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Weight Loss Surgery Makes Life Better for Obese

Gastric Bypass Boosts Mental, Physical Health -- but Complications Common

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The second thing they found was that the operation often has complications. Obese people have many health problems associated with being obese and end up in the hospital more often than normal-weight people. In the year before gastric bypass surgery, nearly 10% of patients had been admitted to the hospital.

"In the first year after surgery, about 20% get admitted -- about double the baseline rate," Zingmond tells WebMD. "It never gets back down to 10% in first three years after surgery. So we see an increase in rates of hospitalization."

Before surgery, most patients were hospitalized for obesity-related problems. After surgery, most patients were hospitalized for problems arising from the surgery itself in the first two years. "What it really comes down to is for potential patients -- at the time of surgery, not after -- to think about what they are willing to put up with after surgery," Zingmond says. "Other researchers have done the analyses and found that the benefits far outweigh the risks for appropriate patients. But people who are overweight will be more likely to be readmitted to hospital in the first three years after the procedure. They should be prepared for this."

Zingmond is quick to point out that laparoscopic weight loss surgery -- a new, minimally invasive technique -- results in far fewer complications. Wolfe agrees and estimates that two out of three weight loss surgeries today use the laparoscopic technique.

Yet nobody yet knows the long-term consequences of offering weight loss surgery to ever larger numbers of patients.

"We know the surgery results in weight loss, lower cholesterol, and resolution of diabetes," Zingmond says. "But we don't know about the changes to the gastrointestinal tract and whether, over a lifetime, this has some impact. We're still looking at what happens."

Surgery the Best Treatment for Morbid Obesity?

Despite the risk of death and other complications, weight loss surgery attracts increasing numbers of patients. The JAMA report by University of Chicago researcher Heena P. Santry, MD, and colleagues chronicles the trend.

From 1998 to 2002, Santry's team finds the estimated number of weight loss surgeries in the U.S. increased from 13,365 to 72,177. As the number of surgeries increased, the rate of complications went down.

Why the increase? Despite the huge number of diet books sold each year, relatively few morbidly obese people manage to lose -- and keep off -- significant amounts of weight.

Weight loss surgery, Santry and colleagues write, "remains the only durable option for weight loss in the morbidly obese." Yet in the U.S., less than 1% of such people undergo weight loss surgery in any given year.

"What is up with that?" Wolfe asks. "There is concern about risk and there are negative perceptions that arise from poor results of operations that have been tried and failed in the past. I believe that risk of complication is the single greatest explanation of why the number of patients is relatively small. As that improves, demand will accelerate quite substantially."

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