STOMACH STAPLING:

SURGICAL TREATMENT FOR OBESITY

Melissa Machen




Index - click to read a topic

Obesity: Definitions and Measurement
Health Risks of obesity
Surgical Programs and Products for Treatment of obesity
Surgical Procedures for the Treatment of Obesity
Candidates for Surgical Treatment of obesity
Risks Involved in the Surgical Treatment of Obesity
Conclusions
References

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.

Obesity: Definition and Measurement

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).

Health Risks of Obesity

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).

Surgical Programs and Products for Treatment of Obesity

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.

Surgical Procedures for the Treatment of Obesity

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.)

Candidates for Surgical Treatment of Obesity

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.

Risks Involved in the surgical Treatment of Obesity

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).

Conclusions

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.







Bibliography

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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