RESULTS OF STUDIES Obesity surgery improves health

The weight-loss techniques are grouped under the umbrella of bariatric surgery.
Stomach reduction and gastric bypass surgery not only help the extremely obese lose weight, but they also can alleviate type 2 diabetes and return high cholesterol levels to normal, according to a new study reported today in the Journal of the American Medical Association.
Dr. Henry Buchwald and his colleagues at the University of Minnesota combined data from 136 studies involving 22,094 patients and concluded that the procedures -- which range from simple rubber bands that reduce the size of the stomach to more complicated procedures that bypass large parts of the digestive system -- are remarkably effective at restoring health and improving quality of life.
They found patients typically lost more than 60 percent of their excess weight, usually more than 100 pounds. Diabetes was resolved in nearly 77 percent of patients with the disease. Cholesterol levels were lowered in at least 70 percent of patients.
Blood pressure was returned to normal in nearly 62 percent of patients who had high levels before surgery. Obstructive sleep apnea was cured or improved in 83.6 percent of patients who had the breathing disorder.
Because those conditions are closely linked to obesity, the Minnesota team expected to see benefits from the procedures, "but we were a little surprised" by how large the benefits were, Buchwald said.
"The overwhelming majority of patients responded positively," said Dr. Erik Dutson of the University of California, Los Angeles, who performs the surgery but did not participate in the study. "This is a huge chunk of data that gives us very strong indications of what the reality is."
At least 8 million Americans are considered morbidly obese -- more than 100 pounds overweight -- and have other risk factors for heart disease that would make them eligible for the surgery. Most have tried dieting and appetite suppressants to no avail, leaving them with no other recourse.
These people have severe health risks because of their obesity, "and we are only doing the procedure on 1 percent or 2 percent of those who are eligible," Buchwald said. "We couldn't get away with that if this were AIDS or diabetes or anything else. This is the only therapy today that is this effective."
The weight-loss techniques, collectively called bariatric surgery, were first developed in the 1950s and have undergone continuous refinement.
Initially, they involved invasive surgery in which the chest was opened and a large segment of the intestines bypassed, thereby reducing absorption of food. The procedure required several days' hospitalization, had many complications and was never very popular.
In the 1980s, Dr. Edward E. Mason of the University of Iowa developed what is now known as the Roux-en-Y procedure, in which the upper portion of the stomach is stapled to reduce the amount of food it can hold and a new outlet is formed in the stomach wall and connected to the lower intestine, bypassing much of the gastrointestinal tract.
This is now the gold standard for bariatric surgery and was found to be the most effective in the Minnesota study.
Initially it required the chest to be opened, but most surgeons now do the procedure laparoscopically, using instruments inserted into the abdomen through small incisions. Such techniques usually require a short hospital stay.
The newest techniques, called banding, involve placing a rubber band around the upper portion of the stomach to limit food flow, thereby reducing capacity of the stomach. In some cases, the band can be inflated to reduce stomach capacity or deflated to increase it. These procedures also are performed laparoscopically.
Buchwald found that the banding procedures were the least effective but that even those produced major benefits for the patients.

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