A new review finds that weight-loss surgery helps very obese patients drop
pounds and improve their overall health, even if there is some risk for
"We've gotten good at doing this," said Dr Mitchell Roslin, chief
of weight-loss surgery at Lenox Hill Hospital in New York City. "Bariatric
surgery has become one of the safest intra-abdominal major procedures."
"The question is why we don't start facing the facts," said Roslin,
who was not involved in the new review. "If the data were this good with
any other condition, the standard of care for morbid obesity would be
Effects and risks
Roslin said he thinks a bias against obesity tinges the way people look at
"People don't view obesity as a disease, and blame the victim," he
said. "We have this ridiculous notion that the next diet is going to be effective,
although there has never been an effective diet for people who are severely
Morbid obesity is a chronic condition that is practically irreversible and
needs to be treated aggressively, Roslin said. "The only treatment that's
effective is surgery," he said.
Review author Su-Hsin Chang is an instructor in the division of public
health services at the Washington University School of Medicine, in St Louis.
"Weight-loss surgery provides substantial effects on weight loss and
improves obesity-related conditions in the majority of bariatric patients,
although risks of complication, reoperation and [death] exist," Chang
said. "Death rates are, in general, very low."
"The extent of weight loss and risks are different across different
procedures," she said. "These should be well communicated when the
surgical option is offered to obese patients and should be well considered when
Complications and re-operation rates
The report was published online in the journal JAMA Surgery.
For the study, Chang's team analysed more than 150 studies related to weight-loss
surgery. More than 162 000 patients, with an average body-mass index (BMI) of
nearly 46, were included. BMI is a measure of body fat based on height and
weight, and a BMI of more than 40 is considered very severely obese.
Overall, complication rates ranged from 10% to 17% and the re-operation rate
was about 7%. The death rate ranged from .08% to .31%.
However, the operation improved obesity-related conditions, such as
diabetes, high blood pressure and sleep apnoea.
Five years after the operation, the reduction in BMI ranged from 12 to 17 points.
The review showed differences between the types of weight-loss procedures.
For example, gastric bypass was more effective for weight loss but was
associated with more complications.
In gastric bypass, part of the stomach is closed off to prevent the patient
from eating too much.
In adjustable gastric banding, in which a band is used to reduce the size of
the stomach, the death and complication rates were lower but reoperation rates
were higher. In addition, weight loss with gastric banding was less than with
gastric bypass, the researchers found.
Among all the procedures, sleeve gastrectomy appeared to result in the most
weight loss, the researchers said. In this procedure, a large part of the
stomach is removed, reducing it to about 25% of its original size. This results
in a sleeve or tube-like structure.
Roslin said common complications include bleeding, infection and bowel
Roslin said everyone who has a BMI over 35 and has sleep apnoea, severe
heart failure or needs insulin for type 2 diabetes should consider having
"Every patient who needs a joint replacement [and has] a BMI greater
than 40 should consider bariatric surgery," he added.
The US National Library of Medicine has more on weight-loss