SALT LAKE CITY — Diet and exercise alone may not be enough to help people who are severely overweight.
A Utah-based study, and one of the first of its kind in the U.S., has shown that, for severely obese individuals — those with a body mass index greater than 35 — gastric bypass surgery can lead to long-term health benefits that may be unobtainable with just making lifestyle changes.
"We know that with gastric bypass surgery, patients lose a substantial amount of weight," said Dr. Ted Adams, lead author of the study, and research and clinical director for the Intermountain Health and Fitness Institute at LDS Hospital.
Patients typically lose an average of 100 pounds and after two years, a previous study indicated that patients maintained a loss of about 35 percent of that initial weight.
A success story
- More than one-third of all adults in America are obese
- Obesity is a factor in some of the leading causes of preventable death, including heart disease, stroke, Type 2 diabetes and certain types of cancer
Chris Stevenson is a bariatric patient who found similar success. He realized he needed help four years ago when he weighed 270 pounds and had type 2 diabetes.
"(I) was taking insulin," Stevenson said. "Three, four times a day you're poking yourself with a needle to do blood sugar readings. That got old real quick."
After extensive research and consultation with his doctors, Stevenson decided to undergo gastric bypass surgery — mainly to cure his diabetes.
"I have never had one drop of medication, (and) no insulin, since that operation," he said.
"When your blood sugars are not managed properly, down the road you pay a pretty heavy price for having diabetes," Stevenson added.
Doctors have been performing bariatric surgery since the late ‘70s, but no studies followed patients long term. Dr. Ted Adams led this new study with Utah gastric bypass patients — the first comprehensive long-term follow up study of its kind in the United States.
Surgical patients maintained a loss of an average of 34.9% of their initial weight even two years after the procedure. They kept off an average of 27.7% six years later.
The study found that gastric bypass surgery was effective in maintaining weight loss, as surgical patients maintained a loss of an average of 34.9 percent of their initial weight even two years after the procedure. They kept off an average of 27.7 percent six years later, Adams said.
"When they engage in lifestyle approaches like exercise and diet, although that's beneficial to their health, those approaches are generally not very successful long-term," Adams said.
The risks involved
While the surgery has documented benefits, there are also substantial risks. Wanda Taylor's husband,Travis, lost 170 pounds after having gastric bypass surgery in 1993. He kept the weight off, but died in 2008.
"It altered his ability to eat a lot of foods," Taylor said. "He couldn't eat meat very well. He would eat it, and he would throw it up."
Travis damaged his knee in a coal mining accident and slowly grew to 470 pounds. Doctors wouldn't do knee replacement surgery until he lost the weight.
- 418 had Roux-en-Y gastric bypass surgery
- 417 were seeking to have it, but didn't mostly because their insurance wouldn't cover it
- 321 were not seeking to have surgery
"Because we had tried so many things before, … we made the decision to go ahead and do this (bariatric surgery) to lose weight," Taylor said.
She said her husband had other health problems, such as rheumatoid arthritis, high blood pressure, and gout. After the two surgeries, he couldn't stay active and didn't get the proper nutrition.
"I just think (patients) need to be well-informed, and I don't think we were," Taylor said. "I think the medical personnel that worked with us failed us in the regard."
While the surgery has substantial benefits, Adams agreed there are risks, and the possibilities of infection and even death should also be considered. Patients must also be committed to following a regimented balanced diet and be willing to participate in regular physical exercise for the best outcomes.
"After the surgery, you are limited in the volume of food you can eat … forever," he said.
The Swedish Obese Subjects study is the only other study available that follows patients longer, but it includes primarily gastric banding patients and only a small percentage of those who had gastric bypass surgery, Adams said. He has received funding from the National Institutes of Health to continue his research and will apply for funding yet again in four years.
"The longer, the better," Adams said. "It gives patients and physicians more information with which to make their decisions. And it is a big decision, one that needs to be weighed out. It's a major surgery. It's a major change in lifestyle. And it is expensive."
Further research on gastric bypass surgery, which is one of the most popular procedures conducted worldwide, may have an impact on insurance coverage, making the surgery available to a larger percentage of individuals.