Approximately 15 million
people in the US are morbidly obese with a body mass index (BMI) of over 40. Sixty-four percent
of Americans are overweight or obese. More than 25 percent of adults are considered obese (BMI greater than 30). Obesity leads to a myriad of diseases and complications. Increasingly doctors and patients have been turning to bariatric surgical procedures (various surgical procedures to shrink or bypass the stomach to reduce food intake) to improve diabetes and life expectancy and reduce cancer rates and coronary artery disease. Do the short-term and long-term benefits outweigh the risks of surgery?
The National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funded a study called Longitudinal Assessment of Bariatric Surgery
(LABS). This study involved a clinical consortium that was awarded $3 million dollars a year for five years starting in 2003. The consortium includes University of Washington /Virginia Mason, Oregon Health and Science University/Legacy Good Samaritan Hospital, Sacramento Bariatric, Neuropsychiatric Research Institute, University of Pittsburgh Medical Center, University of Pittsburgh Graduate School of Public Health, Columbia/Cornell University Medical Center/ Valley Hospital, NIDDK, and East Carolina University.
LABS has brought together experts in bariatric surgery, obesity research, internal medicine, endocrinology, behavioral science, outcomes research, epidemiology, and other relevant fields to plan and conduct studies that will analyze the risks and benefits of bariatric surgery and its impact on the health and well-being of patients with extreme obesity, and identify the kinds of patients who are most likely to benefit.
The LABS study results reported in the July 30, 2009 issue of the New England Journal of Medicine
involved 4610 patients between 2005 and 2007 who had either a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding
procedure for the first-time. These patients had a mean body mass index (BMI) of 46.5 and age of 44.5 years. The death rate at 30-days post surgery was 0.3 percent (14 patients) with 4.3 percent (198) of the patients suffering at least one major, adverse outcome (death; blood clots; need for additional surgery; and failure to be discharged from the hospital). Bruce Wolfe M.D., co-author of the study, said that certain conditions such as extreme obesity (these are the most obese of this group that is already very obese), obstructive sleep apnea, and a history of deep-vein thrombosis were associated with an increased risk of adverse outcomes. The overall conclusion of the paper is the risk of death and adverse complication is low, but varied by patient.