For Very Obese, Gastric Bypass May Extend Life

MONDAY, Jan. 18 (HealthDay News) -- Gastric bypass surgery could have life-extending benefits for most of the five percent of Americans who are very obese, a new study suggests.

The study, led by researchers at the University of Cincinnati, concluded that the benefits of this form of weight-loss surgery far outweigh the risks for most people who are morbidly obese, which is defined as having a body mass index of 40 or higher.

But individual decisions on the surgery rely on factors such as age, and a special program to help physicians and obese people balance the benefits and risks of weight-loss surgery is on the way, the researchers said.

"In the future, we plan on having a Web-based decision support tool," said Dr. Daniel P. Schauer, assistant professor of internal medicine at the University of Cincinnati Academic Health Center. "Hopefully, it will be available some time in the next year. It is in the development and testing phase."

The program is based on a study reported by Schauer and his colleagues in the January issue of Archives of Surgery. They examined data on more than 23,000 people who underwent bariatric surgery. The study compared that data to the immediate risk of death from the procedure and the years of life expectancy added by having the surgery.

Obesity is a major risk factor for heart attack, stroke and other cardiovascular problems. An increasing number of Americans who cannot control their weight by diet or behavioral changes have turned to bariatric surgery. Gastric bypass is one of several forms of bariatric surgery, which work by either preventing food from entering the stomach or diverting it past the stomach, thereby reducing food intake and absorption.

Current data indicate that a 42-year-old woman with a BMI of 45 would gain three years of life expectancy through gastric bypass, while a 44-year-old man with the same BMI would gain 2.6 years of life, according to the study. For reference, a 5-foot-9-inch man or woman weighing 305 pounds has a BMI of 45.

The 30-day mortality from the surgery has ranged from almost zero to as high as 2 percent in some studies, but it can be higher for some selected populations, the report said.

"The patients who benefit the most are younger patients who have a lower risk of dying from the surgery and a higher BMI," Schauer said. "The patients who benefit the least are older patients with a higher surgical risk because of a combination of age and comorbidities [other illnesses]."

Their model does not calculate the risk added by specific comorbidities, such as coronary disease, he said. "We are working on that for the next generation of models," Schauer said.

The most recent data used comes from 2007, and there is also reason to believe that the surgical risk has decreased since then, Schauer said. "That is something we are working on, updating the model as it becomes available," he said.

Dr. T. Karl Byrne, professor of surgery and director of bariatric surgery at the Medical University of South Carolina, said he would like to see more information on the cost benefits and health improvements associated with gastric bypass.

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