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Obesity Surgery Shows Benefits Years Later

Study finds people lose more weight, avoid complications

WEDNESDAY, Dec. 22, 2004 (HealthDayNews) -- A long-term study of people who had surgery for obesity found they lost more weight and experienced fewer obesity-related complications, including diabetes, than people who didn't have the operation.

The study, one of the strongest long-term examinations of the subject, appears in the Dec. 23 issue of the New England Journal of Medicine.

"It's certainly an endorsement relative to what else is available," said Dr. Caren G. Solomon, deputy editor of the journal and co-author of an accompanying editorial. "Other things don't take weight off as well, and it doesn't stay off well."

"The weight loss seems to be very effective in controlling diabetes, in the development of new diabetes, at controlling hypertension, and the development of new hypertension," added Dr. Marc Bessler, director of the New York Presbyterian Center for Obesity Surgery at Columbia University Medical Center.

According to the editorial, almost one-third of the U.S. population is obese (meaning they have a body mass index of 30 or greater), while close to 5 percent are morbidly obese (with a body mass index of 40 or higher).

Given the lack of effective alternatives, there has been an increasing interest in bariatric surgery, or surgery to combat obesity. In the past seven years, the number of such surgeries performed in the United States has increased fivefold, to 100,000 in 2003, the editorial stated.

While other studies have been done, long-term data is sorely needed.

For this study, based in Sweden, researchers looked at 1,703 individuals who had undergone one of several types of bariatric surgery two years prior and 4,047 individuals who had undergone surgery a decade before. Both of these groups were compared to a group of people who had not undergone surgery. All participants in the subject were obese, with a mean body mass index of 41.

After two years, the weight of people in the control group had increased by 0.1 percent, while, in the surgery group, it had decreased by 23.4 percent.

After 10 years, the weight of those in the control group had increased by 1.6 percent. Those in the surgery group saw their weight decrease to an overall total of 16.1 percent, meaning that individuals did gain some weight back. People in the surgery group also consumed fewer calories and were more physically active than those in the control group.

At both two and 10 years, people who had undergone surgery had higher rates of recovery from diabetes, lower triglyceride levels, blood pressure, glucose and insulin levels, as well as higher "good" cholesterol levels than the control group. People in the surgery group were also less likely to develop diabetes.

On the other hand, people in the surgery group did not experience a decrease in "bad" cholesterol levels. "The only thing they didn't find was cholesterol improvement, but that may be because they didn't use gastric bypass surgery," Bessler said. Some of the specific procedures used in the study are less commonly used today, although overall the information is applicable to current methods, Solomon said.

"Those who had surgery clearly had weight loss. The other group didn't lose," Solomon said. "If they had diabetes or one of several other health conditions, they were much more likely than those who didn't have surgery to show no signs of the disease, and were also less likely to develop it."

One piece of information that is still missing, however, is whether these improvements also translate into reduced rates of heart disease and other cardiovascular complications, Solomon said.

In this particular study, the surgeries were also very safe, with a mortality rate of only 0.25 percent.

"What's very clear is that the surgeons at these centers are good at what they do," Solomon said. "The surgeon is obviously going to have a good bit to do with subsequent outcomes. These are very encouraging outcomes among a group that had experienced surgeons."

What would be even better, Solomon pointed out in her editorial, is if experts had better preventive approaches so that surgery wasn't necessary in the first place.

More information

The National Institute of Diabetes and Digestive and Kidney Disease has more on surgery for obesity.

SOURCES: Marc Bessler, M.D., director, New York Presbyterian Center for Obesity Surgery, Columbia University Medical Center, New York City; Caren G. Solomon, M.D., M.P.H., deputy editor, New England Journal of Medicine, Boston; Dec. 23, 2004, New England Journal of Medicine
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