications, but the rate may be higher for
less-experienced surgeons.
- The evidence review also found that some prescription medicines—particularly
orlistat and sibutramine, the most widely studied drugs—promote
moderate weight loss when prescribed along with recommendations for
dieting. The amount of weight loss directly attributable to these drugs
averages less than 11 pounds, but research shows that even such a modest
weight loss may decrease the occurrence of diabetes.
- No weight-loss drug appears to be superior to others, and, like all
medications, each has side effects. The drugs have not been studied
sufficiently to evaluate the risk of rare side effects, nor has there
been enough research to determine the optimal time to treat obesity
with drugs or how this may vary by patients’ age, gender, or race.
- The evidence review found that very little research has been done
on either surgery or medical treatment of obesity in children and adolescents.
Source:
New AHRQ Report on Treatment for Extremely Obese Americans Who Suffer
Life-Threatening Illnesses Finds Weight-Loss Surgery More Effective. October
8, 2004
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