March 14, 2011 -- Severely obese adults may reap significant health benefits from bariatric surgery, including reduced heart risks. And rewards of the weight loss procedure may outweigh risks, according to a new scientific statement.
The scientific statement from the American Heart Association is the first to focus solely on bariatric surgery and cardiac risk factors, says lead author Paul Poirier, MD, PhD, of Laval University Hospital in Canada.
Poirier, director of the prevention and rehabilitation program at Laval’s Quebec Heart and Lung Institute, says in a news release that the new statement does not represent an across-the-board endorsement of bariatric surgery but provides views of experts on the procedure that can be used to inform doctors and obese patients.
"It is a consensus document that provides expert perspective based on the results of recent scientific studies," he says.
Bariatric Surgery Effective Way to Fight Obesity, Health Problems
Bariatric surgery is a term that includes various types of procedures aimed at restricting food intake and/or causing food to pass through the gastro-intestinal tract without being fully absorbed or digested.
The AHA has long held the position that bariatric surgery should be considered carefully, based on the medical profile of individual patients.
Operative mortality associated with bariatric surgery historically has been between 0.1% and 2.0%, with more recent data showing a mortality rate no more than 1%, according to the AHA.
“Obesity has reached epidemic proportions in the United States as well as in much of the industrialized world,” Poirier says. “The most rapidly growing segment of the obese population is the severely obese. The health consequences of severe obesity are profound.”
He says that compared to normal-weight people, a 25-year-old man who is severely obese has a 22% reduction in expected life span.
A person with a BMI of 25-29.9 is considered overweight, and 30 or greater obese.
Severe obesity is defined as having a body mass index of 40 or more. BMI is a measure of body fat based on a ratio of height and weight.
Calculating Body Mass Index
BMI can be calculated easily online.
For example, a sedentary 6-foot-tall man who weighs 295 pounds has a BMI of 40. A 5-foot-4 inch tall woman weighing 235 pounds has a BMI of 40.3.
“Substantial long-term successes from lifestyle modifications and drug therapy have been disappointing,” he says, “making it important to look at surgical options.”
Poirier and others on the statement-writing committee reviewed scientific literature and found that bariatric surgery can lead to significant weight loss and general improvements in health.
Benefits of Weight Loss
According to the statement, the potential benefits of weight loss include reducing high cholesterol, the risk of liver disease, diabetes, high blood pressure, obstructive sleep apnea, and cardiovascular problems.
The statement points out that bariatric surgery has risks, including death, as well as long-term post-surgical lifestyle implications. It says people who undergo bariatric surgery must make lifelong behavior changes, such as supplement use, and keep in contact with doctors.
“Bariatric procedures are generally safe,” Poirier says. “However, this is not a benign surgery. At the moment, bariatric surgery should be reserved for patients who can undergo surgery safely, have severe obesity, and have failed attempts at medical therapy.”
He says more research on bariatric surgery in adults and youths is needed, especially because the severely obese adolescent population continues to increase with no effective sustainable treatments available.
Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York, who was not involved in the formulation of the statement, says in a statement that information in the new pronouncement is “essential for all severely obese” people to understand.
“Data has been accumulated that shows that obesity surgery reduces the risk of major cardiac events by approximately 50%,” he says. “Rather than treat the various risk factors, weight loss surgery can treat the diabetes, hyperlipidemia, and hypertension with a single procedure.”
“Yet, we struggle to get approvals,” Roslin says. “If prevention is the goal, there is no better preventive tool for heart disease than a well-done bariatric procedure in a severely obese individual.”
Psychological Evaluations May Be Useful
The statement says the value of psychological evaluations in bariatric cases is uncertain, and there is no existing data to support mandatory psychological evaluation.
However, the authors say psychological evaluations are frequently performed and should assess the behavioral and environmental factors that may contribute to a person’s obesity, as well as the patient’s ability to make dietary and behavioral changes necessary for the surgery to achieve desired results.
The statement is published in Circulation: Journal of the American Heart Association.