Panel says stomach stapling can help obese but advises other steps first

March 28, 1991|By Jonathan Bor

A panel of medical experts concluded yesterday that stomach-stapling surgery can help thousands of severely obese Americans lose weight, but they cautioned people to try or at least consider non-surgical methods first.

The 14-member panel, assembled by the National Institutes of Health, said two techniques now in use carry much lower risks than a discredited method called intestinal bypass that faded from use a decade ago because of unacceptably high rates of complications and death.

But the panel cautioned that the newer methods -- although much safer -- are appropriate only for the most obese patients and for slightly less overweight patients who suffer from life-threatening complications of obesity such as heart disease and diabetes.

"Clearly, they are capable of causing weight reduction in people with severe obesity, and as a result they do deserve serious attention," Dr. Scott M. Grundy, chairman of the NIH panel, said of the techniques during a news briefing.

The panel issued its "consensus statement" after hearing testimony from a succession of patients and weight-loss experts. The three-day conference took place at NIH headquarters in Bethesda.

The two procedures currently in favor involve the use of surgical staples to cordon off a small portion of the stomach so people feel full after ingesting relatively small amounts of food.

The methods, called gastroplasty and gastric bypass, have been in use for the past 10 to 15 years; annually, several thousand patients undergo the operations.

Dr. Grundy said the surgery is appropriate for patients who suffer from "clinically severe obesity" -- about 100 pounds over ideal weight for a man of average height, and about 80 pounds for a woman of average height. The panel urged patients to consult medical centers that make a variety of treatments available -- including diet, exercise and behavior modification.

But it conceded that non-surgical techniques -- although preferable because they pose fewer risks and aim to change the behavioral causes of obesity -- fail more often than they succeed.

"Although acceptable weight reduction may be achieved, a major drawback of the non-surgical approach is failure to maintain reduced body weight in the vast majority of patients," the panel said in its statement.

Experts said a 300-pound woman who stands 5-feet-5 could lose 80 to 100 pounds after a stapling operation. Dr. Jeremiah A. Barondess, president of the New York Academy of Medicine, said patients usually reach their lowest weight in 18 to 24 months. And while many regain some of their weight over the next four or five years, a majority are able to keep most of the pounds off.

Long-term effects remain unknown, however, because the techniques are relatively new, the experts said.

"Far less than 1 percent" of stomach-stapling patients have died as a result of surgical complications -- but 10 percent to 20 percent have needed repeat surgery to repair problems such as leaks from staples or suture lines, Dr. Grundy said.

Some patients have suffered diarrhea, persistent vomiting, ulcers and gallstones as a result of the surgery.

Dr. Lawrence Cheskin, director of the Johns Hopkins Weight Management Center, said he refers less than 2 percent of his obese patients to surgery. The center uses a team of nutritionists, psychologists and physicians to help patients change their eating habits and address the source of their overeating.

"If the problem is mostly behavioral, which it usually is, fullness is not always the issue," he said. "Most obese people eat whether they are hungry or not -- to alleviate boredom or because they are unhappy with various aspects of their life."

Only "four or five" doctors in Baltimore perform the operation, according to one Johns Hopkins surgeon.

Obese people attending the conference both praised and criticized the procedure.

Valerie Jones of Kokomo, Ind., said she dropped to 135 pounds from her original weight of 275 pounds. "The vast majority of people are like us," she said. "They'd never go back to their old way of life."

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