Operations such as gastric bypass and gastric banding may lead to weight loss and improvements in diabetes, cholesterol and blood pressure, and those benefits may outweigh the hazards, the Dallas-based heart group said in a paper today in the journal Circulation.
Almost 34 percent of Americans are obese, a number that has doubled in the past 30 years, and more than 5 percent are considered extremely obese, according to the Atlanta-based Centers for Disease Control and Prevention. Overweight or obese people have a greater risk of diabetes, heart attacks and strokes. Efforts with diet, exercise and drugs have been “disappointing,” so doctors need to look at surgical options, said Paul Poirier, lead author of the report.
“At the moment, bariatric surgery should be reserved for patients who can undergo surgery safely, have severe obesity and have failed attempts at medical therapy,” Poirier, director of the cardiac prevention and rehabilitation program at Quebec Heart & Lung Institute at Laval University Hospital in Quebec City, said in a statement.
The report isn’t an “across-the-board” endorsement, Poirier said. More studies are needed on the weight-loss procedures in adults and children, he said.
About 220,000 people in the U.S. had weight-loss surgery in 2009, according to the most recent figures from the American Society for Metabolic & Bariatric Surgery, a doctors’ organization based in Gainesville, Florida. The procedures cost on average of $14,000 to $26,000, the group said on its website.
Allergan Inc., based in Irvine, California, won U.S. clearance in February to broaden marketing of its Lap-Band weight-loss device. The Food and Drug Administration now will let the company target people with a body mass index of at least 30 and at least one obesity-related condition. Lap-Band competes with Realize, a band sold by Johnson & Johnson (JNJ), of New Brunswick, New Jersey.
Body mass index, or BMI, is a measure of weight and height, with a 5-foot, 4-inch (160-centimer) woman weighing 175 pounds (80 kilograms) having a BMI of 30. BMI of 30 or more is considered obese, while a BMI of 25 to 29.9 is considered overweight, according to the National Institutes of Health, based in Bethesda, Maryland. A BMI of 40 and more is considered extremely obese.
‘Treatment of Choice’
“The AHA hasn’t addressed this issue in such a direct manner previously, but has included bariatric surgery as an option for severely obese patients in other documents,” Robert Eckel, past president of the group and a professor of medicine at the University of Colorado Anschutz Medical Campus, in Aurora, Colorado, said in an e-mail on March 11.
For people who have a BMI of 40 and higher, surgery is the “treatment of choice,” Eckel said.
The heart group’s researchers found that surgery “provides the greatest sustainable weight loss.”
The surgeries also reversed diabetes and improved high blood pressure, sleep apnea and liver disease, according to the heart group. A review of eight studies showed that those who underwent weight-loss surgeries had a lower risk of dying compared with those who didn’t have the procedures, according to the paper.
One study showed the risk of dying was 9 percent in those who had surgery compared with 28 percent in those who didn’t.
“The medical literature has found that diet and exercise alone simply does not work for everyone who is obese and that without effective treatment the obese will likely remain obese, which is why we applaud the American Heart Association for recognizing that weight-loss surgery needs to be part of the obesity treatment continuum,” Cathy Taylor, a spokeswoman for Allergan, said an e-mail on March 11.
In gastric bypass, doctors create a small pouch about the size of a walnut at the top of the stomach and connect it to a passage that bypasses the rest of the stomach and part of the small intestine. That arrangement limits the body’s ability to absorb calories. Gastric bypass accounts for than 80 percent of weight-loss procedures, according to the heart association.
In laparoscopic gastric banding, a band is placed around the upper end of the stomach, creating a pouch that narrows the passage into the rest of the stomach, causing a patient to feel fuller.
The heart group’s statement adds to growing awareness of the weight-loss surgery, said Bruce Wolfe, president of the bariatric surgery society, in a telephone interview on March 11.
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