Is gastric bypass becoming the new nose job?
Bariatric surgery, once a secret last resort of the rich, may not yet be as uncontroversial as getting a bit shaved off the top, but doctors say it ought to be -- not as a cosmetic procedure, but because it saves lives.
"It should be," says Dr. Michael Snyder, president of the Bariatric Surgery Program at Rose Medical Center in Denver. "Not to be flippant, but obesity-related disease is the number two cause of preventable disease in the United States."
The number of patients is certainly climbing. According to the American Society for Metabolic & Bariatric Surgery, more than 200,000 operations were performed in 2007. And Snyder says the number of bariatric patients has doubled in the past four years.
There is an extended family of seven, all former patients of Snyder's, that seem to illustrate the success of the operation made popular by the likes of Al Roker, Carnie Wilson and Star Jones.
Frank Espinosa, 57, says he lost 147 pounds after having gastric bypass surgery in 2003. His 38-year-old daughter Tanya had her surgery on the same day and went from 205 pounds to a barely-there 124 pounds, though she says she's gained most of it back due to stress.
But Tanya's mother-in-law, Clara, 59, seems to have lost 130 of her 270 pounds for good. And Frank's wife Pam, 56, is now only 148, down from the 215 pounds she carried around until her 2004 surgery.
Dee and Nancy Dreiling, ages 52 and 60, are Pam's cousins. Together they've lost a total of nearly 230 pounds. Ron Kohler, another cousin of Pam's, weighed 358 pounds in 2006. He's since dropped more than 100 pounds.
The Espinosas and their extended family may be doing well as a whole, but how safe is stomach-stapling?
A mortality-cause study published last year in the journal Archives of Surgery seems to indicate that while gastric bypass improves the health of many, there could be a darker side.
The study, which looked at 16,683 deceased bariatric patients in Pennsylvania, found that a large number died from coronary heart disease and, oddly enough, suicide and accidents.
It comes as no surprise to surgeons that the No. 1 cause of death among patients would be prove to be heart disease, as that is the No. 1 killer of Americans in general.
"We already know that morbidly obese people are at a higher risk for coronary disease and many other medical conditions," says Dr. Anita Courcoulas, director of Minimally Invasive Bariatric & General Surgery at the University of Pittsburgh Medical Center. "We know these people have advanced coronary disease, so it's not surprising that many of them died from that underlying cause."
To bring the numbers down, all surgical practices should emphasize solid and comprehensive pre-screening and after-care, says Dr. Alexander Abkin, a laparoscopic bariatric surgeon in Floram Park, N.J.
Patients over 50 should always be seen by a cardiologist, for example. Those with compromised hearts may be poor candidates, and a reputable practice will not operate on such a candidate.
But what about suicide and accidents? According to Snyder, bariatric patients have a 58 percent higher risk of suicide and accidents than does the general population.
It's a bit of a puzzle for researchers, but one that reinforces the importance of psychological pre-screening, says Abkin.
"You can't just staple someone's stomach and send them on their merry way," he says.