The Benefits of Obesity Surgery

Recently a panel of experts in the field of obesity surgery was convened to create a consensus statement and to establish guidelines regarding obesity surgery. These important documents summarized the history, present state and probable future of obesity surgery. They included a description of the various obesity surgeries and recommendations regarding indications and use. The statements also discussed the medical necessity and benefit of these procedures and included a section directly addressed to health insurers that made a case for cost reimbursement in morbidly obese patients. What follows is a summary of the key features of these documents as discussed by the top experts in the field of obesity surgery.

 

 

Perhaps the boldest statement made in these expert statements was the claim that “bariatric surgery (obesity surgery) is the most effective treatment for morbid obesity and can result in improvement or complete resolution of obesity comorbidities.” However, when you consider what obesity surgery can provide patients—freedom from obesity—the statement is accurate. It is not uncommon for obesity surgery to allow a person to lose 45 to 80 percent of their body weight within one to two years of the surgery and to maintain this weight loss for at least ten years, the maximum duration of most studies on the subject.

 

Not only does obesity surgery provide a freedom from extremes of excess body weight, but obesity-related illnesses can be treated and even cured after obesity surgery. Type 2 diabetes mellitus, the “sugar diabetes” that generally afflicts overweight and obese people, is sent into remission in over half of patients following obesity surgery. In fact, 95 to 100 percent of patients undergoing a biliopancreatic diversion surgery for obesity achieve a remission of their Type 2 diabetes. Two-thirds of patients can expect their high blood pressure to be under control after obesity surgery, without medication. Obstructive sleep apnea, that is, the state in which a person stops breathing at night due to a closure deep in their throat, is cured in four out of ten patients. In addition, blood cholesterol levels are normalized (LDL or bad cholesterol decreases; HDL or good cholesterol increases) in 85 % of patients undergoing obesity surgery.

 

The dramatic improvement of illnesses that are directly linked to obesity has essentially forced health insurance companies to see the overall cost benefit of obesity surgery procedures. When they consider the cost of daily medicines for hypertension, diabetes, and cholesterol coupled with breathing machines for obstructive sleep apnea and coronary angioplasty and stents for people with severe atherosclerosis, one surgery to directly treat obesity becomes the less expensive alternative.

 

The primary obesity surgeries are Vertical banded gastroplasty, Gastric banding, Silastic ring gastroplasty, Laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, Biliopancreatic diversion with or without a duodenal switch. Not all of these procedures are performed in all people and the selection of a surgery is based on the degree of obesity and the relative health of the patient. Generally, in order to qualify for obesity surgery, a patient must have a body mass index (BMI) of 40 or above OR a BMI of at least 35 and one obesity-related disease, as described previously. The Centers for Disease Control and Prevention (CDC) provides an online body mass index calculator at http://www.cdc.gov/healthyweight/assessing/bmi/ for adults and children.

 

 

Buchwald H; Consensus Conference Panel. (2005) Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis 1(3):371-81.

 

Mechanick JI, Kushner RF, Sugerman HJ, et al. (2008) American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 4(5 Suppl):S109-84.