Weight-Loss Surgery Offers Best Hope for Morbidly Obese

Contributed by Ron Gara - 05 April, 2005  

Weight loss surgery is the most effective treatment available for morbid obesity, a panel of experts has concluded. It can improve or cure diseases associated with obesity, according to a consensus statement published in the April edition of the Journal of the American College of Surgeons (JACS).

About 8 to 10 million people in the US are morbidly obese, and this group represents one of the fastest growing segments in the obese population, having quadrupled between 1986 and 2000, while obesity doubled. In the morbidly obese population, the average life expectancy is reduced by 9 years in women and 12 years in men.

At a conference convened last year by the American Society for Bariatric Surgery (ASBS) and the American Society for Bariatric Surgery Foundation, scores of surgeons, researchers, primary care doctors, and other medical professionals presented evidence-based data to a 12-member multi-disciplinary panel of experts from around the world.

Devastating Illness

"We have accumulated so much data since a consensus statement was made 13 years ago that it became vital to hold this conference, so patients, health professionals and third-party payors know the latest thinking on treating the devastating illness of morbid obesity," said Henry Buchwald, MD, PhD, Professor of Surgery, University of Minnesota and the Consensus Panel Chairperson.

"It has become crystal clear that in appropriate patients, weight loss surgery -- and now laparoscopic weight loss surgery -- is not just an option, it's the best option, and people who are morbidly obese should consider and have access to this life-saving opportunity."

The first consensus statement on "Gastrointestinal Surgery for Severe Obesity" was made in 1991 by the National Institutes of Health (NIH). That consensus statement concluded that surgery was an option for treating people with a body mass index (BMI) of 40 or more or about 100 pounds or more overweight, or those with a BMI of 35 or more with a co-morbid condition. They noted the majority of patients who undergo medically supervised dieting fail to remain at their reduced weight.

Powerful Consensus

In the new consensus statement, the panel concluded that weight loss surgery can improve life expectancy, eliminate or resolve many diseases associated with obesity, including type 2 diabetes, heart disease and cancer, and that the standard of care for weight loss or bariatric surgery includes the use of laparoscopic and open techniques. The panel agreed that obesity is a chronic disease that has serious health consequences.

The panel stated that the safety of weight loss surgery procedures has significantly improved and that the risk of this surgery is comparable or even less than other major operations.

"The consensus statement is powerful, and we hope it will help the millions of people in this country who are morbidly obese and have run out of options," said Harvey Sugerman, MD, President of the ASBS and a speaker at the conference. "There is a risk associated with weight loss surgery. This is a serious surgery for a serious disease. But the risks and consequences of failed treatments or doing nothing about morbid obesity may be much greater."

Surgery for Teens Too?

The panel recommended that candidates for weight loss surgery should have attempted to lose weight by dieting, nutrition counseling, and commercial and hospital-based weight loss programs, but should not be required to complete formal non-surgical obesity therapy as a precondition for the operation.

They said a multidisciplinary team, including a surgeon, anesthesiologist, dietitian, nurse and experienced office personnel should care for bariatric surgery patients. They recommended that consideration be given to extending the benefits of bariatric surgery to morbidly obese teens and those who have a condition that "can be cured or markedly improved by substantial and sustained weight loss."

The panel called for a major prospective database to study bariatric surgery outcomes, establishment of a pediatric (adolescent) bariatric surgery registry, and a study of the risk-to-benefit ratio of treating morbid obesity with and without bariatric surgery.

The panel included clinicians and researchers in epidemiology, pediatrics, endocrinology, nutrition, internal medicine, psychology, and surgery.