Weight Loss Surgery is a Healthy Solution for Some
> 8/23/2007 11:07:43 AM

Gastric bypass surgery is not a fashion trend or a career-boosting vanity cure for celebrity cellulite. It is a drastic, complex and controversial procedure recommended only for those whose severe obesity dramatically compromises their physical health. And according to new research, it is a legitimate life-saver in a surprising number of cases.

The gastric bypass or bariatric procedure, also known in common parlance as "stomach stapling" or "banding," centers around the surgical act of reducing the stomach's volume by dividing it into two compartments, the lesser of which sits above the larger, and connecting both  "pouches" to the small intestine. Each section drains into the intestinal tract, but foods and fluids consumed bypass the lower, larger compartment, and the stomach's diminished size leads to a reduced appetite and a profoundly altered physiological response to food. Ensuing weight loss can be rapid and pronounced, significantly reducing the risk of related disorders. An important consideration for those entertaining the option: the procedure should not be mistaken for a quick fix in preparation for swimsuit season as it is recommended only for the severely obese.

Of course, like any other major operation, bariatric surgery carries the risk of complications and may prove deadly, as previous reports indicated that 1 in 50 recipients died within a month of surgery. Alternate research contradicts this frightening statistic, listing the mortality rate at 0.11% percent after 30 days and 0.3% after 90 days. The newest study on the subject, which is the first large scale effort to track the post-surgical health of gastric bypass patients, is far more encouraging, estimating a fatality prevention rate of 40% within 10 years. The major reason for this dramatic reversal is the surgery's documented ability to minimize or eliminate comorbities. The survey, comparing the outcomes of more than 2,000 individuals who'd received bariatric surgery and 2,000 who'd received more traditional medical treatments, bore crystal-clear results: those who'd undergone the stomach stapling procedure lost, on average, 25% of their weight at the end of the decade. Those with the less extreme banding operation lost 15% and those who went without surgery lost almost no weight at all (less than 2%). The number of deaths in the control group was significantly higher as well: 129 to 101.

An independent American study of related mortality rates produced very similar results, finding that "the surgery patients had a 56% decrease in deaths from cardiovascular disease, a 92% drop in deaths from diabetes and a 60% decline in deaths from cancer." Overall deaths: 321 to 213, a 40% difference. The conclusions are obvious. Still, significant risks associated with the surgery remain, among them infection, hernia, internal bleeding and a state of malnutrition caused by the digestive system's compromised ability to absorb nutrients such as iron, calcium and certain proteins.

More than 175,000 Americans underwent the operation in the last year, but that sizable number makes up only 1% of the individuals whose measurements render them eligible (BMI of 40 or BMI of 35 accompanied by at least one related condition, a category that includes men who are more than 100 lbs overweight and women with more than 80 extra lbs). Certain researchers, in light of the latest findings, advocate loosening the restrictions designed to determine who may qualify for the surgery, but their advocacy should not be seen as an open invitation to go under the knife. The BMI index has been criticized as unrealistic and overly inclusive, labeling many famously healthy individuals (including our current exercise advocate president) as overweight.

Bariatric surgery indisputably reduces the instance of comorbid conditions, and it seems to increase average lifespans even while posing small threats to one's general physical health. But it cannot be taken lightly, and encouraging overweight or even slightly obese patients to seek it out may not be a good thing. While genetic conditions leave some with no viable alternative, most Americans can add years to their lives and remove inches from their waistlines simply by taking "brisk walks" three times a week, watching what they eat, and accepting the fact that their body types are a little large.

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