Weight loss surgery helps people keep weight off for at least 6 years, and also leads to lasting health improvements, a new study shows. The study focused on 1,150 severely obese people. More than 400 of them had gastric bypass surgery. The procedure they had blocks off part of the stomach. The small pouch that is left is attached to the small intestine, bypassing the first part of it. Other people in the study tried to lose weight just with diet and exercise. After 6 years, people in the surgery group had lost about 28% of their weight. Of those who had type 2 diabetes before surgery, 62% no longer had the disease. About 42% of those with high blood pressure returned to normal pressure. The no-surgery groups did not lose any weight long-term. During the study, 17% of those in the no-surgery groups who did not have diabetes developed the disease. This happened to only 2% of those in the surgery group who didn't start out with diabetes. The Journal of the American Medical Association published the study September 18. HealthDay News and Reuters Health news service wrote about it.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

The number of obese people soared in the 1980s and 1990s. Obesity is defined as a body mass index (BMI) of 30 or greater. The rate of rise has a slowed a bit. But currently more than 35% of American adults are obese. So are about 16% of children ages 2 to 19.

If we continue at our current pace, experts predict that by 2030 more than one-half of the people in 39 states will be obese. Mississippi holds the record now for the highest percentage of obese people. By 2030, that number could reach 67%.

Some consider obesity the greatest health threat today. Obesity brings greater risks of:

• Diabetes
• Heart and blood vessel diseases
• Osteoarthritis
• Sleep apnea

The United States is not alone in this obesity epidemic. The dramatic increase has occurred in many countries, including those considered to be underdeveloped.

Treatment of obesity through changes in diet and exercise has a very poor success record. Some people do successfully lose weight. However, very few of them keep it off. This is true even with the help of weight-loss medicines.

Surgery is clearly the best treatment for severe obesity. Today's Journal of the American Medical Association provides even more support for the benefits of obesity surgery.

Researchers from the University of Utah did the study. They compared gastric bypass surgery with intensive lifestyle changes (diet and exercise) for weight loss. They kept track of people for six years and observed what happened to them.

After 6 years, the people who had surgery weighed 28% less, on average, than they did before surgery. The average weight loss, 6 years later, for people treated with intensive lifestyle changes was nearly zero.

In addition, 62% of obese people with diabetes treated with surgery did not show evidence of diabetes 6 years later. Only 8% of similar people treated with diet and exercise had normal blood sugar levels after 6 years.

Surgery also led to much greater improvements in other health factors that increase the risk of heart and blood vessel diseases. The changes included:

• Lower blood pressure
• Lower total cholesterol
• Higher HDL (good) cholesterol
• Much lower risk of developing diabetes for people who did not have it when the study began

A word of caution: Suicide rates were higher in the people treated with surgery. The reasons could not be determined from this study.

What Changes Can I Make Now?

Despite the benefits that obesity surgery appears to have, you need to fully understand what lies ahead before proceeding. That includes both the risks of surgery and the commitment you will need to make to changes in your eating.

In general, the operation is intended for people with a body mass index of:

• 40 or higher, OR
• 35 and higher with one or more obesity-related health problems, such as diabetes

Before being considered for surgery, you also must have tried a structured weight loss program that did not succeed.

Surgeons generally suggest one of three weight loss procedures:

• Open Roux-en-Y gastric bypass -- The surgeon cuts into the abdomen and creates a small pouch in the stomach. The operation bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.
• Laparoscopic Roux-en-Y gastric bypass -- There's no large surgical cut. Small holes are made in the abdomen. Cameras are used to guide the instruments. The technique is otherwise similar to the open Roux-en-Y.
• Laparoscopic adjustable gastric banding -- This is the simplest of the three procedures. It is done through small holes in the abdomen. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach.

Roux-en-Y gastric bypass is the most effective. This study looked only at people who had this procedure.

The surgery has become less risky over the years. As with any operation, though, unexpected problems can occur. And some people have died, during or after the procedure.

You will need to stay in close contact with your doctor to check on how well you are adjusting to the major changes in your life and your body. The doctor also will check to make sure you are getting enough vitamins and minerals.

What Can I Expect Looking to the Future?

Obesity surgery is a treatment after the fact. Preventing obesity is the goal. It has to begin in early childhood.

Sure, the answer is to eat less and exercise more. But it's a battle. Tasty, sweet foods are abundant and relatively cheap. And children have too many indoor interests that keep them away from physical play.

We will continue to be challenged to find the best ways to combat these forces and make progress toward obesity prevention.