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Every doctor can tell you their names — the patients who change their diet, begin exercising, and lose 40, 50, even 100 pounds. Along the way, those patients also lose something else: medical problems like diabetes, high blood pressure, high cholesterol and sleep apnea. And their back pain and arthritis stop bothering them. They go from taking a half dozen medications to taking none. The reason that doctors can tell you their names is that every physician has one or two such success stories — but only one or two. Many people are overweight, and most cannot lose it. The medical consequences include not just the diseases mentioned above, but also heart attacks, heart failure, cancers and stroke. Sad to say, surgery is the only proven treatment that leads to long-term “significant” weight loss. Not surprisingly, as the Baby Boomers age and gain weight, and as the operations themselves get more sophisticated, the number of operations performed has gone up about fivefold in the last seven years. And an ever-increasing number of hospitals are now advertising their weight-loss centers, driven in part because these operations can help the hospitals fill beds and stay afloat financially. Thus, the questions facing many people are, should they should have surgery, and, if so, where? The current U.S. guidelines suggest that surgery be considered for people with a body mass index of 40 or more. If you have existing obesity-associated conditions such as diabetes, cardiovascular disease or sleep apnea, then a body mass index of 35 can be used as the threshold for considering surgery. To calculate your BMI, click here. Just as the risks of having such a high BMI are considerable, the health benefits of dramatic weight loss for very overweight people can be huge. Ten years after surgery for obesity, the average weight loss is about 15 percent. Similar patients treated with standard diets did not lose weight. In fact, they had a two percent weight gain on average. With surgery, one-third of people with type 2 diabetes can achieve normal blood sugars. The problem is that the risks of obesity surgery are also considerable. In the Swedish study, significant complications occurred to 13% of those who had surgery, and the mortality rate was 0.25%. These rates are actually better than those at many hospitals — presumably because centers that are more experienced with these operations have better outcomes. If you decide to undergo surgery for obesity, you should strongly consider choosing a surgeon and a hospital that meet the criteria recently developed by the Betsy Lehman Center for Patient Safety and Medical Error Reduction. These guidelines recommend that the procedures be performed by surgeons who do 50 to 100 cases or more per year, and at hospitals where more than 100 cases are performed annually. There should also be designated teams at the hospital (anesthesia, operating room) focused on weight-loss surgery, and round-the-clock attending physicians on site to cover patients who have these operations. The bottom line: First, do your best to avoid obesity, and to help those in your family do the same. Try to lose weight in the old fashioned ways. But if you are very overweight, surgery can be a solution. The risks of surgery are not trivial, however, and you should do your best to pick a surgeon and a hospital that minimize the chances that you will have complications. Thomas H. Lee, M.D. is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.
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