In today's society there is an increasing number of obese people despite
the growing concerns about leading a healthy lifestyle. There are numerous
programs, diets, medications, etc. that have been developed to aid weight
loss efforts and weight maintenance. One field that is being rapidly explored
is methods of surgical treatment for obesity. This paper will explore these
surgical methods. In doing so it is important to also discuss the definition
and measurement of obesity, programs that have been established and claim
to aid weight loss efforts, candidates for this type of treatment, medical
research that has been conducted and the risks involved in this type of
treatment for obesity. The purpose of this paper is to correctly inform
the reader about the claims of surgical treatment and the risks that are
actually involved.
The term obesity is quite difficult to define for the mere fact that humans are highly individualistic and vary in weight and height. Therefore, a standardized definition of obesity is not inclusive. One definition of obesity is "a clinical term for excess body weight generally applied to persons who are 20% or more above a desired weight for height" (Williams, 1992, p.221). Another way to define obesity is simply as an "excess accumulation of body fat" (Perri, Nezu and Viegener, 1992, p.23); however, this definition seems to be simplistic because it does not explicitly determine what the percentage overweight should be in order to define a person as obese. Because there is no standard body weight, overweight is often measured by body mass index (BMI). Body mass index is calculated as follows: BMI=weight(in kilograms)/height in meters squared. A person with a BMI of 27 (20% overweight) is classified as mildly obese. A moderately obese person has a BMI of 30 (40% overweight). A person with a BMI of 35 or greater (100% overweight) is morbidly obese and this is when surgical treatment is a necessary option (Wadden and VanItallie, 1992, p.34).
Clinically severe obesity is a condition that causes people often to
suffer from severe medical problems or death due to their obesity.
Many health complications can occur because of this condition which can
only be alleviated by large amounts of weight loss. Clinically severe obese
people may suffer from one or a combination of the following conditions
and health risks: "increased risk for cardiovascular disease (especially
hypertension), dyslipidemia, diabetes mellitus, gallbladder disease, increased
prevalences and mortality ratios of selected types of cancer, and socioeconomic
and psychosocial impairment" (National Institutes of Health Consensus
Development Conference Statement, March 1991). Because of these risks,
and others, treatment methods of obesity, both surgical and non-surgical,
have been established. Nonsurgical methods of treatment include low calorie
diets, exercise, modification of behavior, and the use of drugs. These
treatments may be explored and utilized, but for some people they prove
to be ineffective methods of treatment for obesity and therefore surgery
becomes a viable option. A conclusion has been drawn that "surgical
techniques offer a wider range of possibilities for treatment than do non-surgical
methods such as behavior modification or drug therapy" (Maxwell, Gazet,
and Pilkington, 1980, p.314).
Numerous programs and products that aid in weight loss and weight management are advertised daily. The purpose of these programs and products is to advertise surgery as a viable option in the treatment of obesity. As examples of the types of programs and products that are advertised and claim to aid in weight loss and weight maintenance, a discussion of the LapBand and LifeLite are necessary. First, the BioEnterics Corporation markets a product called the LapBand. The purpose of this product is to reduce the size of the stomach and therefore one's appetite. This LapBand is fitted to the stomach and "creates a thin canal in the stomach that slows digestion to the remaining portion. It leaves a lingering feeling of fullness when you eat" (http:www.ivanhoe.com/docs/backissues/lapband.html). This company claims that the surgery can be done under general anesthesia and that the patient can return to his or her normal lifestyle within 3 days. However, research has only proven that "patients are generally able to resume work in a few weeks" (Bray, 1980, p. 108). The company also claims that patients lose 10 pounds in a month. The only evidence they use to establish effectiveness of this product is former patient success stories. They do not use any medical research to back up their claims about the effectiveness of their product and in fact they do state that the product is going through Food and Drug Administration trials. Therefore the product has not yet been approved. It is clear from this advertisement that the company's goal is merely to create profit, and not to benefit those in need of help to treat obesity.
Another example is a program called LiteLife. This is a comprehensive
weight loss program that consists of "medical evaluations, a surgical
procedure known as gastroplasty, or "stomach stapling", nutritional
guidance, exercise guidelines, and behavioral modification, all with LiteLife
team support and counseling" (http:www.commpro.com/thin/obesity.html).
This program combines both the surgical and non-surgical methods of treatment
for obesity to obtain weight loss. The advertisement of this program discusses
its success stories, the surgical procedure, its staff and support team,
and other issues as a means for luring possible patients. They set guidelines
for candidacy, as well. One claim they make is that a candidate must be
at least 75 pounds overweight, but morbid obesity has been defined as 100%
or 100 pounds overweight. Therefore, this guideline suggests that in order
to qualify for this program, a person does not have to meet the criteria
of being morbidly obese. Therefore, patients accepted into this program
could be undergoing surgery for obesity treatment prematurely which may
have extreme complications in the long run. The advertisement for the LifeLite
program discuss the risks involved with being obese, but never discusses
the risks that are actually involved in surgical treatment of obesity.
The only evidence they use to support their claims are the success stories
of past patients. Again, this program is clearly a profit making endeavor.
There are two commonly practiced surgical procedures for the treatment
of obesity, vertical banded gastroplasty and Roux-en-Y gastric bypass.
(For figures see http://www.commpro.com/thin/surgery.html)
In 1991, the National Institute of Health concluded that "the surgical
procedures currently in use (gastric bypass and vertical banded gastroplasty)
are capable of inducing significant weight loss in severely obese patients,
and in turn, have been associated with amelioration of most of the comorbid
conditions that have been studied" (http:www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm).
Vertical banded gastroplasty involves "constructing a small pouch
with a restricted outlet along the lesser curvature of the stomach. The
outlet may be externally reinforced to prevent disruption or dilation"
(National Institutes of Health Consensus Development Conference Statement,
March 1991, p.3). The gastric bypass procedure involves "constructing
a proximal gastric pouch whose outlet is a Y-shaped limb of small bowel
of varying lengths" (National Institutes of Health Consensus Development
Conference Statement, March 1991, p. 3). Both the National Institutes of
Health Consensus Development Conference participants and the Ohio State
University Department of surgery prefer gastric bypass surgery over vertical
banded gastroplasty because it has "greater weight loss and better
long term weight maintenance" (http://www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm
and http://text.nlm.nih...ww/84txt.)
Not everyone who is obese should utilize the surgical methods of treatment.
In order to determine candidacy for this method of treatment, the risks
involved for each individual need to be reviewed and assessed. Standard
procedure for choosing a candidate requires that a person have a BMI of
above 40, although patients with a BMI below 40 and extreme comorbid conditions
may also be selected for surgical treatment (National Institutes of Health
Consensus Development Conference Statement, March 1991, p.3). In 1985,
guidelines were set by a Task Force of the American society of Clinical
Nutrition to determine candidacy for surgery. The guidelines state that
a patient should have "an actual body weight that is either 100 pounds
or 100 percent over ideal weight, serious medical conditions and a history
of substantial obesity despite attempts at weight reduction"(Perri
et al, 1992, 73). These guidelines are inclusive and suggest that surgery
should be used as a last resort after all other options have been exhausted.
The risks involved in this type of treatment are both short and long
term, pre- and post-operative. Reoperation is one risk and can be necessary
due to "pouch and distal esophageal dilation, persistent vomiting,
cholecystitis, or failure to lose weight" (http://text.nlm.nih...ww/84txt.).
Consequently, reoperation has a higher mortality and morbidity rates than
primary operations. ( http://text.nlm.nih...ww/84txt.)
Other risks include micronutrient deficiencies but are treatable. A
person must also consider how this surgery will affect his or her life
due to side effects of the surgery and the changing body image one may
encounter. (National Institutes of Health Consensus Development Conference
Statement, March 1991, p.5) Depression is another risk that is involved
in this type of surgery. Death is a risk, as it is in all surgeries, but
only occurs in one out of one hundred patients (http://www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm)
Other risks involved in the surgical treatment of obesity are leakage through
the incision, infection, bleeding, heart and/or lung problems, blockage
of the intestines, and general health risks associated with the surgery
(http://www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm).
Surgical treatment for obesity is a common practice and procedure, but
one that involves many risks. Mason et al. (1987) found that gastric bypass
surgeries took longer and resulted in a higher infection rate than the
gastroplasty procedures. Both types of surgery were longer and had higher
infection rates for patients with super versus morbid obesity. The overall
morality rate was 0.4%. They also found that weight loss achieved with
the gastroplasty was slightly less than that obtained with gastric bypass.
As with any type of treatment, surgery should be used only when all other
options have been exhausted. Surgery is the best treatment found for obtaining
massive weight loss, but no treatment is a safe and reliable way of producing
large and lasting weight loss ( Perri et al., 1992, p.78). Products and
programs should not be used unless thoroughly researched and proven to
undoubtedly produce safe and lasting results. As of this time, no treatment,
surgical or non-surgical, for obesity has been proven safe and effective.
Bray, M.D. George. (1980). Obesity. London: Libbey and Company.
Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement
1991, March 25-27; 9(1):1-20.
Mason, E.E., Doherty, C., Maher, J.W., Scott, D.H., Rodriguez, E.M.
and Blommers, T.J. (1987). Super obesity and gastric reduction procedures.
Gastroenterology Clinics of North America, 16, 495-502.
Perri, Michael G., Nezu, A.M., and Viegener, B.J. (1992). Improving
the Long Term Management of Obesity. New York: Wiley.
Wadden, T.A. and VanItallie, T.B. (1992). Treatment of the Seriously
Obese Patient. New York: Guilford Press.
Williams, Sue R. (1992). Basic Nutrition and Diet Therapy. St.
Louis: Mosby-Year Book, Inc.
http://www.commpro.com/thin/obesity.html
http://www.commpro.com/thin/surgery.html
http://www.ivanhoe.com/docs/backissues/lapband.html
http://www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm
http://text.nlm.nih...ww/84txt.
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