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Surgery Can Help Control Obesity

Date: Monday, October 24, 2005

Source: The Times

Operations to staple, strap, bypass or even remove parts of the stomach really do work for the morbidly obese, according to a comprehensive review of the subject.

Patients typically lose 100lb (45.5kg) after these operations, and in the majority, symptoms of type 2 diabetes completely disappear. So while such operations may appear to be a last resort, they are effective.

Some can be done by keyhole procedures and have a low death rate, and while others are more major operations with death rates of about 1 per cent, this compares favourably with the death rate from diabetes.

In Journal of the American Medical Association, a team led by Dr Henry Buchwald, of the University of Minnesota, reviewed 136 studies into the results of bariatric surgery, the panoply of techniques that surgeons have developed for treating the 5 per cent of the US population that is morbidly obese.

The most common of the operations are gastric banding or gastric bypass. In banding, a hollow elastic band is inserted by keyhole surgery around the stomach and tightened, dividing the stomach into a small pouch above the band and a larger one below.

The size of the passage between the divisions can be controlled by injecting saline solution into the band. The small upper pouch can take less food, leading to a sense of fullness after eating less.

A gastric bypass takes the process a step further, by attaching the small intestine directly to the upper pouch, allowing food to bypass the lower stomach and the first two parts of the small intestine, thereby reducing food absorption.

The study shows that patients given gastric banding typically lose just under 50 per cent of their excess weight; with a gastric bypass this increases to 62 per cent; and with more invasive procedures still, such as removing parts of the stomach, 68 per cent.

Diabetes was completely resolved in 77 per cent of patients, and resolved or improved in 86 per cent. High blood fat levels were lowered in 70 per cent, and high blood pressure resolved in 62 per cent. Such surgery is available from some surgeons in the NHS and in the private sector. The review suggests that its benefits are real.

Nigel Hawkes