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Weight-loss surgery: Moving into new dimensions?

Bariatric surgery can dramatically improve type 2 diabetes and other risks for heart disease.

The latest statistics on obesity suggest that this disease remains a huge problem in the United States: nearly one in three American adults meet the criteria for obesity. What’s more, about one in 10 women and one in 20 men are considered extremely obese (see “Obesity in the extreme”).

People with extreme obesity face a high risk of cardiovascular disease and myriad other health problems, as well as a shortened life span. Most have struggled with excess weight since childhood or early adulthood, and many have undergone multiple, frustrating attempts to shed pounds. For some, weight-loss surgery (also known as bariatric surgery) may be the best—perhaps only—option for lasting weight loss.

Obesity in the extreme

Obesity, which is defined as a body mass index of 30 or higher, is divided into three categories (see www.health.harvard.edu/bmi for a BMI calculator):

BMI

Classification

30.0–34.9

Class 1 obesity

35.0–39.0

Class 2 obesity

40.0 and above

Class 3 obesity (also known as extreme or morbid obesity)

Currently, weight-loss procedures may be appropriate for people with Class 3 obesity and those with Class 2 obesity who also have an obesity-related health problem, such as type 2 diabetes, high blood pressure, or sleep apnea.

A shift in focus

Bariatric surgery leads to dramatic improvements in type 2 diabetes and other problems closely linked to heart disease, such as high cholesterol, high blood pressure, and sleep apnea (a condition marked by brief breathing pauses during sleep). A growing appreciation of these benefits is now expanding the focus of the surgery, says Dr. Ali Tavakkoli, co-director of the Center for Weight Management and Metabolic Surgery at Harvard-affiliated Brigham and Women’s Hospital.

“Many experts now feel that the focus of these surgeries should change from weight loss to improving health,” he says. Recently, a consensus statement from five international diabetes societies said that surgery should become a more routine treatment option for type 2 diabetes. They also proposed lowering the surgery threshold from a BMI of 35 down to 30 (and to 27.5 for Asians, who develop diabetes at lower BMIs than non-Asians). The growing use of the term “metabolic surgery” (rather than weight-loss or bariatric surgery) reflects this trend.

There are several surgical options, most of which are now performed with miniature instruments passed through small incisions (laparoscopically). Gastric bypass, once the most common procedure, is gradually being replaced by the gastric sleeve procedure. Gastric banding has also fallen from favor (see “Weight-loss surgeries”).

Curbing the hunger drive

“We think of surgery not as a cure for obesity but as a tool that allows people to implement the healthy eating and life-style habits that ensure sustained weight loss,” says Dr. Tavakkoli. Most people can lose weight by eating small, healthy amounts of food for a few weeks or months, he explains. “But it’s very difficult to fight the continuous hunger drive that makes them want to eat more. That strong biological drive ultimately wins, and they end up regaining weight.” The stomach secretes a hunger hormone (ghrelin), so removing most of that organ also shrinks a person’s appetite.

Bariatric surgery is no more risky than other major surgery, such as hip replacement, but it does require one to two days in the hospital and a major lifestyle change. The average cost is $20,000 to $25,000; insurance coverage varies by state and provider.

If you are considering weight-loss surgery, choose a center certified by the American College of Surgeons that specializes in bariatric procedures. You’ll be evaluated by clinicians specializing in medicine, nutrition, and psychology to make sure you’re a good candidate.

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Posted by: Dr.Health

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