Growing numbers of obese people are opting for weight-loss surgery - once a risky last-resort procedure for the very fat - and new research suggests it is saving lives.
Two studies being published today in The New England Journal of Medicine show that patients who choose surgery to drop their extra pounds can restore some of the life expectancy that obesity shortens. One of the studies, on American patients, shows that seven years after their gastric bypass operations, death from diabetes decreased 92 percent, from cancer 60 percent and from coronary artery disease 56 percent.
"It's much safer to undergo the surgery than do nothing," said Dr. Thomas H. Magnuson, director of the Johns Hopkins Center for Bariatric Surgery, who was not involved in the study.
Some obesity researchers are suggesting that the data show the surgery is so safe and the consequences of not having it so dire that more patients - lighter patients - should be eligible for it.
Other weight-loss doctors - those who do not focus on surgery in their practices - are afraid that too many people might opt for the operation, which is still not completely without risk, instead of committing to diet and exercise programs.
There's less debate when it comes to the morbidly obese. For them, "the only effective long-term treatment is surgery," said study author Dr. Ted D. Adams, who researches the genetics of obesity at the University of Utah School of Medicine.
Doctors have long known that losing weight can improve quality of life and reduce the incidence of some diseases, but these are the first large-scale studies to show that weight loss through surgery really prolongs life.
Logically, Adams said, the assumption would be that it is not the surgery itself that is the life-saver, but the weight loss, 100 pounds or more in many cases. But, he said, in practice that does not hold. In 80 percent of diabetic patients, for example, the symptoms are resolved within weeks of surgery - long before most of the weight is lost, he said.
"It's intriguing to me that there are perhaps biochemical or other physiological mechanisms related to the surgery aside from weight loss that may be improving the health of the patient," Adams said.
Obesity is being called an epidemic in medical circles. Nearly one-third of American adults are now considered obese; another third are overweight. About 15 million are morbidly obese, weighing 100 pounds or more over what is optimal. Children aren't immune either. Doctors are seeing children with high blood pressure, Type 2 diabetes, even arthritis - diseases previously rare in patients so young.
With obesity on the rise, the number of bariatric surgeries performed in the United States has risen exponentially in the past decade, more than doubling from 2002 to 2005, according to the National Institutes of Health. An estimated 180,000 surgeries were performed last year, according to the American Society for Metabolic and Bariatric Surgery.
The surgery is much less risky today. Once done openly with added risks of infection, it is now primarily laparoscopic. In the second New England Journal study, involving Swedish patients, 0.25 percent died within 90 days of the procedure, compared with 0.10 percent of those in the control group. By contrast, the death rate in the 1970s and 1980s was as many as one in five, according to researchers.
Dr. Terrence M. Fullum, medical director of the Upper Chesapeake Bariatric Surgery Center in Havre de Grace, said complication rates used to be 25 percent to 40 percent. Now that the surgery is less invasive, complication rates are just 3 percent. He said he has lost three patients in 1,500 cases, and "I anticipate never having another death. We have really evolved."
In the American study, the only instance in which death rates were higher in surgery patients than in a control group of severely obese patients was when patients died from causes other than disease, such as accidents or suicides.
Adams said he isn't sure of the exact reason for that.
It could be that people who lose extensive amounts of weight become more active and then have more accidents as a result. He said other studies have shown an increase of chemical dependence in surgery patients. Also, he said, some see weight-loss surgery as an answer to their psychological concerns, believing that if they lose weight, then they will be happy. It doesn't always work out that way.
In the study, he and his team recommend further research into better methods of evaluating candidates for surgery "including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery."