BARIATRIC SURGERY MOST EFFECTIVE TREATMENT OF MORBID OBESITY.
Bariatric comes from Greek, Baros meaning weight and iatrikos the art of healing. I have previously discussed different types of operations that overweight people can have to affect weight loss. These operations are usually reserved for people that have a BMI (Body Mass Index) of more than 40. Recently there has been some progress in understanding the long term effects of these operations. A large research study was recently published in The New England Journal of Medicine called the Swedish obesity study. This is a large study that provides a better understanding of the effects of these operations.
No one is in doubt that the majority of western countries are experiencing an obesity epidemic that is poised to get worse. The country most severely affected is the USA. More than 30 percent of the U.S population is obese (BMI more than 30) and around 5 percent is morbidly obese (BMI more than 40). There are numerous health problems experienced by overweight people, ranging from joint problems, breathing problems, high blood pressure, high cholesterol, heart problems to diabetes. All these health problems both shorten life and reduce the quality of life. Medications such as xenical have a limited effect and can only be taken for a limited time. Surgical treatment is currently the only effective treatment for very overweight people.
The Swedish obesity study is a research study that has been going for 10 years. Around 4000 people have received operations ranging from gastric banding to gastric by-passes. Extremely promising results from this study has emerged. The people that received operations were compared with people that did not receive any operation. For the people that received operations weight reduction was greatest in the first 6 months. Weight reduction ranged from 38 percent for gastric by-passes to 21 percent for stomach banding. 10 years after the operations were performed the weight loss was still substantial but less than the initial weight loss. Patients that had had a Gastric by-pass had an average weight loss of 25 percent compared to patients that had had gastric banding with a 13 percent weight loss. Majority of the obesity related illnesses were improved over the 10 years, it was also noted that people were exercising at a higher frequency after their operation than people that did not receive an operation. Around 3 in 1000 people died after the operation and a number of complications where noted after the operation. The group of people that did not receive an operation actually gained weight during the same 10 years.
So what does all this mean to you? Surgery does frighten many people. So far Bariatric surgery has only been offered to people that are very overweight. The rational has been that these people carry a high risk of dying from being overweight, the risk of these operations are therefore justified. So far bariatric surgery has been the only demonstrated effective long term treatment for obesity. Gastric banding operations can be done with key-hole surgery and carries a much smaller risk than the more invasive gastric by-pass operations; the draw back is that gastric banding causes less weight loss. There has been great progress in the area of bariatric surgery and with a demonstrated effect it should become a more available treatment for obesity. The risks and complications of laparoscopic banding (key hole surgery) is now far less than it has previously been and certainly much less than the larger gastric by-pass operations.
If you are contemplating surgery you should first discuss this with your local medical officer/ general practitioner. You should also try to go to a center that specializes in these operations. To find out more you can contact your countries surgical society.
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