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Obesity surgery can cure diabetes, high blood pressure and other ills

Patients who undergo obesity surgery get far more than cosmetic benefits – many also shed fat-related ailments including diabetes, high blood pressure and high cholesterol, researchers say.

Their report – an analysis of 136 studies – suggests that, in some cases, the drastic operations may alter the patient's body chemistry and relieve conditions that can lead to heart attacks, strokes and kidney failure.

The analysis was funded by a Johnson & Johnson Co. subsidiary that develops and markets surgical instruments, including staplers for obesity surgery. But the results echo what many doctors have reported seeing.

Diabetes was eliminated in nearly 77 per cent of the affected patients; high blood pressure was eliminated in nearly 62 per cent; cholesterol improved in at least 70 per cent; and obstructive sleep apnea – episodes when breathing stops during sleep – disappeared in almost 86 per cent of case. All four conditions are strongly linked to obesity and can have lethal consequences.

While significant weight loss by diet, exercise or medication can have similar benefits, obesity surgery patients typically lose at least 30 per cent of their body weight and keep it off long-term – results that are difficult to achieve with other methods, said Dr. Samuel Klein, a Washington University obesity specialist who was not involved in the research.

The study appears in Wednesday's Journal of the American Medical Association.

About two-thirds of U.S. adults are overweight, and of those, almost half are grossly overweight, or obese. Surgery in which the stomach is reduced or restricted is typically reserved for people who are at least 100 pounds heavier than their recommended weight and for whom other weight-loss methods have failed.

Doctors have long known that losing weight helps improve blood pressure and cholesterol levels by reducing stress on the cardiovascular system. With diabetes, obesity surgery may have unique benefits, said University of Minnesota surgeon Dr. Henry Buchwald, the study's lead author and a consultant to the Johnson & Johnson subsidiary.

There is evidence that when the intestinal tract is rearranged in obesity operations, patients who were diabetic are “cured” even before they start shedding significant amounts of weight. That may be because such operations alter the intestinal hormones, Dr. Buchwald said.

Dr. Buchwald and colleagues reviewed studies on obesity surgery published in English between 1990 and 2003. The studies involved 22,094 patients ages 16 to 64, at least two-thirds of them women.

The researchers found patients lost an average of 61 per cent of their excess weight.

The greatest weight loss occurred with the most complicated surgery, an operation called a duodenal switch, which is more common in Europe. It involves removing three-fourths of the stomach and rearranging the intestine so digestion occurs in a shortened channel, resulting in less food being absorbed.

The most common U.S. obesity surgery, gastric bypass, involves creating an egg-sized pouch in the upper stomach and attaching it to a section of intestine. The procedure reduces the amount of food patients can eat and results in less food being absorbed. The researchers found it resulted in a 62 per cent loss of excess weight.

Obesity surgery is a major operation, not cosmetic tinkering, Dr. Buchwald emphasized. The risks include malnutrition, stomach problems, infections and, in rare cases, death.

The average 30-day death rate following surgery was about 0.6 per cent in the reviewed studies. Dr. Buchwald said nonfatal complications also occurred, but no more than with other major surgery.

A report last week from the government's Agency for Healthcare Research and Quality said about 20 per cent of obesity-surgery patients experience complications, most of them minor. The report also said surgery is more effective than other methods for weight loss and for controlling obesity-related ailments.