Expert Commentary: Rami E. Lufti, M.D., FACS 12/15/2009

Posted by Admin on December 15, 2009
Obesity has become an epidemic crisis in United States! The problem is further aggravated by the serious threat obesity has on our society. This was evident by a study published by the Journal of the American Medical Association (JAMA) in 2004. Researchers found, looking at the top 10 causes of preventable death in the US, that obesity came a close second to smoking, causing 400,000 deaths yearly! The projection is that obesity will soon surpass smoking as the number one killer in our country! Medical, behavioral, and nutritional interventions are many; and while they are the way to go for the overweight individuals, it has become clear that for the morbidly obese patients (>80 pounds over IBW, Ideal Body Weight), these interventions alone, fail to provide a long term meaningful weight loss.

In this group of patients (morbidly obese), which now is 5% of the population, surgery to date has been the only effective treatment to provide a significant long term weight loss.

Surgical procedures for obesity have gone through a long maturing process reaching a high level of safety and efficacy. Using cutting edge technology, we can perform the most complex procedures through tiny incisions (Minimally Invasive Surgery), and in many times do the surgery in an outpatient setting!

Despite the proven safety, surgery remains a drastic solution; going under general anesthesia, and having abdominal surgery is a major decision that we take very seriously; complications could happen, such as a leakage from suture lines, or Band slippage after placement of an adjustable gastric band.

So how should we determine the way to go?

As in taking any decision in life, we should have the proper education, then weigh the risks and the benefits to be able to make the right decision. Despite continuous scrutiny, the data has been clear for the long term effect of weight loss surgery.

A Utah study¹ compared about 10,000 individuals who had weight loss surgery with a matched 10,000 morbidly obese patients who did not have surgery. After a long term follow up of 18 years (1984 to 2002) a significant 40% reduction of death was found in the morbidly obese group who underwent bariatric surgery.

Similar results were found in a large European study² that followed prospectively morbidly obese patients who underwent surgical treatment, and compared them to a morbidly obese group who underwent intense behavioral and dietary management (over 2000 patients in each group). Follow up was over 10 years span. A clear survival advantage was demonstrated in the surgical group with about 25% decreased in the risk of death in the surgical group.

We do recognize that surgery is not the real solution, but instead it is preventive therapy; however, for morbidly obese individuals who missed the chance of prevention, who suffer from many diseases caused or aggravated by obesity such as diabetes, heart disease, high blood pressure, back and joints pain, surgical therapy when done in a technologically advanced center by fellowship trained surgeons is the only way for cure!!

¹ Adams TD, Gress RE, Smith SC, Halverson RC, et al. Long-Term Mortality after Gastric Bypass Surgery. NEJM 2007; 357-8, pp.753-761.

² Sjostrom L, Narbro K, Sjostrom D, Karason K, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. NEJM 2007; 357-8, pp.741-752.

Rami E. Lutfi, MD, FACS

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