Obesity is second in preventable deaths in the U.S.

Oct. 7, 2005

Obesity second only to smoking as preventable cause of death
By: Robert E. Brolin, M.D. and Gloria N. Beck

Special to The Packet (Princeton, N.J.)

Surgery to treat severe obesity received a great deal of press in the late '90s and early '00s when celebrities including Al Roker and Carnie Wilson came forward to tout their successful weight loss.

While media coverage seems to have slowed in recent years, the number of patients benefiting from the procedure is growing rapidly.

Last year, about 140,000 people in the United States had weight-loss surgery. This number has grown by about 50 percent a year since 1998, according to the American Society for Bariatric Surgery (ASBS). Those numbers should continue to rise as an estimated 8 million to 10 million people in the U.S. are morbidly obese, generally defined as 100 or more pounds overweight.

More people are choosing weight-loss surgery for one reason: It is without question the most successful treatment for morbid obesity. Non-surgical methods, such as drugs or dieting, fail to provide significant long-term weight loss in 99 percent of patients. Multiple studies have shown that bariatric surgery results in sustained weight loss for the great majority of patients. Moreover, it reduces a patient's chances of dying from a variety of obesity-related complications.

Successful treatment of morbid obesity is important because of its damaging health effects including diabetes, high blood pressure and infertility. Obesity is second only to smoking as a preventable cause of death in the U.S. In the morbidly obese population, the average life expectancy is reduced by 9 years in women and 12 years in men, the ASBS says.

Bariatric surgery includes a variety of techniques used to close off a large portion of the stomach, leaving only a small pouch for food. This allows a person to feel full after eating much smaller portions of food, resulting in rapid weight loss. There are four main types of procedures:

Gastric bypass surgery separates the stomach into two unequal compartments with less than 5 percent of the stomach remaining usable for food consumption. During digestion, the food empties from this tiny stomach pouch into the upper intestine.
Biliopancreatic diversion creates a somewhat smaller stomach, but also bypasses (excludes) some intestine, resulting in less absorption of ingested food.
Lap band (gastric banding) is a procedure in which the stomach is encircled with an inflatable plastic band that restricts food intake.
Gastroplasty is a procedure in which the stomach is stapled close to the top with a small outlet or stoma leading to the remainder of the stomach and digestive tract.

Weight loss usually reaches a maximum between 18 and 24 months after surgery. More importantly, most patients keep off much of their excess weight. In a study of more than 600 patients following gastric bypass, the average patient still kept off more than 50 percent of his or her excess weight 14 years after surgery, according to the ASBS.

During the past several months, two large studies have reported lower mortality rates for surgically treated patients compared with obese patients of the same age and gender who did not have weight-loss surgery.

Researchers at University of Washington found that the death rate over a 15-year period was a third lower in patients who had surgical treatment. During a five-year Canadian study, the death rate was 1 percent in the surgical group compared with more than 6 percent in the non-surgical group.

This recent research backed the findings of a 1997 study at East Carolina University that evaluated 232 morbidly obese diabetic patients. Of the group, 154 had gastric bypass, and 78 did not. The researchers found that the annual death rate in the non-surgical group was nearly five times higher than that of the surgical group during the six-to-nine-year follow-up interval. In fact, 28 percent of the non-surgical group died during this time versus only 9 percent of the surgically treated patients.

What all of these studies demonstrate is that the risk of untreated morbid obesity is extremely high — much higher than the risk associated with surgery. Perhaps the most important choice for a morbidly obese patient is finding the right place to have surgery. Bariatric surgery is complicated, and studies show that patients have the best results at centers with the most experience.

University Medical Center at Princeton was the first hospital in Mercer County to offer bariatric surgery for weight control. The hospital was also recently named an American Society for Bariatric Surgery Center of Excellence for providing outstanding surgical treatment for morbid obesity.

UMCP earned the designation following an extensive application process and site visit by Surgical Review Corporation, a Raleigh, N.C.-based nonprofit group dedicated to promoting safe and effective bariatric surgery throughout the U.S. The review found that UMCP's Bariatric Surgery Program meets or exceeds national standards for equipment, staffing, training, safety and patient outcomes.

For more information about the Bariatric Surgery Program at University Medical Center at Princeton, call (888) 742-7496 anytime, day or night. You may also call (609) 430-7761 during normal business hours.