What is the future of weight loss surgery? The LA Times recently examined that question.
Usually reserved for the most obese people, weight-loss surgery is unlikely to be a last-ditch option much longer. Technological advancements are turning it into a one-hour, incisionless procedure — making it more attractive to moderately overweight adults, overweight and obese teenagers and normal-weight people with difficult-to-control diabetes.
Advancements in surgical procedures are making all surgeries less painful and less invasive. That’s good news for patients who must undergo what would otherwise be more difficult and painful procedures.
But that begs the question: Is this something that patients “must undergo”?
I see surgery playing a bigger role,” said Judith Stern, a professor of nutrition and internal medical at UC Davis, “. . . because the weight-loss drugs we have now are lousy.
It is difficult to make an objective evaluation of the evidence surrounding these new procedures. As you can see from the above quote from Dr. Stern, some doctors tend to view anything that affects a patient as a disease, something to be attacked with drugs or surgery.
And these are the doctors that are reporting on the new procedures. Clearly, this viewpoint — that everything is a “disease” — affects how they view the research and how they report the results.
And a report released in November from the American Public Health Assn. and other groups projected that healthcare costs related to obesity would quadruple in 10 years, accounting for 21% of healthcare spending.
Bariatric surgery, many doctors say, should be a bigger part of the solution.
It stands to reason that doctors that do weight loss surgery for a living would feel this way. But is this viewpoint universal?
Nutritionists are not enthusiastic. They reject the notion that surgery should take the place of dieting and exercise.
Here is the crux of the matter. Losing weight is possible. It is within the capabilities of those individuals suffering from obesity.
And when properly done, natural weight loss leads to improvement in health and vigor and a longer life.
But this is not always true with surgery.
Paul Ernsberger, an associate professor of nutrition at Case Western Reserve University School of Medicine, has studied the long-term complications of weight-loss surgery. While the surgical procedure itself has become quite safe, he said, too many patients suffer problems later, such as nutritional deficiencies, diarrhea, regurgitation and bowel obstructions.
Surgery is potentially dangerous and may lead to complications. The outcome is not always predictable. And there may be long-term adverse consequences.
According to the Agency for Healthcare Research and Quality, 19% of patients experience dumping syndrome, which is involuntary vomiting or defecation. Complication rates involving ulcers, wound problems, hemorrhage, deep-vein thrombosis, heart attacks and strokes range from 2.4% to 0.1%.
And it can be expensive.
The costs of traditional weight-loss surgery vary widely across the nation, with an average cost in California of $52,224, according to a HealthGrades report released in July.
Surgery is sometimes necessary. But it should be reserved for those conditions which cannot be treated any other way. And this is clearly not the case for obesity, particularly in those cases with more modest degrees of overweight for whom the newer procedures are being developed .
http://articles.latimes.com/2010/jan/03/science/la-sci-weight-surgery3-2010jan03
