Weight loss surgery found effective

By NANCI HELLMICH / USA Today

04/12/2005

Expensive weight-loss surgeries such as gastric bypass are by far the most effective options for severely obese people who want to lose a lot of weight, according to a new analysis.

The report suggests that prescription diet drugs combined with diet and exercise provide modest weight loss for the overweight or moderately obese. But for those who are 100 or more pounds too heavy, the researchers say, these weight-loss tools may not be enough.

While these findings might not seem surprising, this analysis is important because it was financed by the government - the U.S. Agency for Healthcare Research and Quality - and may be a factor as insurance companies and government agencies debate whether to pay for surgeries.

Medicare covers bariatric surgery only if the obese patient has other life-threatening conditions, such as diabetes. Benefits for Medicaid patients vary by state.

Scientists from several medical institutions reviewed 225 studies on diet drugs and bariatric procedures, including gastric bypass and adjustable gastric banding. Among the find- ings reported in Annals of Internal Medicine:

• Severely obese people who have procedures such as gastric bypass surgery lose and keep off an average of 44 to 66 pounds for up to 10 years. The average cost for gastric bypass, which creates a much smaller stomach and rearranges the small intestine, is $26,000.

• Overweight people who take prescription diet drugs while dieting and exercising lose an average of 8 percent to 10 percent of their starting weight, about 15 to 20 pounds, in the first year.

• Weight-loss surgery helps improve or eliminate diabetes, high blood pressure, sleep apnea and high cholesterol for most patients.

• The mortality rates from all the bariatric procedures is less than 1 percent. Overall, about 20 percent of people had some complications. Deaths and complications were significantly higher when performed by surgeons who had done fewer than 50 such surgeries.

• The medications have some side effects. Studies on sibutramine have documented cases of increased heart rate and blood pressure. Study participants who took orlistat have reported gastrointestinal problems.