Bariatric surgery (weight loss surgery) has been around for a couple of decades. It’s benefits in helping to control diabetes and high cholesterol is well established. In an observational study through the Cleveland Clinic and published in JAMA last week, those benefits seem to apply to reducing cardiovascular events (i.e. heart attack and strokes) as well as reducing all cause mortality.
Body Mass Index is calculated by dividing one’s height in meters squared by one’s weight in kilograms. Or just Google BMI calculator. BMIs from 30-35 are considered obese, from 36-40 morbidly obese, and above 40 super morbidly obese. Each level increase parallels an increase risk in cancer, vascular events, and death. Lowering one’s weight lowers the risk of these events. Lower caloric intake and increased caloric expenditure has been the mainstay of therapy for obesity. Some call that diet and exercise. The failure rate for that approach is through the roof and it should not come as a surprise that obese patients cannot lose weight despite their best efforts. It’s difficult. For those carefully selected patients with an obesity related diagnosis such as high blood pressure or diabetes, bariatric surgery ought to be considered.
There are two approaches to the surgery. The first is restrictive where the stomach is made smaller with either a lap band or a gastric sleeve to reduce the amount of calories that can be consumed. The second is both restrictive and malabsorptive where the duodenum, where calories are absorbed, is bypassed along with making the stomach smaller (the Roux Y gastric bypass). Depending on how much weight needs to be shed and tolerance of the potential complications, a patient can decide with their surgeon which to pursue.
This study compared 2300 patients who underwent any type of bariatric surgery to 11,000 of their obese counterparts who didn’t for over 10 years and found that the group undergoing surgery did in fact have better outcomes. A limitation of the study was that currently there are more potent drugs to treat diabetes than were available during the duration of the study. We don’t know if better diabetic control would have improved the outcome of the non-surgical group.
But the take home message from me is that: Bariatric Surgery is NOT a cop-out! Those who qualify should not feel guilty about getting a surgery to prolong their lives, reduce mortality, reduce their risk of cancer and vascular events, and reduce morbidity. Those who watch them do it should not judge them for getting these procedures. And most of all — insurance companies should cover it fully. These are proven effective and the barrier of affording it should be lifted.