Stomach surgeries save lives, studies find!

Published August 22, 2007

[ From LSJ.com ]

Stomach surgeries save lives, studies find

Evening update

Judy Peres

MCT News Service

<!--STORY TEXT--> CHICAGO — Stomach surgery saves lives among severely obese people and reduces the risk of serious illness, including heart attacks and cancer, according to two new studies.

Doctors have known for many years that weight loss improves cardiovascular risk factors, but it was not known whether it prevented deaths. Some studies had suggested that losing weight might even worsen life expectancy, though those studies didn't distinguish between intentional weight loss and unintentional weight loss.

To address the question, Swedish researchers followed some 4,000 patients for up to 18 years. The people who underwent bariatric surgery to reduce stomach capacity lost up to 32 percent of their body weight and kept most of it off. By comparison, a matched control group of patients who received conventional, nonsurgical treatment see-sawed, gaining and losing up to 2 percent.

The reward for the surgical patients: Their chances of surviving to the end of the study period were significantly improved. Five percent of the surgery group (101 people) died, compared with 6.3 percent in the control group. The surgery group also experienced 12 fewer heart attacks and 18 fewer malignant tumors.

In the second study, conducted by researchers at the University of Utah, 8,000 Americans who underwent gastric bypass surgery were matched with the same number of severely obese control subjects. During an average follow-up of seven years, deaths from heart disease were reduced by 56 percent; deaths from diabetes, by 92 percent; and from cancer, by 60 percent.

The estimated number of lives saved was 136 per 10,000 stomach operations.

"The question as to whether intentional weight loss improves life span has been answered, and the answer appears to be a resounding yes," said Dr. George Bray of Louisiana State University, who wrote an editorial that accompanied publication of the two new studies in Thursday's issue of the New England Journal of Medicine.

The National Institutes of Health issued guidelines in 1991 saying bariatric surgery-gastric bypass or banding-should be considered for people with a body mass index over 40, nearly double the average normal BMI, and only if other forms of treatment fail. Subjects in the Swedish trial, which began in 1987, had BMIs as low as 34.

The Swedish trial included banding procedures, which are less effective than gastric bypass. The procedure of choice in the U.S., gastric bypass involves stapling off a portion of the stomach and connecting it to the intestine.

In his editorial, Bray suggested the NIH should re-examine its guidelines and lower the threshold for bariatric surgery.

But Dr. John Alverdy, an expert in bariatric surgery at the University of Chicago, said that despite the significance of the new data it might or might not result in more patients undergoing bariatric surgery in the U.S.

"Even though the risk-benefit ratio is in favor of the surgery, and it is cost-effective, not every insurance company covers it, not every doctor believes in it, and not everyone has access to hospitals that do it," he said.

Alverdy said there's a perception that obesity is self-inflicted and can be cured by diet and exercise. That makes some patients reluctant to undergo surgery and some doctors reluctant to recommend it.

"Are you letting them off the hook?" he asked rhetorically. "Do you want to risk the complications of surgery when there's another way to get better?"