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Though Americans’ weight continues to climb, our use of weight loss surgery has topped out. No one has precise figures, but one new study estimates that rates of bariatric surgery have been flat since 2004. So, if we’re still getting fatter, why aren’t we relying more on weight loss surgery, a surefire way to trim significant weight?
Some researchers say it's because of cost. The surgery runs anywhere from $11,000 to $26,000, according to the American Society for Metabolic & Bariatric Surgery. Even if insurance covers the procedure, there are copays and other expenses to the surgery, which probably deter lots of people. Plus patients are supposed to lose weight through diet and exercise before the procedure – but if they could do that, they might not need the surgery in the first place.
Others say that because excess weight doesn't stop us in our tracks – even people who are hundreds of pounds overweight can hold down jobs and play with their kids – we underestimate the dangers of living with those extra pounds.
“You can be pretty highly functioning and be at significant risk and not really know it,” said Dr. David Lautz, director of bariatric surgery at Brigham and Women’s Hospital. “The risks associated with obesity can sneak up on you.” As you get heavier it’s harder to do the operation and harder to lose weight without an operation.
Weight loss surgery has become far safer over the last decade, as surgeons got more used to doing the procedures, and most turned to less invasive laparoscopy – surgery done through keyhole openings instead of large incisions.
Risk of death used to be around 1 in 100, but now it’s down to roughly 6 in 10,000. In many cases, it’s safer than not getting the procedure.
“If you are a big person with diabetes [and other health problems], your chance of dying is much higher if you don’t have surgery,” says Dr. Robin Blackstone, president of the American Society for Metabolic & Bariatric Surgery and medical director of the Scottsdale Bariatric Center in Arizona.
Of course, surgery alone is never enough to solve health problems, she and other doctors said. It’s got to be part of a comprehensive program that includes eating less and exercising more.
But losing 30 to 50 percent of excess weight in the first six months, as most people do with weight loss surgery, can really help jump-start the process.
“Try to exercise when you’re 300 pounds, it’s just not an easy task,” said Dr. Ninh T. Nguyen, chief of the Division of Gastrointestinal Surgery at the University of California, Irvine Medical Center. “Bariatric surgery gives them that edge to begin to do everything they need to do to keep the weight off.”
And most people do keep the weight off, studies suggest. If someone loses 100 or 150 pounds, they may gain up to 30 pounds back beginning about 2 years after surgery, Lautz said. But they’re still way ahead of where they started.
There are several different types of procedures with different pros and cons (see the bottom of this page for more info.)
Research suggests that the least effective of the procedures is Lap-Band, in which a band is placed around the upper part of the stomach. Weight loss is usually less dramatic with Lap-Bands and some can slip off or require adjustments. Removal rates are relatively high, and the public is starting to move away from it.
“We probably did the most bands in 2008-9,” Blackstone said. Now, she puts in maybe one or two a month, down from at least that many per week, she said.
Another difference between Lap-Band and the more invasive surgeries is their impact on diabetes. Though research is still preliminary, some of the more invasive surgeries, like Roux en Y gastric bypass – in which the stomach is attached to the middle of the small intestine, bypassing part of it – seems to improve or even resolve type 2 diabetes, the kind that’s associated with obesity.
Lautz is doing a study now comparing Lap-Band with Roux en Y and lifestyle changes to confirm the benefits for diabetics and to understand the mechanism for how it works.
Blackstone said she’s eagerly awaiting news of why bypass resolves diabetes.
“Whatever the answer is to that question is going to help us answer the question how we get diabetes to go away, period,” she said.
Long-term, Blackstone says, the real answer will be finding medications that do the same thing as surgery, without the scalpel.
Did you decide to have bariatric surgery? Why or why not?
Karen Weintraub is a freelance Health and Science writer based in Boston.
This program aired on August 23, 2011. The audio for this program is not available.
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