Fwd: >OSSG_Moderator< Digest Number 535

January 5, 2006

Note: forwarded message attached. Huggles!! Open RNY: 08/19/03 Starting Weight: 315 Current: 160 Goal: 135 "Its not how many breaths you take each moment, but how many moments take your breath away"

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1. AP Story: As obesity surgery soars, patients weigh which method is best

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Message: 1

Date: Wed, 4 Jan 2006 11:07:44 -0500

Subject: AP Story: As obesity surgery soars, patients weigh which method is best

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DIET: As obesity surgery soars, patients weigh which method is best

2006 January 01

By By MARILYNN MARCHIONE (AP Medical Writer)

MILWAUKEE - As more people abandon New Year's resolutions to lose weight and

turn to obesity surgery, doctors are debating which type is safest and best.

And researchers are uncovering some surprising trends.

The most common method in the United States - gastric bypass, or

stomach-stapling surgery - may be riskier than once thought. Yet surgeons

still favor it for people who need to lose weight fast because of heart

damage or other serious problems.

A gentler approach favored in Europe and Australia - an adjustable stomach

band - can give long-term results that are almost as good and with far fewer

risks. It may be the best option for children or women contemplating

pregnancy, and is reversible if problems develop.

A radical operation - cutting away part of the stomach and rerouting the

intestines - is increasingly being recommended for severely obese people. It

gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three

options.

But regardless of which method is used, studies show an inescapable reality:

No surgery gives lasting results unless people also change eating and

exercising habits.

" The body just has many ways of compensating, even after something as

drastic as surgery, " said Dr. Louis Aronne, director of the weight loss

program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in

bariatrics, as this field is known. The group's recent annual conference in

Vancouver featured many studies on surgery's long-term effects.

Obesity is a problem worldwide. About 31 percent of American adults - 61

million people - are considered obese, with a body-mass index of 30 or more.

That's based on height and weight. Someone who is 5 feet, 4 inches

(1.63meters) is obese at 175 pounds (79 kilograms); 222 pounds (100

kilograms)

does it for a 6-footer (1.83-meter person).

Federal guidelines say surgery shouldn't be considered unless someone has

tried conventional ways to shed pounds (kilograms) and is at least 100

pounds (45 kilograms) over ideal weight, or has a BMI over 40, or a BMI over

35 plus a weight-related medical problem like diabetes or high blood

pressure.

More people are meeting those conditions. A decade ago, less than 10,000

such surgeries were done in the United States. That ballooned to 70,000 in

2002 and more than 170,000 in 2005, says the American Society for Bariatric

Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y

gastric bypass, or the adjustable band, which is rapidly gaining fans.

Either can be done through a big incision, or laparoscopically with tiny

instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the stomach

and connected to the small intestine. People eat less because the pouch

holds little food, and they absorb fewer calories because much of the

intestine is bypassed. They must take protein and vitamin supplements to

prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far

longer in Europe and Australia where it is dominant. It accounted for 17

percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to

tighten it and restrict how much food can enter and pass through the

stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent

for gastric bypass. One recent study of Medicare patients found deaths a

year after gastric bypass as high as 3 to 5 percent.

The band's reversibility makes it a better choice for children, some doctors

say.

" It's becoming more well-known and more accepted. Patients like it because

it's less invasive. It's an easier surgical procedure. It's safer, " said

ann Mallory, executive director of the bariatric society.

" To me it is a very straightforward decision, " said Dr. O'Brien,

director of the Centre for Obesity Research and Education at Monash

University in Melbourne, Australia. " I would strongly recommend that the

consumer consider the safest effective procedure first, " which is the band,

he said.

American doctors have preferred bypass operations because they produce

faster, greater weight loss. But new research by O'Brien and others calls

that into question.

Combining results on 23,638 patients in 43 published studies, they found

that bypasses beat bands for the first three years but were comparable after

seven years, with excess weight loss of 55 percent for bypass and 51 percent

for bands.

That impressed Dr. Livingston, chief of gastrointestinal surgery at

the University of Texas Southwestern Medical Center and chief of bariatric

surgery for the Department of Veteran's Affairs national system.

" I really was not enthusiastic about bands until I came to Dallas from Los

Angeles and saw the results from the group that I joined, which where quite

good, " he confessed. " What you can accomplish in a year with a gastric

bypass you can accomplish in five years with a laparoscopic band. "

Results would improve if Americans copied the Australians and included in

the price of the band any future adjustments, Livingston said.

" A key to the success of banding procedures is the followup and working with

a patient on their compliance, " he said. " When they come in and they've sort

of fallen off the wagon, you adjust the band. It really has an amazing

effect. "

Bands also appear safer for women attempting pregnancy. Several years ago in

Massachusetts, a woman and her 8-month-old fetus died of complications 18

months after gastric bypass surgery. Other pregnancy-related deaths have

been reported.

In contrast, another study O'Brien and colleagues presented at the obesity

meeting found that pregnancy outcomes for women with stomach bands were

comparable to normal-weight women, and better than for obese women without

bands.

Dr. Roslin, chief of obesity surgery at Lenox Hill Hospital in New

York City, did a band operation in October for Long Islander Donna Dotzler,

who weighed 279 pounds (126 kilograms), but wants to do a more drastic

surgery for her husband.

" I gave up on New Year's resolutions maybe five years ago, " said Jim

Dotzler, who weighs 479 pounds (216 kilograms). " I'm a smart guy. If this

were a matter of willpower, I'd have taken care of this a long time ago. "

The operation Roslin has advised for him is BPD, which stands for

biliopancreatic diversion, with or without a second procedure called a

duodenal switch. Studies show it can cause loss of up to 80 percent of

excess body weight for at least as long as 10 years afterward.

Surgeons remove three-fourths of the stomach to leave a sleeve- or

banana-shaped organ that is connected to the small intestine, bypassing more

of it than a standard gastric bypass does. It can be done in two operations

a year apart to reduce its severity and the chances of death, which can be

as high as 5 percent.

The " switch " preserves a valve that controls release of food into the

intestines from the stomach. These operations account for nearly 5 percent

of U.S. obesity surgeries and are growing.

On the horizon are other approaches, like vagus nerve stimulation, to

control impulses to eat, and new drugs like rimonabant, which blocks a

pleasure center in the brain that makes people want to munch.

" I see the future as combined therapy, " with surgery, medication and other

approaches used simultaneously, said Aronne, the obesity society president.

" Time will tell what works out best. "

---

On the Net:

Surgery explainer: http://win.niddk.nih.gov/publications/gastric.htm

American Society for Bariatric Surgery: http://www.asbs.org

American Obesity Association: http://www.obesity.org

The Obesity Society: http://www.naaso.org

Body Mass Index calculator:

http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.Engl ish

material may not be published, broadcast, rewritten, or redistributed.*

January 5, 2006