Obesity surgery: is it worth it?

Philip J. Goscienski, M.D.

July 2006

Some of the publicized results of obesity surgery are spectacular — a 100-pound weight loss, less shortness of breath, a more stable blood sugar. Surgeons can remove part of, staple, place constricting bands around or otherwise deform the stomach so that anything more than a golf-ball-sized serving of food just won't fit anymore. Pounds of fat gradually melt away when those tiny meals don't keep up with calorie needs.

This year more than 150,000 Americans will sacrifice the ability to eat a normal meal in order to avoid debilitating health problems. The morbidly obese, persons who strain under a burden of more than 100 pounds of life-shortening, heart-damaging fat now comprise 2 percent of the population — 6 million of us!

It is this ultra-heavy population that has the most to gain from a surgical procedure that accomplishes what traditional weight-control programs cannot. The average patient can expect to lose about 100 pounds, sometimes more, in the year following stomach-reduction. Nearly all morbidly obese persons have high blood pressure and high blood sugar. These usually drop significantly, lowering the risk of early stroke, kidney failure and amputations.

Will these benefits last? Many of these patients remain overweight and the damage wrought by years of heart strain and high blood sugar won't disappear completely. After all, the 400-pound man who loses 150 pounds is still obese.

Sadly, some persons who submit themselves to the complications of anesthesia and surgery and the discomfort of a stomach that is barely roomy enough to fit a hen's egg find ways to perversely undo it all. Within 5 years about 85 percent of patients regain about half the weight that they lost in the first year. Some regain even more.

In today's lawsuit-happy climate physicians or their surrogates take great care to advise patients of possible risks. Obese persons don't tolerate anesthesia or surgery as well as those of normal weight. Wounds heal more slowly and recovery takes longer. In the days that follow surgery there is a risk of hospital-transmitted infection and blood clots; both can be fatal. The risk of dying in the year after weight-reduction surgery ranges from 3 to 13 percent depending on the age and sex of the patient.

About 20 percent of patients find themselves back in the hospital within a month or two because of bleeding or poor wound healing. Late problems such as gallstones, anemia and osteoporosis occur in about one-third of individuals that have had weight-loss surgery.

Is it worth it? For many people surgery is truly a last resort and it probably does extend their lives by several years. One can only wonder if those tens of thousands of dollars could be spent more wisely — and safely. Perhaps several months of residential care, intensive psychological counseling, a personal trainer and nutritionist and the judicious use of weight-reducing medication would accomplish as much. I am reminded of a 1,200-pound patient who lost more than 400 of those pounds prior to undergoing surgery. Could he have lost another 400 pounds with more aggressive supportive and medical treatment?

Maybe we don't try hard enough.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.