Extreme Measures

A study was completed from 2005 to 2007 that has been analyzed and reported in the New England Journal of Medicine this week. It pertained to bariatric or weight loss surgery. Long time readers will know that I have written about this in the past and that I am 100 percent against the surgery. My main reasons for opposing it have been the high percentage of complications, the need for repeat surgeries and the terribly invasive nature of the surgery itself. In my mind, rearranging the internal workings of our bodies instead of losing weight with calorie control and exercise is far too extreme to be considered healthy or sane.

I have been overweight..I have not been obese. My empathy then is very limited and I must be fair. I am especially reconsidering my position because someone I care very much about has recently had the surgery. I have always been worried about her weight and of course, encouraged her to eat fewer calories and to exercise.. but often she could not exercise because she was so heavy. Today when reading the article I was surprised to learn that some people could lose 20 years of life due to their obesity and just as with smoking, the quality of life they have before their early death is not going to be very high due to chronic disease conditions.

There has been concern about adverse outcomes with both the Roux-en-Y and the gastric banding surgeries and though this study attempts to ease our minds, I do have a concern. The study, abbreviated as LABS, included a good number of persons (almost 5000) and they noted several different adverse outcomes as endpoints. These were death, VTE, having to have any additional operations or reinterventions, and not being discharged from the hospital. You do remember VTE yes? That is venous thromboemolism, or more simply a blood clot. As stated in the Medscape report, the 30 day mortality rate was .03% and the 30 day rate for one or more of the other listed adverse outcomes was over 4%. The mortality rate is low compared to other surgeries.. I looked it up. However, the 30 day endpoint is not long enough in my mind. That really doesn't tell us anything about effectiveness and serious complications.

I know that we have to look at the risks of death, disease and disability from being obese as compared to the risks from the surgery, but in my heart I just cannot believe that this is better than a lifestyle approach. I will concede that the lifestyle change would likely involve a host of specialists to promote, support, encourage and monitor the patient and that the cost may be off putting to insurance companies, but until I get real long term data on outcomes, I am not convinced that this is a best practice option.

The researchers did note that certain things will increase the risk of death or adverse outcome and they are an extremely high BMI, though a BMI over 40 is usually needed to be considered for surgery so I cannot imagine what extremely high would be, as well as, history of clots, chronic obstructive sleep apnea and impaired functional status.. I assume this would mean immobility.

My friend, who is eating pureed food for now is keeping notes and will be one of two guest bloggers that I have on tap for you guys.. but we are going to wait a while for that one.