Introduction
Against a background of widespread obesity among all US age-groups, and the relative failure of conventional weight loss methods, doctors are increasingly resorting to gastrointestinal surgery if you wish to curb the rise of weight-related disease, and associated costs. An estimated 170,000 weight loss surgeries will become performed in 2005, and event though the average bariatric surgery patient is a woman in her late 30s who weighs approximately 300 pounds, operations like vertical banded gastroplasty and roux-en-Y bypass are now being successfully conducted on patients as young as 13 years.
But Does Bariatric Surgery Work?
While the increasing popularity of obesity surgery is a clear reflection of these inability of most obese patients to comply with conventional dietary treatments, the question remains: does this particular kind of surgical medical care offer an effective solution regarding severe clinical obesity? To realize the dilemmas raised by this particular question, let us examine the problem of obesity and how surgery attempts to reduce it.
How Widespread is Obesity?
According to current statistics, 61.3 million American adults (30.5 percent) are obese. Furthermore, an estimated 10-15 percent of childs (ages 6?11) and 15 % of older children are overweight and at risk of developing weight-related unaware of. Severe obesity is also on the rise. 6 million American adults are morbidly obese (BMI 40+), while another 9.6 million simply have a BMI of 35-40. (Source: USA Census 2000; NHANES III data estimates)
How Does Obesity Affect Health?
Excess body fat associated with high body mass index (BMI) carries an increased risk of premature death. Obese patients (BMI 30+) just have a 50-100 percent increased risk of passing away from all causes, compared with individuals of usual weight (BMI 20?25). Morbid obesity (BMI 40+) and super-obesity (BMI 50+) carries a still higher risk of passing away younger. Most of the increased risk is because of co-morbid conditions just similar to cardiovascular disease (atherosclerosis, coronary center (heart) attack or perhaps stroke). The effects of severe obesity on longevity are dramatic. Obese white males between 20 and 30 years old (BMI > 45) can shorten their life expectancy by 13 years. African-American men of similar age and BMI can lose up to 20 years of life. Obese white females between 20 and 30 years old (BMI > 45) can easily shorten their life expectancy by 8 years. African-American women of related age and BMI can easily lose around 5 years of life.
Research Into Obesity and Premature Death
A 12-year study of 330,000 obese men and 420,000 obese women, revealed that premature mortality rates with regard to morbidly obese men were twice the normal: 500 percent higher for diabetics and 400 % higher regarding those with digestive tract disease. In severely obese women, the mortality had been also increased two fold, while in female diabetics the mortality risk increased eight fold and 3 fold in those with digestive tract disease. Another study of 200 men aged 23-70 years with severe clinical obesity, showed a 1200 percent grow up in mortality in the 25-34 year age group and a 600 percent grow up in the 35-44 year age group. Average cancer mortality rates are 150-500 % higher in obese patients.
Other Obesity-Related Diseases
Aside from premature death, obesity is strongly associated with a wide range of health disorders. 80 % of patients with type two diabetes are obese, while almost 70 % of diagnosed coronary center (heart) disease is obesity-related. Other obesity-related unaware of include: high blood pressure, cancer, carpal tunnel syndrome, depression, gallstones, gastroesophageal reflux (GERD), insulin resistance, low back pain, obstructive sleep apnea, musculoskeletal complaints and osteoarthritis, respiratory issues, stroke, and vein disorders.
Why is Surgical Medical care is Needed?
As the facts demonstrate, obesity is an independent risk factor regarding a number of serious diseases. Severe obesity, if left untreated, leads to life-threatening disorders and possible premature passing away. It is against this kind of background that the viability of bariatric surgery should end up being assessed. 3 key quiz are: (1) Does bariatric surgery lead to a significant loss of weight? (2) What are the health benefits of surgery? (3) What are health risks?
Does Bariatric Surgery Lead To A Significant Loss of Weight?
Yes. According to most patient-surveys the health and weight reduction benefits of bariatric surgery exceed all other medical care methods by a wide margin. Weight loss surgery is considered successful when excess weight is reduced by 50 % and the weight loss is sustained for 5 years. At present, average excess weight reduction at five years is 45-75 percent after gastric bypass and 40-60 % after vertical banded gastroplasty. In a statistical review of over 600 bariatric patients following gastric bypass, with 96 % follow-up, mean excess weight loss still exceeded 50 percent of initial excess weight at fourteen years. Another 10 year follow-up research with the University of Virginia reports weight reduction of 60 % of excess weight at 5 years and in the mid 50's between years 6 and 10. A significant percentage of less-committed patients do regain weight 2-5 years after having surgery, especially those who undergo the less drastic stomach banding procedure, however if the patient is nicely motivated and given proper post-operative support, the weight loss is often permanent. By comparison, according to a single 4-year study of non-surgical weight loss programs involving obesity medication, routines modification, diet and exercise, average weight reduction has been three pounds in those subjects who were followed regarding the 4 years of these study.
What Are The Health Benefits of Surgery?
According for the International Federation regarding the Surgery of Obesity (IFSO), weight reduction caused by gastric reduction surgery improves longevity and reduces rates of premature dying. Furthermore, hypertension is cured in regarding 50 % of patients, while measurements of cholesterol and other blood fats present visible improvements, all leading to a reduction in the risk of coronary center (heart) disease. Type two diabetic issues is cured in 80 % of diabetic patients while hyperglycemia and associated conditions just similar to hyperinsulimia and insulin resistance are even more likely to benefit from gastric bypass. Obstructive sleep apnea is cured in about 75 % of patients, shortness of breath is relieved in 75-80 percent of cases, while asthma attacks are a great reduced, particularly when regarding gastroesophageal reflux disease. Obesity surgery also relieves low back pain and arthritis, heartburn, urinary incontinence, and lower limb venous disorders.
What Are The Health Risks?
Generally speaking, the health complications of bariatric surgery divide into three classes. First, during the operation themselves, patients are subject towards the typical health dangers of any serious surgical procedure. Risk factors include: sick person condition, the expertise of these bariatric surgeon and anesthesiologist and the excellent of operating room services. Premature death happens in regarding 1-2.5 percent of bariatric cases. Second, there are well-documented post-operative health risks, that largely depend on the kind of procedure performed.
Post-Operative Health Problems of Gastric Banding
Restrictive procedures just similar to gastric-banding and stomach stapling carry a number of short-term post-operative health risks, including: (1) Risk of hernia. Regarding 10-20 percent of patients require extra surgery to fix dilemmas such as abdominal hernias caused by excessive straining after surgery before the incision heals. Laparoscopic surgery reduces this particular risk. (2) Risk of blood clots. About a single % of patients contract blood clots in the legs. (3) Risk of infection. On average, there is a 5 percent risk of infection in the incision area. (4) Risk of gastric staple breakage. This happens in bariatric operations such as vertical banded gastroplasty, which use staples to reduce stomach size. (5) Risk of band slippage and saline leakage. A routine complication, this kind of occurs after lap band or perhaps other forms of adjustable gastric banding. (6) Risk of bowel obstruction. This particular rare complication can easily come up as a result of adhesions caused by scar tissue. (7) Risk of stomal stenosis and marginal ulcers.
Post-Operative Health Dilemmas of Gastric Bypass
Post-operative health dangers of bypass procedures just similar to roux-en-y or biliopancreatic diversion include: (1) Corrective operations. Regarding 15-20 % of bypass patients require follow-up gastrointestinal operations to precise complications (eg. hernias). These follow-up operations tend to carry higher risk of complication and dying. (2) Dumping Syndrome. Caused by overindulging or perhaps over-rapid eating, dumping, just isnt a real health danger, but signs or indicators (nausea, faintness, sweating and diarrhea) can easily end up being distressing. (3) Risk of nutritional deficiency. Since stomach bypass surgery involves bypassing the duodenum and part/all of these jejunum, causing insufficient absorption of vitamins and minerals, patients may develop deficiencies in nutrients such as: iron, calcium, vitamin D and B12 deficiency. This kind of can easily be easily corrected by a program of nutritional supplementation. (4) Risk of gallstones. About one-third of bypass patients develop gallstones. (5) Bowel Disorders. After all bypass operations, there is a moment of intestinal adaptation during which bowel movements can easily become liquid and frequent. Typically accompanied by bloating, gas and foul smelling stools, this complaint can reduce with time, yet occasionally becomes a permanent condition.
Bariatric Surgery is No Easy Answer To Obesity
Even though surgical methods are becoming more and more successful for the reduction of severe obesity, it would become misleading to display surgery as an easy option. To start with, its success depends entirely on sick person compliance with post-operative guidelines. And pressures to overeat do not disappear after surgery. If patients adhere to instructions, they tend to lose weight without regain. If these people "cheat", these people tend to regain most of their weight loss and may end up in a worse situation compared to before. Second, because of cost and availability problems, bariatric surgery may only ever treat a tiny percentage of these population who are severely obese. Third, we lack long term feedback on the success of the operations. With regard to these types of reasons, it seems that bariatric surgery is no easy solution to our obesity epidemic.