FW: Seattletimes.com: Weight-loss surgery means weighing risks

[Guest guest]

Weight-loss surgery means weighing risks

Full story:

http://seattletimes.nwsource.com/html/localnews/134644627_obeserisks03m0.html

By Sommerfeld

Seattle Times staff reporter

With her 30th birthday looming, Marla decided to take control of her

lifelong weight problem once and for all. So she booked an appointment with a

Bellevue surgeon to discuss gastric bypass surgery.

When the Enumclaw woman, beaming with excitement, walked into a support group

where prospective patients meet surgical success stories, she imagined the

procedure would answer her prayers. Eyeing the group's leader, a spiky-haired

woman who dropped from size 28 to size 2 in 20 months, envisioned shedding

100 pounds from her more than 250-pound frame.

She was startled from her reverie when, like vets trading battle tales, patients

began sharing their most repellent postsurgery stories: vomiting, diarrhea,

wound infections, hernias and hair falling out in clumps.

This was far from the glamour had expected.

" My mind was pretty much made up to do the surgery, but then what they said

settled in and scared me. I don't want to be sick like that, " she said after

changing her mind the next day.

And with the surgery's risk of death estimated at one to two per 200 patients,

, the mother of a toddler and an 8-year-old, says that's a risk she just

can't take.

" A family member said to me, 'You are really willing to leave behind two

children to be thin?' That was a real eye-opener, " she says.

For now, says, she plans to put some miles on the treadmill.

Online resources

& #149; and Leo Loos, who both underwent gastric bypass surgery recently,

are chronicling their experience: www.jeleo.com

& #149; American Society for Bariatric Surgery: www.asbs.org

& #149; Evergreen Morbid Obesity Surgery Support group (EMOSS): www.emoss.info

& #149; More resources: www.obesityhelp.com " I need to get weight off, but this

wasn't the answer I thought it was, " she says. " If I were 500 pounds and

couldn't get out of bed, then maybe, but I'm not to that point. I'm still

healthy and mobile, so there's no point to risk it right now. "

For many people considering obesity surgery, before-and-after photos speak much

louder than complication checklists.

With the popularity of the drastic operation soaring across the nation, critics

are concerned that its risks are being overlooked. Advocates counter that the

far greater risk is remaining obese.

Gastric bypass, so named because it reroutes part of the small intestine around

much of the stomach, is done through a long incision down the abdomen or

sometimes through a small puncture with a scope. The upper stomach is closed off

with staples, reducing the functioning stomach from the size of a football to a

shot glass. The small intestine is cut from below the original stomach and

reconnected to the upper pouch.

Pounds melt off for most patients because the new, tiny stomach fills with just

a few bites, and because food travels a shorter digestive route & #151; skipping

the lower stomach and upper small intestine & #151; so less of it is digested and

absorbed by the body.

Other weight-loss surgeries involve constricting the stomach with an adjustable

silicone band or bypassing most of the small intestine. But gastric bypass

surgery, considered the gold standard, is the most popular form of obesity

surgery.

The National Institutes of Health has embraced the operation as the only

consistently effective method of weight loss for people who are morbidly obese,

or at least 100 pounds overweight.

Yet the American Society for Bariatric Surgery estimates one in 200 patients

dies from the surgery. Dr. E. Patchen Dellinger, chief of general surgery at the

University of Washington Medical Center, says he surveyed Washington surgeons

and found the risk to be about double that, or one in 100.

Either way, the rate is significantly higher than that for most elective

surgeries. For instance, liposuction carries a one-in-47,000 risk of death.

Gastric bypass is about as dangerous as gallbladder surgery but three times

safer than a heart bypass.

anne Bodolay, director of the National Association to Advance Fat

Acceptance, questions why surgeons are willing to operate for weight loss even

while refusing to perform other operations on obese people because they deem

them too risky.

About 7 percent of gastric-bypass patients suffer from complications, including

infections, blood clots that travel to the lungs, respiratory failure and

hernias, and many require second or third operations. One in three develops

gallstones caused by rapid weight loss and needs gallbladder surgery. Each of

those additional surgeries multiplies the risks.

Even for those who get through the operation relatively unscathed, it's not

easy. Many vomit several times a day for the first couple of months, and 30

percent suffer from nutritional deficiencies such as anemia because their bodies

aren't absorbing enough vitamins and minerals; they must take supplements the

rest of their lives.

Another common side effect of surgery & #151; one that particularly repelled

& #151; is known as dumping syndrome. When some people who've had the

surgery eat refined sugars and starches such as chocolate or pasta, the food

flies into the small intestine too quickly, causing an episode of sweating,

nausea, heart palpitations and sometimes diarrhea. Some patients embrace the

effect because it compels them to avoid junk food.

Possible complications,side effects

Anemia/nutritional deficiencies

Wound infection or re-opening

Gastrointestinal leak

Respiratory difficulties or failure

Gallstones

Injury to the spleen

Blood clots in leg veins, clots traveling to lungs

Stomach obstruction or narrowing

Breakdown of staples

Persistent vomiting, diarrhea

Dehydration

Infection of body cavity

Ulcers

Acid reflux

HerniaAfter going through all that, about 10 to 15 percent of patients don't

lose much weight or gain it back quickly. And for many, the pounds start

creeping back after a couple of years.

" It's important people be realistic, " Dellinger says. " Most people who are

operated on lose a lot of weight but still end up heavy. If they lose one-third

of their weight, they may still end up at 200 pounds. "

If most people aren't going to shrink down to their dream weight, and the

surgery carries such serious risks, why do it?

It's not a cosmetic procedure, it's a life-saving one, says Dr. Thirlby,

who performs about 120 gastric-bypass surgeries per year at Virginia Mason

Medical Center.

" Ideal body weight is not a term conceived by Cosmopolitan magazine, " he says.

" It's from life-insurance companies who found when you get above that, people

don't live as long. "

Government guidelines approve the surgery only for the morbidly obese & #151;

that's 6 million Americans & #151; and those who aren't quite as heavy but have

serious obesity-related health problems.

Because they are at much higher risk for a variety of health conditions,

including heart disease, diabetes and sleep apnea, severely obese people have a

fourfold higher risk of dying, Thirlby says.

Ernsberger, a professor of nutrition at Case Western Reserve University in

Cleveland, says the surgery's proponents have exaggerated the risk of obesity.

Morbid obesity takes seven to 10 years off someone's life expectancy, he says,

so they'll die in their late 60s rather than their 70s.

" A typical patient is a 30-year-old woman, so if she doesn't have surgery now

she will likely live another 30 years. But she's treated as if she's going to

die any minute, " he says.

Plus, he says, all of the diseases associated with obesity have effective

treatments. " So what they're really saying is it's better to have your

intestines rearranged and throw up several times a week than to take pills for

blood pressure or diabetes. "

But Dr. Atkinson, president of the American Obesity Association, says

that such arguments ignore the tremendous emotional pain of obesity.

He cites a decade-old study in which researchers posed a series of

" would-you-rather " questions to four dozen people who had lost more than 100

pounds through surgery. They found 100 percent of patients said they would

prefer to be deaf than their previous weight, 91.5 percent would rather have a

leg amputated and nearly 90 percent would rather be blind.

" Can you imagine how painful it is to be fat in America, so that 89 percent of

people would rather be blind? " he says. " For people who have that kind of pain,

the risks of obesity surgery are well worth it. "

Sommerfeld: or jsommerfeld@...

Copyright © 2002 The Seattle Times Company

www.seattletimes.com

Your Life. Your Times.

[Guest guest]

Weight-loss surgery means weighing risks

Full story:

http://seattletimes.nwsource.com/html/localnews/134644627_obeserisks03m0.html

By Sommerfeld

Seattle Times staff reporter

With her 30th birthday looming, Marla decided to take control of her

lifelong weight problem once and for all. So she booked an appointment with a

Bellevue surgeon to discuss gastric bypass surgery.

When the Enumclaw woman, beaming with excitement, walked into a support group

where prospective patients meet surgical success stories, she imagined the

procedure would answer her prayers. Eyeing the group's leader, a spiky-haired

woman who dropped from size 28 to size 2 in 20 months, envisioned shedding

100 pounds from her more than 250-pound frame.

She was startled from her reverie when, like vets trading battle tales, patients

began sharing their most repellent postsurgery stories: vomiting, diarrhea,

wound infections, hernias and hair falling out in clumps.

This was far from the glamour had expected.

" My mind was pretty much made up to do the surgery, but then what they said

settled in and scared me. I don't want to be sick like that, " she said after

changing her mind the next day.

And with the surgery's risk of death estimated at one to two per 200 patients,

, the mother of a toddler and an 8-year-old, says that's a risk she just

can't take.

" A family member said to me, 'You are really willing to leave behind two

children to be thin?' That was a real eye-opener, " she says.

For now, says, she plans to put some miles on the treadmill.

Online resources

& #149; and Leo Loos, who both underwent gastric bypass surgery recently,

are chronicling their experience: www.jeleo.com

& #149; American Society for Bariatric Surgery: www.asbs.org

& #149; Evergreen Morbid Obesity Surgery Support group (EMOSS): www.emoss.info

& #149; More resources: www.obesityhelp.com " I need to get weight off, but this

wasn't the answer I thought it was, " she says. " If I were 500 pounds and

couldn't get out of bed, then maybe, but I'm not to that point. I'm still

healthy and mobile, so there's no point to risk it right now. "

For many people considering obesity surgery, before-and-after photos speak much

louder than complication checklists.

With the popularity of the drastic operation soaring across the nation, critics

are concerned that its risks are being overlooked. Advocates counter that the

far greater risk is remaining obese.

Gastric bypass, so named because it reroutes part of the small intestine around

much of the stomach, is done through a long incision down the abdomen or

sometimes through a small puncture with a scope. The upper stomach is closed off

with staples, reducing the functioning stomach from the size of a football to a

shot glass. The small intestine is cut from below the original stomach and

reconnected to the upper pouch.

Pounds melt off for most patients because the new, tiny stomach fills with just

a few bites, and because food travels a shorter digestive route & #151; skipping

the lower stomach and upper small intestine & #151; so less of it is digested and

absorbed by the body.

Other weight-loss surgeries involve constricting the stomach with an adjustable

silicone band or bypassing most of the small intestine. But gastric bypass

surgery, considered the gold standard, is the most popular form of obesity

surgery.

The National Institutes of Health has embraced the operation as the only

consistently effective method of weight loss for people who are morbidly obese,

or at least 100 pounds overweight.

Yet the American Society for Bariatric Surgery estimates one in 200 patients

dies from the surgery. Dr. E. Patchen Dellinger, chief of general surgery at the

University of Washington Medical Center, says he surveyed Washington surgeons

and found the risk to be about double that, or one in 100.

Either way, the rate is significantly higher than that for most elective

surgeries. For instance, liposuction carries a one-in-47,000 risk of death.

Gastric bypass is about as dangerous as gallbladder surgery but three times

safer than a heart bypass.

anne Bodolay, director of the National Association to Advance Fat

Acceptance, questions why surgeons are willing to operate for weight loss even

while refusing to perform other operations on obese people because they deem

them too risky.

About 7 percent of gastric-bypass patients suffer from complications, including

infections, blood clots that travel to the lungs, respiratory failure and

hernias, and many require second or third operations. One in three develops

gallstones caused by rapid weight loss and needs gallbladder surgery. Each of

those additional surgeries multiplies the risks.

Even for those who get through the operation relatively unscathed, it's not

easy. Many vomit several times a day for the first couple of months, and 30

percent suffer from nutritional deficiencies such as anemia because their bodies

aren't absorbing enough vitamins and minerals; they must take supplements the

rest of their lives.

Another common side effect of surgery & #151; one that particularly repelled

& #151; is known as dumping syndrome. When some people who've had the

surgery eat refined sugars and starches such as chocolate or pasta, the food

flies into the small intestine too quickly, causing an episode of sweating,

nausea, heart palpitations and sometimes diarrhea. Some patients embrace the

effect because it compels them to avoid junk food.

Possible complications,side effects

Anemia/nutritional deficiencies

Wound infection or re-opening

Gastrointestinal leak

Respiratory difficulties or failure

Gallstones

Injury to the spleen

Blood clots in leg veins, clots traveling to lungs

Stomach obstruction or narrowing

Breakdown of staples

Persistent vomiting, diarrhea

Dehydration

Infection of body cavity

Ulcers

Acid reflux

HerniaAfter going through all that, about 10 to 15 percent of patients don't

lose much weight or gain it back quickly. And for many, the pounds start

creeping back after a couple of years.

" It's important people be realistic, " Dellinger says. " Most people who are

operated on lose a lot of weight but still end up heavy. If they lose one-third

of their weight, they may still end up at 200 pounds. "

If most people aren't going to shrink down to their dream weight, and the

surgery carries such serious risks, why do it?

It's not a cosmetic procedure, it's a life-saving one, says Dr. Thirlby,

who performs about 120 gastric-bypass surgeries per year at Virginia Mason

Medical Center.

" Ideal body weight is not a term conceived by Cosmopolitan magazine, " he says.

" It's from life-insurance companies who found when you get above that, people

don't live as long. "

Government guidelines approve the surgery only for the morbidly obese & #151;

that's 6 million Americans & #151; and those who aren't quite as heavy but have

serious obesity-related health problems.

Because they are at much higher risk for a variety of health conditions,

including heart disease, diabetes and sleep apnea, severely obese people have a

fourfold higher risk of dying, Thirlby says.

Ernsberger, a professor of nutrition at Case Western Reserve University in

Cleveland, says the surgery's proponents have exaggerated the risk of obesity.

Morbid obesity takes seven to 10 years off someone's life expectancy, he says,

so they'll die in their late 60s rather than their 70s.

" A typical patient is a 30-year-old woman, so if she doesn't have surgery now

she will likely live another 30 years. But she's treated as if she's going to

die any minute, " he says.

Plus, he says, all of the diseases associated with obesity have effective

treatments. " So what they're really saying is it's better to have your

intestines rearranged and throw up several times a week than to take pills for

blood pressure or diabetes. "

But Dr. Atkinson, president of the American Obesity Association, says

that such arguments ignore the tremendous emotional pain of obesity.

He cites a decade-old study in which researchers posed a series of

" would-you-rather " questions to four dozen people who had lost more than 100

pounds through surgery. They found 100 percent of patients said they would

prefer to be deaf than their previous weight, 91.5 percent would rather have a

leg amputated and nearly 90 percent would rather be blind.

" Can you imagine how painful it is to be fat in America, so that 89 percent of

people would rather be blind? " he says. " For people who have that kind of pain,

the risks of obesity surgery are well worth it. "

Sommerfeld: or jsommerfeld@...

Copyright © 2002 The Seattle Times Company

www.seattletimes.com

Your Life. Your Times.