At 626 pounds, 33-year-old Bo McCoy suffered from high blood pressure, high cholesterol, and sleep apnea that were so severe he had spent half his life sleeping with a pressurized air mask over his nose to control it - until he had weight loss surgery. McCoy is now 35, almost 400 pounds lighter, and he no longer needs the machine to sleep through the night, nor medication to control his blood pressure.
Two years ago McCoy had gastric bypass surgery. His experience is similar to that of most people who have weight loss surgery, according to the largest review ever to examine improvements in obesity-related conditions among surgery patients.
Published in the Oct. 13 issue of the Journal of the American Medical Association, the review of more than 130 studies and 22,000 obese or morbidly obese patients shows that the vast majority of people who have weight loss surgery experience dramatic improvements in type 2 diabetes, high blood pressure, high cholesterol, and sleep apnea.
Safety Reviewed for Weight Loss Surgery
The review also presents the most comprehensive picture to date of the risks of various weight loss surgeries. Gastric banding was the safest procedure, with a mortality rate within 30 days of the procedure of 0.1%. Whereas one out of 200 patients who underwent gastric bypass procedures died within 30 days and one of 100 patients who had biliopancreatic diversion or duodenal switch procedures died.
These latter weight loss surgeries are more complicated procedures requiring more operative skills. They are considered to cause more malabsorption compared with banding procedures known better as restrictive procedures.
Although gastric banding was the safest procedure, it was not as effective as the other weight loss surgeries. Gastric banding patients lost an average of 47% of their excess weight, compared with an average of 62% excess weight loss by patients who has gastric bypass surgeries, and 70% excess weight loss by patients who had biliopancreatic or duodenal switch procedures.
"It is true that there are risks with these surgeries," researcher Henry Buchwald, MD, PhD, tells WebMD. "But the risks compare quite favorably with other major surgeries. And the risks of obesity are much greater than the surgical risks."
In studies reviewed by Buchwald and colleagues that assessed type 2 diabetes before and after weight loss surgery, the disease completely disappeared in just under 77% of patients and it improved or resolved in 86% of patients. Improvements in cholesterol were seen in 70% of patients and high blood pressure either resolved or improved in 78% of them. In studies assessing sleep apnea before and after weight loss surgery, the condition disappeared in 86% of patients who lost weight.
"Tip of the Iceberg"
While more and more people are having weight loss surgery, Buchwald says the number is still very low. He estimates that between 8 and 10 million Americans are candidates for surgery, based on National Institutes of Health guidelines. Those guidelines include patients with morbid obesity, which is a BMI of greater than 40, or an individual with a BMI of greater than 35 with other health conditions such as diabetes. In these people initial treatment for weight loss, which is diet (with a low- or very low-calorie diet) and lifestyle changes, is ineffective according to the researchers.
"We are now operating on about 140,000 patients a year, which is 1% to 2% of the people who qualify," he says. "What do you think would happen if we as a nation said we are only going to treat 1% to 2% of people with AIDS or cancer. Surgery is the only successful method of treating morbid obesity, but only a small number of people who need it are getting it."
American Society for Bariatric Surgery president Harvey J. Sugerman, MD, says there is a growing trend among insurance companies to refuse to pay for weight loss surgeries, which typically cost between $20,000 and $25,000.
"It makes no sense because the cost of treating someone with multiple co-morbidities related to obesity is much greater," he says. "The co-morbid conditions mentioned in this study are just the tip of the iceberg."
Message From a Movie
McCoy now counsels other people who are struggling with morbid obesity.
"Surgery is not something someone should go into lightly, he says. "But a person who is morbidly obese or even just obese whose lifestyle has diminished to the point where they aren't living anymore owes it to themselves to at least consider it."
He tells WebMD that he decided to have weight loss surgery after reflecting on a line in one of his favorite movies, The Shawshank Redemption.
"The line was, 'You have to get busy living or get busy dying,' and it just hit me that that is what I had to do," he says. "My life had downgraded to an almost animal existence because my body was so out of control. I had no hope when I weighed 600 pounds, but I got it back when I had the surgery."