Studies Bring New Hope for Obese

Losing weight is an uphill battle — especially for the morbidly obese. Diet and exercise often fail. Drugs are not very effective. And in the end, many people suffer for years only to be left with one last and very expensive resort: surgery. That was certainly the case with Shawn Tarman, a 42-year-old woman from Willow Grove, Penn., who says she'd tried absolutely everything to lose weight. She finally resorted to gastric bypass surgery, a procedure that shrinks the stomach, and lost over 100 pounds.

In the last decade, bariatric surgeries like gastric bypass have become an acceptable method for treating the 15 million people in the U.S. who suffer from morbid obesity. "Obesity can be life threatening," says Dr. Philip Schauer, president of the American Society for Bariatric Surgery (ASBS). "And surgery is the next best step." Despite this, only 1% of patients who are eligible for surgery (those with a BMI over 40 or a BMI of 35 or more in conjunction with an obesity-related disease) actually get it. Sometimes, people just don't want to undergo a surgical procedure, but more often than not, obese patients are dissuaded by difficult insurance companies and are sometimes discouraged by doctors who feel they may not be the right age for the procedure.

But two new studies presented the annual meeting of the ASBS in San Diego, Calif., from June 11 to 16 show that adolescents and seniors, two age groups that have traditionally been urged to shy away from bariatric procedures, can actually benefit from surgical intervention. Another study shows that insurance companies could wind up spending less by approving bariatric surgery when compared to the life-long cost of obesity. And the latest piece of science shows that even though patients lose weight, they still need to be careful around certain indulgences — substances like alcohol have been found to have an even greater effect after surgery.

Researchers from the University of Texas Southwestern Medical Center in Dallas have found that teenagers handle bariatric surgery even better than adults. The study of 309 adolescents and 55,192 adults found that only 5.5% of teenagers had complications after surgery compared with 9.8% in adults. "There has always been a lot of concern that doing surgery in a young person, however extreme the case is, will carry a lot of complications," says Dr. Esteban Varela, lead author of the study and director of Minimally Invasive Surgery at VA North Texas Health Care System. "But it is even safer." Between 2000 and 2003, the number of teenagers who had bariatric surgery tripled. While the number is growing, with 771 adolescents signing up in 2003, teenagers still represent less than 1% of all bariatric surgeries — a number that will begin to increase as more doctors view the practice as safe.

From the same center, a similar study of the elderly population showed that seniors do not experience significantly more complications than young adults. In fact, only 13% of patients, age 65 and older, who had laparoscopic adjustable gastric banding (LAGB) — a surgical procedure that inserts a hollow band around the stomach to limit food intake — had complications. Even more compelling, nearly two-thirds of patients lost their excess weight and significantly improved their obesity-related conditions like diabetes. "No one questions whether we should offer knee or hip replacements to people over age 65," says David A. Provost, an associate professor at the University of Texas Southwestern Medical Center, who authored the study. "Weight loss surgery can provide similar quality of life improvements with less risk."

Even though Medicare and Medicare began covering bariatric surgery last year, many private insurance companies still do not want to pay for such an expensive procedure, which can cost anywhere from $10,000 to $40,000. However, a small preliminary study presented at the conference could change some of this thinking. Researchers found that the average cost of bariatric surgery is often completely recouped by the patient after three years, after which time the medical expenses of patients who did not have surgery are twice as high. "Patients who come in for surgery have a lot of medical problems," says Dr. Anita Courcoulas, lead author of the study. "It makes sense that it would end up costing less." A larger study still needs to be done, but this new research shows that surgery may actually be the cheaper option in the long term.

Most insurance companies will make patients jump through hoops before they will actually pick up the tab for bariatric surgery. Providers often require that patients lose a specified amount of weight by staying on a medically enforced diet plan. However, a new study from Duke University Medical Center found that 62% of bariatric surgery patients trimmed the excess fat regardless of whether they lost or gained 10 pounds before surgery. "There is no value in policies like this," says Dr. Eric DeMaria, the study's lead author. "If there is no value, we shouldn't use it as a requirement."

Bariatric surgery isn't a cure-all. There are still significant diet and lifestyle changes that need to be enforced. For example, a new study from Stanford University shows that patients who have gastric bypass are more susceptible to the effects of alcohol. Inspired by an episode of Oprah Winfrey in which most individuals who had undergone gastric bypass said they got drunk faster on less alcohol, the researchers decided to test this theory. The study found that for people who had the surgery, drinking 5 ounces of wine would give them an average blood alcohol level of 0.08, while the level of non-patients was only at 0.05. People who had the surgery also took 108 minutes to sober up, while non-patients only needed 72 minutes. Since the stomach is smaller after bypass, alcohol is absorbed faster and takes longer to clear the system.

It may be an uphill battle, but the evidence at this year's conference shows that gastric bypass surgery is more effective and safer that originally thought, and can significantly improve the quality of life for all ages. It certainly did for Shawn Tarman. "Eating used to be my life," Tarman says. "And surgery helped me get that life back."