That’s “bariatric,” not “geriatric.” You know, that crazy operation they perform on fat people to tie their tummies. You’ve heard the drill before. May have even considered making the leap, to reduce those unsightly pounds, when willpower has just not carried its weight in the face of chocolate cake, French fries, and a veritable potpourri of artery-clogging delicacies. Now your back is to the wall, and it’s high time you scoured the scientific literature for an angle on this medical marvel. What does this thing they call bariatric surgery consist in? Is it true what they say that it can keep girth down on wannabe Prince Charmings and Cinderellas, while at the same time increasing their life spans? Let’s debunk the myth and proceed to the short and skinny, as we create room at the bar by unfettering space around our waists.
For years doctors have known that weight loss improves cardiovascular risk factors. To the average Joe on the street, that in itself is not an earth-shattering revelation from our Einstein’s in white. What is interesting and to date unanswered has been the question of the possible reduction in serious illnesses, like heart attacks and cancer, and their progression toward death by weight loss. In short, does bariatric or stomach surgery prevent deaths?
We have all heard that obesity has become an epidemic in the United States, with about 24% of the population defined as obese in 2005. Worldwide, 300 million people are obese, and those legions are growing. The numbers are simply staggering! The buck does not stop there, either. Abdominal obesity is not only associated with increased risks of maladies such as hypertension, diabetes, hyperlipidemia, sleep apnea, coronary artery disease, and stroke, but also contributes significantly to U.S. health care expenditures, in excess of $100 billion annually for that collective and so-called innocuous jaunt to the doughnut store daily. Shame on us! It is expected that the overall life expectancy in this great nation of ours is destined to decline if we fail to stem the rising tide of obesity. Fat, not wars, pestilence, or Mother Nature, is going to take us down.
The scenario appears bleak, but medical advances are, indeed, on the horizon. One of them is bariatric surgery. The word “bariatric” comes from the Greek word baros, meaning weight, and bariatric surgery or weight loss surgery describes surgical procedures performed specifically for the purpose of attempting to induce appetite control, weight loss, and long-term dietary modification. Bariatric surgical procedures reduce caloric intake by modifying the anatomy of the gastrointestinal tract. They do this by either creating a small gastric reservoir with a narrow outlet to delay gastric emptying, or by bypassing varying portions of the small intestine where nutrient absorption occurs. The latter procedure, known as gastric bypass surgery, while accounting for only 13% of all bariatric surgery to date, is rapidly growing in popularity and fast becoming the procedure of choice.
Although many of us believe that we should not tamper with the designs of the Almighty, in the morbidly obese the hand of man may be a useful adjunct to the hand of God. Extensive studies conducted over an 18-year period in both Sweden and here in the U.S. in Utah on a total of 12,000 patients who underwent bariatric surgery have demonstrated the undeniable benefits of the procedure. The participants in the studies lost 32% of their body weight and kept most of it off, survived longer than matched control patients who did not undergo surgery, and saw a 56% reduction in deaths from heart disease. In fact, the estimated number of lives saved was 136 per 10,000 stomach operations. So, one might say that there is no doubt that intentional weight loss, via the surgeon’s knife, improves life span.
What good would a silver lining be, however, without a few storm clouds. Indeed, bariatric surgery is not a panacea, and nowhere is the adage of the end not justifying the means more true than in our consideration of complications. Obese patients who undergo bariatric surgery are at high risk for venous thromboembolism, pulmonary embolism and death, and irreversible postoperative copper, thiamine, and vitamin B12 deficiencies leading to peripheral neuropathies, encephalopathies, degeneration of the spinal cord, optic neuropathies, and a host of other neurologic abnormalities.
So, just what is the short and skinny, and who should undergo the surgeon’s invasive hand? There is no doubt that the severely obese stand to gain, in terms of morbidity and mortality reduction, from bariatric and gastric bypass surgery. Let the buyer beware, however. The bariatric bonus may be a Pandora’s box in disguise. Opening it may unleash something far worse than the weight of added pounds. Only time and your physician’s professional opinion and experience hold the key.
© 2007, Albert M. Balesh, M.D. All rights reserved.
