Benefits of bariatric surgery may outweigh risks for severely obese

Bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults, according to a scientific statement from the American Heart Association.

The statement, published in Circulation: Journal of the American Heart Association, is the first by the American Heart Association focused solely on bariatric surgery and cardiac risk factors, according to lead author Paul Poirier, M.D., Ph.D., director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada.

'The statement is not an across-the-board endorsement of bariatric surgery for the severely obese,' Poirier said. 'It is a consensus document that provides expert perspective based on the results of recent scientific studies.'

Bariatric surgery encompasses various procedures that decrease appetite while restricting food intake and/or causing food to pass through the gastro-intestinal tract without being fully absorbed or digested. The American Heart Association has long considered bariatric surgery an option to be evaluated carefully based on each patient's medical profile.

Severe obesity is defined as a body mass index (BMI) of more than 40 kg/m2, according to the statement. For example, a sedentary woman who is 5-feet, 4-inches tall and weighs 235 pounds has a BMI of about 40.3 kg/m2. A 6-foot tall sedentary man who weighs 295 has a BMI of 40.

'Obesity has reached epidemic proportions in the United States, as well as in much of the industrialised world,' Poirier said. 'The most rapidly growing segment of the obese population is the severely obese. The health consequences of severe obesity are profound. In comparison with normal-weight individuals, a 25-year-old severely obese man has a 22 percent reduction in his expected lifespan.'

Doctors and patients have been frustrated with the challenges of treating obesity, Poirier said. 'Substantial long-term successes from lifestyle modifications and drug therapy have been disappointing, making it important to look at surgical options,' he said.

When reviewing the scientific literature, the statement-writing committee found that, when indicated, bariatric surgery leads to significant weight loss and improvements in the health consequences of being overweight, such as diabetes, high cholesterol, liver disease, high blood pressure, obstructive sleep apnea and cardiovascular dysfunction. Recent studies have suggested that bariatric surgery prolongs life in the severely obese.

There are, however, surgical risks - including death - and long-term post-surgical lifestyle implications. Patients must make lifelong behaviour changes, such as supplement use, and follow up with the surgical team.

'Bariatric procedures are generally safe; however, this is not a benign surgery,' Poirier said. 'At the moment, bariatric surgery should be reserved for patients who can undergo surgery safely, have severe obesity and have failed attempts at medical therapy.'

More research on bariatric surgery in adults and youths is needed, Poirier said. The severely obese adolescent population continues to grow with no effective sustainable treatment available.

The value of psychological evaluations and profiles in bariatric surgery cases is uncertain. The statement's authors suggest psychological evaluations should assess the behavioural and environmental factors that may have contributed to a patient's obesity, as well as the potential impact on a patient's ability to make the dietary and behavioural changes needed to achieve the best results from surgery.