February 25, 2011 | 4:12 pm
Posted by Albert Fuchs, M.D.
Readers who have been following my posts for a few years know that weight-loss surgery is amassing an impressive body of scientific evidence supporting its effectiveness and safety. (Links to my previous posts about weight loss surgery are below.)
This week, two studies in the Archives of Surgery attempted to compare the different kinds of weight loss surgery. An LA Times article (link below) has a clear explanation of the different kinds of surgery and summarizes the findings of the studies. The studies suggest that gastric bypass may be more effective than gastric banding or than sleeve gastrectomy for certain important outcomes. One of the studies randomized moderately obese patients with type 2 diabetes to gastric bypass or sleeve gastrectomy. 93% of the bypass group had their diabetes resolve, compared to 47% of the group that had sleeve surgery. The amazing thing isn’t which surgery was better; the amazing thing is that these patients don’t have diabetes anymore. We don’t have medications that can do that.
I find the accumulation of evidence in favor of weight-loss surgery a fascinating trend because of the comparisons to diet and exercise. Though I constantly recommend diet and exercise to my overweight patients, the long term scientific evidence for it is quite shaky. Most overweight people eventually regain weight after dieting, and long-term success stories are the exception not the rule. I have certainly had motivated patients who have lost weight and kept it off, but large studies suggest that most patients can’t (or don’t). So the counter-intuitive truth is that weight loss surgery is actually a more evidence-based treatment for obesity than diet and exercise.
The other interesting facet about this trend is that obesity is an illness in which surgery is clearly more effective than medications. In many diseases such as heart disease and stomach ulcers surgical treatments are becoming much less common as medications improve. Coronary bypasses will be quite rare in our children’s lifetimes because of the improvements in cholesterol and blood pressure medicines. But for obesity, the medications thus far have been dangerous and ineffective while surgery seems to be providing good results.
So until you discover a safe pill for weight loss, I’ll be recommending surgery for very overweight patients who don’t achieve results with diet and exercise.
LA Times article: Gastric bypass more effective than other procedures, studies find
LA Times graphic: Gastric surgeries compared
Archives of Surgery article: Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding
Archives of Surgery article: Gastric Bypass vs Sleeve Gastrectomy for Type 2 Diabetes Mellitus
My previous posts about weight loss surgery:
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