Doctors debate safety of obesity surgeries

updated 10:33 a.m. ET Jan. 2, 2006

As more people abandon New Year's resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best. And researchers are uncovering some surprising trends.

The most common method in the United States — gastric bypass, or stomach-stapling surgery — may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.

A gentler approach favored in Europe and Australia — an adjustable stomach band — can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.

A radical operation — cutting away part of the stomach and rerouting the intestines — is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three options.

But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.

"The body just has many ways of compensating, even after something as drastic as surgery," said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group's recent annual conference in Vancouver featured many studies on surgery's long-term effects.

Global epidemic
Obesity is a problem worldwide. About 31 percent of American adults — 61 million people — are considered obese, with a body-mass index of 30 or more. That's based on height and weight. Someone 5-foot-4 is obese at 175 pounds; 222 does it for a 6-footer.

Federal guidelines say surgery shouldn't be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.

The band's reversibility makes it a better choice for children, some doctors say.

"It's becoming more well-known and more accepted. Patients like it because it's less invasive. It's an easier surgical procedure. It's safer," said Georgeann Mallory, executive director of the bariatric society.

"To me it is a very straightforward decision," said Dr. Paul O'Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. "I would strongly recommend that the consumer consider the safest effective procedure first," which is the band, he said.

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