Benefits of Weight Loss Surgery
Overweight and obesity together represent the second leading preventable cause of death in the United States.
Obesity is a serious, chronic disease that can inflict substantial harm to a person's health.
- Overweight and obesity are not the same; rather, they are different points on a continuum of weight ranging from being underweight to being morbidly obese. The percentage of people who fit into these two categories, overweight and obese, is determined by Body Mass Index (BMI). Learn about the BMI calculated provided by the National Heart, Lung and Blood Institute. (BMI Calculator).
- In adults, a BM from 18.5 to 24.9 is considered normal while a BMI of more than 25 is considered overweight. A person is considered obese if the BMI is greater than 30 and morbidly obese if the BMI is 40 or greater.
Factors which may influence the occurrence of obesity include, but are not limited to:
- Genetics. Studies have shown that a predisposition toward obesity can be inherited. Although researchers have identified several genes that appear to be associated with obesity, most believe that one gene is not responsible for the entire obesity epidemic. The majority of current and future research aims to better understand the interaction between these gene variations and our ever-changing environment in the development of obesity.
- Metabolic factors. How a particular person expends energy is different from how someone else's body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain. Recent studies show that levels of ghrelin, a peptide hormone known to regulate appetite, and other peptides in the stomach, play a role in triggering hunger and producing a feeling of fullness (satiety).
- Socioeconomic factors. There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are more likely to be obese than women of higher socioeconomic status. The occurrence of obesity is also highest among minority groups, especially among women.
- Lifestyle choices. Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.
The health effects of obesity
Obesity has a far-ranging negative effect on health. Each year obesity-related conditions cost over 100 billion dollars and cause premature deaths in the US. The health effects associated with obesity include, but are not limited to high blood pressure, diabetes, heart disease, joint problems, including osteoarthritis, sleep apnea and respiratory problems, cancer, metabolic syndrome and various psychosocial effects.
Osteoarthritis of Weight-Bearing Joints
Reproductive Health
Type 2 Diabetes
High Blood Pressure/Heart Disease
Dyslipidemia/High Cholesterol
Health Benefits Associated with Bariatric Surgery
Asthma and Pulmonary Conditions
Sleep Apnea and Respiratory Problems
Gastroesophageal Reflux Disease(GERD)
Urinary Stress Incontinence
Depression
References
Osteoarthritis of Weight-Bearing Joints
What is it?
Osteoarthritis is one of the most common forms of arthritis. Known as the wear-and-tear kind of arthritis, osteoarthritis is a chronic condition in which there is a breakdown of a joint's cartilage. For anyone who is suffering from morbid obesity, the excess body weight placed on joints, particularly knees and hips, results in rapid wear and tear, and pain caused by inflammation. Similarly, bones and muscles of the back constantly are strained, causing disk problems, pain, and decreased movement ability. While osteoarthritis may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
How is it affected by bariatric surgery?
As less weight is placed on joints, the strain placed on these joints is reduced. Bariatric surgery can reduce much of this weight over a long period of time and can be very effective in treating osteoarthritis.
What success have patients found through bariatric surgery?
A recent study of 500 patients showed a 90 percent resolution of arthritis among surgical patients.8
Reproductive Health
What is it?
Reproductive health can be a concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities may occur due to morbid obesity. Menstruation issues include cycle interruption, abnormal flow, and additional pain during your menstrual cycle. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS).
PCOS is an endocrine disorder in women of childbearing age that can cause infertility and other reproductive health conditions. Classic symptoms include obesity, an increase of facial and body hair (hirsutism), acne, irregular menstrual cycles, and infertility.
16
How is it affected by bariatric surgery?
Bariatric surgery has been found to improve or resolve conditions that may interfere with pregnancy, such as PCOS and hypertension. This procedure also reduces weight on reproductive organs and influences other physiological changes affecting fertility.
Surgeons commonly will request that female bariatric patients take steps to prevent pregnancy during the first year after surgery. Therefore, it's important to know about any changes in fertility after surgery so that you don't become pregnant too soon.
What success have patients found through bariatric surgery?
A recent study of women following gastric bypass surgery showed improvement of multiple clinical problems related to infertility and PCOS. All women continued to have normal menstrual cycles after about three months following surgery. Of the women who experienced hirsutism, 52 percent had complete resolution.15 In overweight women, weight loss (as little as 5 percent) may restore ovulation and fertility.16
Type 2 Diabetes
What is it?
Type 2 diabetes is a long-term metabolic disorder where the body produces insulin, but resists it. Insulin is necessary for the body to be able to use sugar.4 Because of excess weight, obese individuals develop a resistance to insulin, which controls blood sugar. While type 2 diabetes may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
How is it affected by bariatric surgery?
Patients who had gastric bypass surgery had lower insulin resistance. Their risk for metabolic syndrome, high blood pressure, and a high amount of fats in the blood also decreased.
5 In fact, a landmark study found that resolution of diabetes often occurred within days following gastric bypass surgery, even before marked weight loss was achieved.
3
What success have patients found through bariatric surgery?
A recent meta-analysis showed 76.8 percent of gastric bypass patients found complete resolution of type 2 diabetes, and 86 percent found improvement or resolution.3 Many gastric bypass surgery patients with type 2 diabetes have demonstrated little or no need for continuing medication.6
High Blood Pressure/Heart Disease
What are they?
Excess body weight keeps the heart from working properly. The result can be high blood pressure (hypertension), which can cause strokes and heart and kidney damage. Evidence shows that the age-related lifetime risk of hypertension in men and women ages 45 to 54 will double as their average BMI increases from 25 to 35.7 While hypertension may occur regardless of someone's age, gender, or body mass, it tends to be more severe in the obese.
How are they affected by bariatric surgery?
Bariatric surgery reduces excess body weight over time, which takes away some of the strain on the heart. Changes in diet and exercise after surgery can lead to significant improvement of hypertension and other cardiovascular problems. Studies have shown reductions in total cholesterol and LDL levels and increased HDL levels. Even a weight loss of 10 percent can lower blood pressure significantly.3
What success have patients found through bariatric surgery?
A recent meta-analysis showed hypertension was resolved or improved in 78.5 percent of patients.3 A study of 500 patients showed 92 percent resolution of hypertension.8
Dyslipidemia/High Cholesterol What are they?
Dyslipidemia is a disorder of lipids -- the fat-like substances in the blood. A common form of dyslipidemia is hyperlipidemia (or high cholesterol), the condition that exists when someone has too much of certain lipids in the blood. As these lipids build up inside the artery walls, harmful scar tissue and other debris begin thickening and hardening the walls. Doctors call this condition atherosclerosis or hardening of the arteries. While dyslipidemia may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
What success have patients found through bariatric surgery?
Recent research on the impact of gastric bypass surgery found that hyperlipidemia and hypercholesterolemia were improved in more than 93 percent of patients.3
Health Benefits Associated with Bariatric Surgery
Morbid obesity can lead to a shorter life and many life-threatening health problems, known as co-morbidities. Recent studies show that the risk of an early death for those struggling with obesity is twice that of a non-obese person.
1 With treatment, there is a better chance for enjoying good health and a longer life. A clinical study shows that gastric bypass surgery improves life expectancy in patients by 89 percent.
2
Dedicating yourself to effective treatment is necessary for better health. Finding that treatment begins with learning how weight affects you.
Obesity-Related Health Conditions
If you find yourself struggling with one or more obesity-related health condition, bariatric surgery could be right for you.
If you choose to have bariatric surgery, your choice should be based on discussions between you and your doctor, including goals and strategy for long-term care. Patient selection for bariatric surgery is based on the National Institutes of Health (NIH) criteria:1
- 100 pounds or more above ideal body weight or a BMI of 40 or greater
- BMI of 35 or greater with one or more obesity-related health condition
Other factors your doctor may consider include:
- History of documented dietary weight loss attempts
- Lifelong commitment to dietary, exercise, and medical guidelines and follow-up care
- Psychological evaluation
Studies show that bariatric surgery effectively can improve and resolve many weight-related health conditions.3 A review of more than 22,000 bariatric surgery patients showed improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea.
Asthma and Pulmonary Conditions
What are they?Asthma is a disease of the respiratory system in which the airways unexpectedly narrow. Adult-onset asthma is closely associated with GERD. Common symptoms of asthma include wheezing, coughing, and chest tightness. While asthma may be found regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
What success have patients found through bariatric surgery?
While asthma remains a treatable but incurable disease, research has shown improvement in asthmatic symptoms through significant weight loss.14
Sleep Apnea and Respiratory Problems
What are they?
Obstructive sleep apnea is when breathing suddenly stops because soft tissue in the rear of the throat collapses and closes during sleep. Morbid obesity can cause sleep apnea and other respiratory problems. The greater your excess body weight, the greater the amount of fat pressing down on your chest and lungs. When you are morbidly obese, you are likely to have a greater buildup of fat deposits in the tongue and neck. While sleep apnea may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
How are they affected by bariatric surgery?
Reducing overall excess body weight reduces fat deposits in the tongue and neck that cause sleep apnea. Clinical data show that sleep apnea is present in 60 percent of patients undergoing bariatric surgery.10
What success have patients found through bariatric surgery?
Recent research found that obstructive sleep apnea was resolved in 85.7 percent of patients through gastric bypass surgery.3
Many people suffering from sleep apnea go undiagnosed. If you are obese and feel tired and fall asleep during the day, talk to your physician about sleep apnea.
Gastroesophageal Reflux Disease (GERD)
What is it?
Gastroesophageal Reflux Disease is injury to the esophagus caused by chronic exposure to stomach acid. While the symptom of heartburn is often associated with this disease, GERD is more than an annoyance. It is a serious disease that can cause esophagitis, Barrett's esophagus, and esophageal cancer. Occasional heartburn does not indicate GERD.
Excess body weight may weaken the valve at the top of the stomach, allowing acid to escape into the esophagus. This escape is known as gastroesophageal reflux. While GERD may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
A five- to 10-year follow-up study that included 16,191 participants showed that there is an independent relationship between obesity, nighttime GERD and habitual snoring, and the onset of asthma and respiratory symptoms in adults.
11 A 130-patient study found that people who suffer from GERD experienced a worsening of symptoms as their weight increased.
12
How is it affected by bariatric surgery?
Obesity increases a person's risk of GERD. Bariatric surgery improves GERD by reducing the amount of stomach acid produced.
What success have patients found through bariatric surgery?
A 2000 study of 500 patients showed complete resolution of GERD in 98 percent of patients.
8 While there is anti-reflux surgery, it fails more often in people with morbid obesity and only addresses one co-morbidity.
13 Another study found that all participants who had gastric bypass surgery reported an improvement in or no symptoms of GERD.
13
Obesity increases a person's risk of GERD. Bariatric surgery improves GERD by reducing the amount of stomach acid produced.
What success have patients found through bariatric surgery?
A 2000 study of 500 patients showed complete resolution of GERD in 98 percent of patients.
8 While there is anti-reflux surgery, it fails more often in people with morbid obesity and only addresses one co-morbidity.
13 Another study found that all participants who had gastric bypass surgery reported an improvement in or no symptoms of GERD.
13
What are they?
Obstructive sleep apnea is when breathing suddenly stops because soft tissue in the rear of the throat collapses and closes during sleep. Morbid obesity can cause sleep apnea and other respiratory problems. The greater your excess body weight, the greater the amount of fat pressing down on your chest and lungs. When you are morbidly obese, you are likely to have a greater buildup of fat deposits in the tongue and neck. While sleep apnea may occur regardless of someone's age, gender, or body mass, the disease tends to be more severe in the obese.
How are they affected by bariatric surgery?
Reducing overall excess body weight reduces fat deposits in the tongue and neck that cause sleep apnea. Clinical data show that sleep apnea is present in 60 percent of patients undergoing bariatric surgery.10
What success have patients found through bariatric surgery?
Recent research found that obstructive sleep apnea was resolved in 85.7 percent of patients through gastric bypass surgery.3
Many people suffering from sleep apnea go undiagnosed. If you are obese and feel tired and fall asleep during the day, talk to your physician about sleep apnea.
Urinary Stress Incontinence
What is it?
Among women, morbid obesity is a big risk factor for urinary stress incontinence, or uncontrollable urine loss. A large, heavy abdomen and relaxation of the pelvic muscles due to morbid obesity may cause the valve on the urinary bladder to weaken, leading to leakage of urine with coughing, sneezing, or laughing. While urinary stress incontinence may occur regardless of someone's age, gender, or body mass, the condition tends to be more severe in the obese.
How is it affected by bariatric surgery?
Bariatric surgery has been found to improve urinary stress incontinence. Less weight is placed on the bladder, and other physical changes take place to improve this condition.
What success have patients found through bariatric surgery?
A 2000 study of 500 patients showed 97 percent resolution of urinary stress incontinence in patients after gastric bypass surgery.8
Depression - What is it?
Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things.9 There are many reasons people with morbid obesity experience depression. Many of the everyday activities people with healthy body weight take for granted are big challenges for a person suffering from morbid obesity. These activities may include walking, social interaction, finding clothes that fit, and fitting in public seats. While depression may occur regardless of someone's age, gender, or body mass, it tends to be more severe in the obese.
How is it affected by bariatric surgery?
Emotional health goes hand in hand with physical health. Lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health.
What success have patients found through bariatric surgery?
Patients who have had bariatric surgery report improved quality of life, social interactions, psychological well-being, employment opportunities, and economic conditions. Psychological screening before surgery may help prepare you for the changes that come with surgery, and help you set realistic goals and expectations.
References
1 American Society for Bariatric Surgery. Rationale for the Surgical Treatment of Morbid Obesity. [Online] 8 April 1998. www.asbs.org/html/ration.html.
2 Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240(3):416-24.
3 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292(14):1724-37.
4 American Diabetes Association. Type 2 Diabetes: Conditions, Treatments, Resources. [Online] 1 August 2005. http://www.diabetes.org/type-2-diabetes.jsp.
5 American Diabetes Association. The Link Between Obesity and Metabolic Syndrome. [Online] 1 August 2005. http://www.diabetes.org/diabetes-research/summaries/vasquez-obesity.
6 Sampalis J, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg 2004;14:939-47.
7 Presutti R, Gorma R, Swain J. Concise Review for Clinicians. Primary Care Perspective on Bariatric Surgery. Mayo Clin Proc 2004 Sep;79(9):1158-66.
8 Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass, Roux-En-Y 500 Patients: Technique and Results, with 3-60 Month Follow-up. Obes Surg 2000 Jun;10(3):233-9.
9 National Institute of Mental Health. Depression. [Online] 4 August 2005. http://www.nimh.nih.gov/publicat/depression.cfm.
10 Rasheid S, Magdalena B, Gallagher SF, et al. Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity. Obes Surg 2003;13:58-61.
11 Gunnbjornsdottir MI, Omenaas E, Gislason T, et al. Obesity and Nocturnal Gastroesophageal Reflux are Related to Onset of Asthma and Respiratory Symptoms. Eur Respir 2004;24:116-21. Gastroesophageal Reflux are Related to Onset of Asthma and Respiratory Symptoms. Eur Respir 2004;24:116-21.
12 Smith SC, Edwards CB, Goodman GN. Symptomatic and Clinical Improvement in Morbidly Obese Patients with Gastroesophageal Reflux Disease Following Roux-en-Y Gastric Bypass. Obes Surg 1997;7:479-84.
13 Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-En-Y Gastric Bypass for Recalcitrant Gastroesophageal Reflux Disease In Morbidly Obese Patients. J Lap Surg 2004 Jan-Mar;8(1):19-23.
14 Simard B, Turcotte H, Marceau P, et al. Asthma and Sleep Apnea in Patients with Morbid Obesity: Outcome After Bariatric Surgery. Obes Surg 2004;14:1381-88.
15 Eid GM, Cottam DR, Velcu LM, et al. Effective Treatment of Polycystic Ovarian Syndrome with Roux-En-Y Gastric Bypass. SOARD 2005 Mar;1(2):77-80.
16 Dr. Joseph F. Smith Medical Library. Polycystic Ovary Syndrome. [Online] 1 August 2005. <http://www.chclibrary.org/micromed/00061250.html>.
17 Kushner RF. Roadmaps for Clinical Practice: Case Studies in Disease Prevention and Health Promotion -- Assessment and Management of Adult Obesity: A Primer for Physicians (Booklet 7: Surgical Management). Chicago, IL. American Medical Association 2003.
18 Fitch K, Pyenson B, Abbs S, et al. Research Report: Obesity: A Big Problem Getting Bigger. 2004 Mar.
19 Balsiger BM, Kennedy FP, abu-Lebdeh HS, et al. Prospective Evaluation of Roux-en-Y Gastric Bypass as Primary Operation for Medically Complicated Obesity. Mayo Clinic Proc 2000 Jul;75(7):673-80.
20 Foster G, Wadden T, Makris A, et al. Primary Care Physicians' Attitudes about Obesity and Its Treatment. Obes Res 2003;11(10):1168-77.
21 American Society for Bariatric Surgery 2005.
22 American College of Surgeons. Recommendations for Facilities Performing Bariatric Surgery. Bulletin of American College of Surgeons 2000 Sep;85(9):20-3.
23 American Obesity Association Fact Sheet: Obesity in the U.S. [Online] 14 January 2004. http://www.obesity.org/subs/fastfacts/obesity_US.shtml.
24 Nguyen NT, Ho HS, Palmer LS, et al. A Comparison Study of Laparoscopic Versus Open Gastric Bypass for Morbid Obesity. J Am Coll Surg 2000 Aug;191(2):140-55.
25 Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000 Oct;232(4):515-29.
26 Buchwald H. 2004 ASBS Consensus Conference Statement, Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third party payers. SOARD 2005;(1):371-8.
27 Long SD, O'Brien K, MacDonald KG, et al. Weight Loss in Severely Obese Subjects Prevents the Progression of Impaired Glucose Tolerance to Type 2 Diabetes: A Longitudinal Interventional Study. Diabetes Care 1994;17(5):372-5.