Bariatric Surgery For More Than Just Weight Loss?
Gone may be the days of limiting bariatric surgery just to helping patients lose weight.
Indeed, these weight loss surgeries, in all forms, do just as the name describes. But a slew of new research suggests bariatric surgery can also be used to help reverse medical complications of obesity, not just eliminate obesity itself.
These procedures may reduce the risk of chronic disease, and even help patients better qualify for organ transplants, according to studies presented Wednesday at the American Society for Metabolic and Bariatric Surgery annual meeting.
An estimated 72 million Americans are considered obese and nearly 200,000 Americans undergo bariatric surgery each year, according to the American Society for Metabolic and Bariatric Surgery.
Obesity can lead to chronic illnesses like heart disease and diabetes, which can cause organ damage. But many who are morbidly obese and in need of a new organ do not qualify for transplants because of the increased risk of complications from medications and surgery.
“We tend to see obesity as a lifestyle problem, but it’s really leading to worse medical problems,” said Dr. Jaime Ponce, president-elect of the American Society of Metabolic and Bariatric Surgery. “Eventually it becomes a vicious cycle of deteriorating health.”
Some forms of weight loss surgery, which have grown to be less invasive and therefore less risky than procedures like transplant surgery, are not only regarded by surgeons as a way to shed dangerous pounds, but also reverse the complications of metabolic diseases.
“[Bariatric surgery] has been widely accepted in the medical field, but now we’re trying to apply it to specific patient groups,” said Dr. Matthew Lin, bariatric surgeon at the University of California, San Francisco.
In one pilot study of 26 morbidly obese patients waiting for a kidney or liver transplant, researchers at UCSF found laproscopic sleeve gastrectomy, a procedure where a majority of the stomach is removed and reshaped into a small tube or sleeve, significantly improved the chances of having successful organ transplants.
“The reason why physicians are skittish about bariatric surgery for organ transplant is that these patients have more medical comorbities,” said Lin, who is the lead author of the study. “But our study shows that it is safe to proceed.”
One of the patients in the study was even taken off the transplant list because his kidney function improved, according to the findings.
Not all cases of bariatric surgery will see a reverse in symptoms, or even reversal in damage of organs. Patients who have endured the weight and the metabolic diseases for longer may have less chance to see any type of reversal, said Ponce.
However, there are many factors to the surgery that contribute to changes, he said.
“We’re not just treating the weight; we’re actually treating the metabolic damage by doing this surgery,” said Ponce. “It changes their hormones and how their organs work in their body.”
In other studies, presented at the meeting on Wednesday, bariatric surgery was shown to reverse kidney disease, stave off heart attacks by nearly a decade, and help manage diabetes.
“We can treat increased blood sugars with medications, but we are reversing complications [with surgery],” said Dr. Robin Blackstone, current president of the American Society for Metabolic and Bariatric Surgery. “We are moving away from treating people just because they are obese and now we have disease specific indications for surgery such as heart disease, cancer, and diabetes.”
The procedure does not come without risks, especially since those who qualify for weight loss surgery are typically at least 100 pounds overweight. But it’s not just undergoing the surgery that poses a risk.
A study released Monday in the Journal of the American Medical Association found that weight loss surgery can increase a person’s risk for alcohol-related problems by up to 50 percent.
Most patients experience psychological and physical changes, and are informed about the risks before surgery. But these risks increase if the patient does not follow up with their physician or is not monitored properly after surgery, said Ponce.
“Patients need to understand that there is a team and a practice and a hospital ready to take care of them,” said Ponce. “It’s not a one-time surgical procedure; there is constant follow up.”
“They need to commit themselves to the idea that this is a long-term lifestyle change they need to actively participate in,” said Ponce.
By LARA SALAHI (@BostonLara) and SHEILA REDDY, M.D.
June 20, 2012
Full article available here.