Weight-loss surgery gains medical
respect
But concerns are growing that the radical operation
could be overused
December 2, 2004
By Eric Berger
A radical procedure that treats obesity in the largest
Americans has soared in popularity, raising some concerns
that use of the stomach-cutting operation will extend
beyond those with serious health problems.
Some 140,000 gastric bypass surgeries, which shrink
the stomach from the size of a large melon to a thumb,
will be performed in the United States this year, marking
the surgery's emergence into mainstream medicine.
As the number of procedures grows, patients are migrating
from community hospitals toward major academic health
centers, including the Texas Medical Center, where doctors
once frowned upon the surgery as a tonic for fat people
who did not have the will power to lose
weight by diet and exercise.
But as obesity has come to dominate U.S. health concerns,
and scientists have begun discovering the role genetics
plays in the disease, gastric bypass is no longer shunned.
The Methodist Hospital plans to formally launch a weight-loss
program early next year, and hopes to increase the number
of gastric bypass surgeries from 130 this year to 1,000
per year by 2007. Memorial Hermann Hospital also has
a plan to expand to 1,000 annual surgeries.
The surgery typically costs about $25,000 but can reach
$100,000 if there are complications.
"This is the most serious disease affecting Americans
today," said Dr. Garth Davis, who will lead the
surgical component of the new Methodist Hospital Weight
Loss Center. "The obesity problem is only getting
worse, and this is really the only cure we have for
it right now."
Not everyone is thrilled at broadening the use of gastric
bypass, a surgical procedure that carries substantial
risks.
Best for morbidly obese
Some doctors worry that physicians more concerned
about dollars than a patient's health will perform the
procedure for cosmetic reasons. Gastric bypass has demonstrable
health benefits for patients who are morbidly obese,
or about 100 pounds overweight. But, below that threshold,
the surgery's risks may outweigh the benefits.
"If we're talking about moderate obesity, it's
a pity that people are going in for gastric bypass,"
said Dr. Jerome Kassirer, a Tufts University professor
and former editor of the New England Journal of Medicine.
"Unfortunately, I think you will see people who
are stuck at 250 pounds and really want to get down,
and they're going to go for gastric bypass. That, for
me, would be a real disaster."
Robyn Spano says her gastric bypass surgery performed
seven weeks ago by Davis has been anything but a disaster.
She's already dropped 33 pounds from her pre-operation
weight of 275 pounds.
Before the surgery, Spano, 41, says she took medication
for high blood pressure, acid reflux disease and depression.
She was depressed, she said, because in public situations
she felt as though everyone looked at and judged her
for her weight.
Tool to lose weight
Davis said his patients understand the surgery isn't
a magic bullet, but a tool to help lose weight. They
can cheat by eating many small meals or drinking milkshakes.
What the surgery does, Spano said, is temper the cravings
for food she tried to control her whole life. Chocolate
candy and ice cream had been her weaknesses.
"I've gone to Weight Watchers I don't know how
many times in my life," said Spano, a dentist who
lives in northwest Houston. "My doctor put me on
diet
pills before I was 10 years old."
Now her lunch is Lean Cuisine, perhaps half the entree.
Or maybe a little yogurt and tuna salad. And, at least
for now, that's enough.
A study published in the Journal of the American Medical
Association last October suggests that gastric bypass
has worked for a lot of other people, too. The review
of several thousand gastric bypass surgeries, the most
comprehensive to date, found that patients lost an average
of 68 percent of their excess weight.
The surgery also had profoundly beneficial health effects.
More than 80 percent of those who had the surgery were
cured of diabetes, and more than two-thirds of patients
were cured of high blood pressure, and nearly every
patient — more than 96 percent — had improved
cholesterol levels.
In contrast, numerous studies of diets have found that
97 percent of people who lose weight through diets will
gain it back within five years.
Although the stomach bypass surgery has been around
in various forms for nearly half a century, it has only
recently gained wide acceptance as obesity increasingly
has become a health problem, said Dr. Frank Moody, a
professor of surgery at the University of Texas Medical
School at Houston who helped pioneer the gastric bypass
technique in the mid-1970s.
At the time, he says, it was very difficult to publish
research about the procedure in medical journals. It
was frowned upon because gastric bypass was not widely
viewed as a medically necessary procedure, he said.
So gastric bypass migrated largely to smaller, non-academic
health centers, where doctors often performed the procedure
for cash.
"They were doing it for cosmetic reasons, for
financial reasons," Moody said. "Some of the
surgeons that were doing this were, let's say, at the
fringe of American surgery."
As many physicians have recognized the surgery as the
best option to treat very heavy, sick people, however,
professional attitudes have changed dramatically. TV
personalities such as Al Roker, who had the surgery
two years ago, have likewise raised the surgery's public
profile.
The ability to perform gastric bypass laparoscopically,
with a camera and instruments inserted into a patient's
body at four or five small incisions, rather than making
one large incision, has also increased its popularity.
Laparoscopic gastric bypass surgery, introduced in 1997,
has reduced the number of infections and the incidence
of hernias due to the incision, Moody said.
Focus on gastric bypass
For now, academic centers like Methodist and Memorial
Hermann will focus on gastric bypass, because their
doctors believe it delivers the weight loss that seriously
obese need.
Yet, despite improvements to gastric bypass surgery,
including the laparoscopic option, it still isn't risk-free.
Based upon various studies, between 1 in 50 and 1 in
500 patients die within 30 days of the surgery, largely
because of leaks in the stomach.
What is clear is that experience counts: Surgeons who
have done fewer than 20 such procedures had an almost
5 percent mortality rate in one study, while those who
did 250 or more had few, if any deaths.
Dr. Eugene Boisaubin, a medical ethicist at UT-Houston,
said he doesn't doubt the procedure is safer today,
especially in the hands of an experienced physician.
He is concerned, however, that too many patients undergo
a life-changing procedure without giving a full effort
toward diet and exercise. "I wonder, does this
too easily fit into Americans' desire for the easy way
out?" he said.
A Houston nurse who lost nearly 200 pounds without
surgery or pills, Aliene Adams, agrees. Adams says she
weighs 140 pounds because she eliminated sugar, flour
and wheat from her diet and followed a program to break
her addiction to food.
Although Adams says she can empathize with their desperation,
people considering gastric bypass surgery need to realize
they will never be able to go to a restaurant and finish
a meal, or order a pizza. People considering surgery
in their search of a normal life may be giving up the
very thing they desire.
"A normal life is out of the question," she
said. "Normal is gone."
Source:www.chron.com
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