By Dr. Ann M. Rogers
A paper published in the May 2012 issue of the American Journal of Preventive Medicine tells us that even though the skyrocketing rates of obesity may be leveling off slightly, they are still increasing. This study predicts that by the year 2030, 42 percent of the U.S. population will be obese. The conclusion of the article is that this trend “will further hinder efforts for healthcare cost containment.” On a brighter note, it is important to realize that weight loss surgery is the only effective and durable treatment for severe obesity and the medical conditions that are associated with weight. Multiple studies have shown that weight loss surgery pays for itself within two to four years, meaning that even if the obesity epidemic continues, we have an effective tool to combat it. If more patients who qualified actually underwent such surgery, we would begin to see not only significant improvement in our nation’s health, but significant health care cost savings in a fraction of the time period discussed in this article.
Another interesting topic in the news lately is the remarkable ability of weight loss surgery to improve and sometimes cure diabetes. Operations like the gastric bypass, vertical sleeve gastrectomy, and the duodenal switch procedure have been shown to begin improving diabetes in patients before they have even had a chance to lose weight! Stapled bariatric procedures are very effective not only at improving diabetes, but also thyroid dysfunction, high cholesterol and high triglycerides. There are many exciting procedures and treatments on the horizon for diabetics, and this is why weight loss surgery is starting to be called “metabolic surgery.”
It’s interesting to note that there are operations currently being studied here and in other countries designed to cure diabetes even in patients who are thin. One of these operations is called the ileal interposition. In this operation, a segment of the small intestine is moved from one position to a position closer to the stomach. When the bowel is rearranged in this way, many hormonal signals immediately go to work telling the body to improve its regulation of glucose and insulin. And because no intestine is removed, these patients lose hardly any weight. The hormonal changes seen after this kind of operation are being actively studied to see if these effects can be achieved without an operation. For example, the endolumenal duodenal sleeve is one less-invasive treatment that is under trial. This device is placed into the intestines with an endoscope, and is designed to mimic some of the changes that are brought about by the gastric bypass. Medications are also being tested for the same purposes.
At this time, however, the only proven tool we have to help patients lose a significant amount of weight and keep it off long-term is weight loss surgery. Proper diet and exercise continue to be important for everyone’s general health, but for patients with severe obesity who have tried everything else, surgery may be a good option.
Ann M. Rogers, M.D., is director of the Penn State Hershey Surgical Weight Loss Program, Penn State Milton S. Hershey Medical Center.