Study Finds Weight-Loss Surgery Safer Than Thought

SOURCES: Bruce Wolfe, M.D., professor, surgery, Oregon Health and Science University, Portland, Ore.; Malcolm K. Robinson, M.D., assistant professor, surgery, Harvard Medical School and Brigham and Women's Hospital, Boston; July 30, 2009, New England Journal of Medicine

7/29/2009

WEDNESDAY, July 29 (HealthDay News) -- For those considering bariatric surgery to combat significant obesity, a new study suggests the risk of complications may be much lower than what has previously been reported.

The study, which looked at both gastric bypass surgery and laparoscopic adjustable gastric banding (lap-band surgery), found that the risk of death for these surgeries was 0.3 percent and the risk of a major adverse outcome was 4.3 percent.

"Bariatric surgery is safe," said study co-author Dr. Bruce Wolfe, a professor of surgery at Oregon Health & Science University in Portland. "Certain factors [such as a history of blood clots, obstructive sleep apnea or impaired functional status] increase the risk of complications, but you can discuss these risks as well as the potential benefits with your surgeon."

Results of the study appear in the July 30 issue of the New England Journal of Medicine.

As obesity rates have risen, so, too, has the popularity of bariatric surgery. Although it is a major surgical procedure, the benefits to the severely obese generally far outweigh the risks. In fact, the risk of death over time is about 35 percent lower for someone who's had the surgery compared to someone who remains extremely obese, according to background information in the study.

However, the surgery isn't for everyone. "If you're five or 10 pounds overweight, bariatric surgery isn't for you," said Dr. Malcolm K. Robinson, an assistant professor of surgery at Harvard Medical School, and the author of an accompanying editorial in the same issue of the journal.

"Basically, when I or my colleagues advise surgery, it's because the benefits of surgery outweigh the risks. In general, that's the case for someone with a BMI [body-mass index] of 35 and weight-related health problems like diabetes or high blood pressure, or someone with a BMI of 40 or more," said Robinson, who added that as the risks of the surgery keep dropping, those BMI numbers may get even lower in the future.

The current study included 4,776 people who underwent one of the following types of bariatric surgery: lap-band surgery (1,198 patients), laparoscopic gastric bypass (2,975 patients), open gastric bypass (437 patients) or another procedure (166 patients). All of the surgeries were done by surgeons specifically qualified for this study. All of the surgeries took place between March 2005 and December 2007.

The average age of the study participant was 44.5 years old, 22 percent of the study volunteers were male and 11 percent were nonwhite. The average BMI in the study was 46.5. More than half of the study group had at least two coexisting medical conditions, the study authors noted.

In his editorial, Robinson points out that these procedures may represent "best-case scenarios" because they were done by experienced surgeons in high-volume bariatric centers. However, he said that because the field of bariatric surgery has advanced so much in the past few years, he believes these results are a "generally achievable phenomenon."

Both Robinson and Wolfe recommend that any person considering bariatric surgery should choose a facility that's been designated as a "Center of Excellence" because that means that the surgeon and the whole health-care team are qualified and experienced.

More information

Learn more about bariatric surgery from the U.S. government's Weight-control Information Network.

How Weight Loss Helps the Heart

SOURCES: Philip R. Schauer, director, Cleveland Clinic Bariatric and Metabolic Institute; Christine Ren, M.D., associate professor, surgery, New York University Langone Medical Center, New York City; Aug. 18, 2009, Journal of the American College of Cardiology

8/11/2009

TUESDAY, Aug. 11 (HealthDay News) -- Losing a lot of weight rejuvenates the physical structure of the heart, and it makes no difference whether the weight is lost by surgery or by dieting, a new British study shows.

The heart muscles of people who started with a body mass index (BMI) averaging 40 -- a BMI of 30 is the usual marker of obesity -- became noticeably thinner and more efficient when they brought their BMI down to 32.2 in a single year, according to a report in the Aug. 18 issue of the Journal of the American College of Cardiology.

"Both diet and bariatric surgery led to comparable, significant decreases" in heart structure abnormalities and malfunction, the University of Oxford researchers reported.

Bariatric surgery is designed to induce weight loss by reducing the amount of food people can eat, the amount of food they can metabolize or both.

Weight loss averaging 21 kilograms (about 45 pounds), achieved by the 37 obese people in the study, "is typically what is seen after bariatric surgery," said Dr. Philip R. Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute.

Noting that many of the obese people lost those kilograms by eating less, Schauer called it "quite unusual for someone to diet with that effect. These were a very special subset."

And the problem with weight loss by diet is that "weight regain is the norm, whereas with bariatric surgery there is ample evidence that the weight loss is maintained," Schauer said.

The Oxford researchers used cardiac MRI, a special X-ray technique, to obtain detailed information on the structure of the hearts not only of the 37 obese participants but also of 20 normal-weight volunteers, whose average BMI was 21. They found that the walls of the left and right ventricles, the blood-pumping chambers of the heart, were significantly thicker in the obese people. They also found impaired ability of the heart to hold blood at diastole, the resting point of the heartbeat, in the obese.

A year later, after weight loss, the heart muscles of the obese people were less overgrown and the hearts could also hold more blood. Thickening of the aorta, the main heart artery, was also greatly reduced after weight loss.

"These findings provide a potential mechanism for the reduction in mortality seen with weight loss," the researchers wrote.

And it thus helps explain something of a medical mystery -- why people who are grossly overweight are more at risk of heart attack and sudden death than their numbers show, said Dr. Christine Ren, a bariatric surgeon who is an associate professor of surgery at New York University Langone Medical Center.

"Most of them say they are pretty healthy, maybe with a slight elevation of blood pressure, but when you really drill down to it you can show an abnormal cardiac function," Ren said. "The point is that their heart is not normal and that already is having a negative effect on their health."

Losing weight by dieting is desirable, "but the problem with diets is that statistics show maintenance of weight loss by diet is extremely difficult and quite rare," Ren said.

Bariatric surgery is expensive, costing anywhere from $15,000 to $25,000, she said, and it is not perfect. "There is always going to be 5 percent of these people who gain most of their weight back, but it still is the best chance of having significant weight loss," Ren said.

However, health insurance coverage of bariatric surgery is uncertain, varying from company to company and state to state, she said, and many plans are starting to put more limits on coverage.

More information

Bariatric surgery is described by the U.S. National Library of Medicine.

Social Stress Sends Body Fat to the Stomach

Social Stress Sends Body Fat to the Stomach

SOURCE: Wake Forest University School of Medicine, news release, Aug. 5, 2009

8/5/2009

WEDNESDAY, Aug. 5 (HealthDay News) -- Social stress may cause the body to deposit more fat in the abdomen, which increases the risk of heart disease, a new study suggests.

The findings could lead to new ways to combat rising rates of obesity in the United States and other Western nations, according to principal investigator Carol A. Shively, a professor of pathology at Wake Forest University School of Medicine.

"Much of the excess fat in many people who are overweight is located in the abdomen, and that fat behaves differently than fat in other locations. If there's too much, it can have far more harmful effects on health than fat located in other areas," she said in a Wake Forest news release.

In the study, designed to see how social status affects the development of heart disease, female monkeys were fed a Western-style diet that contained fat and cholesterol. The monkeys were housed in groups and naturally established a pecking order from dominant to subordinate.

The researchers noted that the subordinate monkeys were not included in group grooming sessions as often as dominant monkeys, and were often the target of aggression.

The subordinate monkeys in this study then developed more fat in the abdominal cavity than other monkeys.

Social subordination causes the release of stress hormones that promote fat accumulation in the abdomen, the researchers said. This abdominal (visceral) fat promotes the build-up of plaque in blood vessels that leads to heart disease, the leading cause of death worldwide.

The study appears in the current issue of the journal Obesity.

Shively said the findings reinforce the wisdom of healthy eating, regular exercise and handling stress well.

More information

The U.S. National Heart, Lung, and Blood Institute outlines heart disease risk factors.