Why Surgery?

With the failures of medical management, significant improvements in surgical care and techniques, the astonishing results of several high profile celebrities who have undergone modern day surgery (Al Roker, Randy Jackson – People Magazine November 2002 and January 26, 2004), and publication of major long-term follow up studies, public interest is turning to surgical management of morbid obesity. The scientific community is also changing attitudes and beginning to refer patients in ever increasing numbers. The following are some of the developments swaying opinion:

• In 1996, the National Institutes of Health conducted a Consensus Conference on the Management of Obesity to define clear management options for the next decade. The conference of experts, including nutritionists, psychologists, internists, surgeons, exercise physiologists, and basic scientists, concluded with the following statements:

• Surgical intervention is the only method proven to have a significant long-term impact on the disease of morbid obesity.
• Less invasive methods have failed to have any significant impact.

Other reports include:

• In 1995, long-term success in maintaining significant weight loss following a surgical procedure was published by the group at East Carolina University. Walter Pories and co-workers documented loss of greater than 50% excess weight in 80% of their patients for up to 14 years.
• A ten-year study, published from the University of Virginia, reported similar results with loss of 60% of excess weight at 5 years and in the mid 50% range for up to 6 to 10 years following surgery.
• Multiple other authors have reported 2 to 6 year follow up with similar weight loss.
• The mortality risk is now in much better focus and quite low when the surgery is performed by experienced centers of excellence. In 2004 Buchwald H., et al. published resultes of a review of 136 scientific reports on weight loss surgery totalling 22,094 patients. The average operative mortality 0.5% [Buchwald H., et al: Bariatric Surgery: A systematic review and meta-analysis. JAMA 292:1724-1737, 2004].
• The Buchwald paper also confirmed the dramatic improvement in morbidity with the following rate of improvement or resolution of problems:
  • Diabetes Mellitus: Complete resolution 76.8% Resolved or improved 86%
  • Hyperlipidemia: Improved 70%
  • Hypertension: Resolved 61.7% Resolved or improved 78.5%
  • Sleep Apnea: Resolved 85.7%
• In 2004, McGill University compared five-year survival of 5,746 morbidly obese patients managed medically with 1,035 patients who underwent surgery, matched by sex, age, and length of being obese. Five-year mortality was 6.17% in the medical group. Five-year mortality was only 0.68% in the surgical group (p < 0.001). [Christou NV, et al.: Ann. Surg., 240: 416-422, 2004]

With recognition of the outcomes from surgery, more and more patients are seeking surgical intervetnion. In 2004 over 200,000 surgical weight loss procedures were performed and the number is expected to double in 2005. Even with the increase in trained surgeons and development of Centers of Excellence, our current limited ability to provide the necessary care to the some 10 million possible candidates is now recognized as a medical crisis in America.