Dr. Swiner’s Medical Note of the Month–Obesity, part II

I promised a follow-up on obesity and weight loss surgeries, and here it is. During my break from writing, I’ve had three, if not more, women come to visit solely to discuss having weight loss surgery because of disappointment with other programs they’ve tried. I recently, coincidentally, received a copy of a New England Journal of Medicine study article on comparison of safety of the three major types of surgeries: laparoscopic gastric bypass, open gastric bypass and laparoscopic adjustable gastric banding. 

But let’s first backtrack to my previous article for review. I discussed the ground rules I use when counseling on losing weight, such as not skipping meals, decreasing liquid calories and exercise. I also touched on some of the medications available – safe and unsafe – over the counter and prescription. Some of those medications included Alli, Phentermine and Xenical.

Yet, at the end of the day, many people are still dissatisfied with results for one reason or another and look to surgeries as a “fail proof” way to lose weight. Please be aware that while these surgeries work and have been successful for many, there are always possible side effects and long-term complications. Although these procedures have been perfected over time, sometimes death is the ultimate complication.

Gastric bypass, also called Roux-en-Y, is the most common type of surgery. It is when the top portion of the stomach is attached to the middle part of the small intestine, thereby “bypassing” a large portion of the stomach. This makes the stomach a smaller size, which makes it more difficult to eat large amounts of food. The laparoscopic banding is the method that involves placing a silicone, adjustable band that is attached around the stomach.

In an article from the New England Journal of Medicine, about 5,000 patients were studied with an average age of 45. The results of this study discussed overall risk of death and complications from both gastric bypass and laparoscopic banding surgeries. Although these procedures are safer than they used to be, complications still include blood clots, death and hospitalization for up to a month after the surgery. It found that less than 1 percent (about five patients) died and a total of 4.3 percent (about 215 patients) had a complication.*

This is my usual discussion when a patient asks about having surgery for weight loss. I always want to know what he or she has tried for diet and exercise first, and how long were they committed to their program. I then remind them that unless he or she has money to pay out of pocket, a surgeon and an insurance company have to approve it. Just having diabetes or hypertension doesn’t cut it anymore.

Time and time again, however, diet and exercise is my gold standard.

*N Engl J Med, vol 361, no. 5, Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery. P. 445

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