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American Medicine

Obesity is an epidemic in America. The frequency of gastric bypass surgery is increasing. Insurance companies are more frequently paying for gastric bypass surgery, since the insurance companies recognize that treating the American epidemic of obesity is very important.

In an important article, T. Adams and co-workers (JAMA 2012; 308:1122) evaluated over 1,000 severely obese patients who had either received gastric bypass surgery, or did not have the surgery. Patients who had gastric bypass surgery had 62% remission of diabetes compared to 6-8% in patients who did not have surgery. Furthermore, patients in the surgical group with gastric bypass surgery had better weight loss with 94% maintaining at least a 20% weight loss two to six years after surgery.  The amount of weight loss was 28% for those who had gastric bypass surgery compared to only 0.2% in those who did not have surgery.  These excellent results indicated that gastric bypass surgery was beneficial.

However, in that study, hospitalizations were more frequent in patients who had surgery, 8%, compared to 2 to 4% in patients without surgery.  In another study, Dr. M. Neovius and co-workers (JAMA 2012; 308: 1132) found that the patients who had gastric bypass surgery or gastric banding had higher use of both inpatient and outpatient care during the first six years after surgery compared to those patients who did not have surgery.  However, costs of drugs to treat the complications of obesity between years 7 and 20 after surgery were lower for the surgery patients then for patients who did not have any surgery.

Furthermore, some patients who have had gastric surgery have uncomfortable complications, being unable to eat satisfactorily and have greater food intolerance rates.

If you are obese, here are my tips for you:

• Take steps with your physician to prevent worsening of obesity and to attempt to lose weight and reduce the side effects of obesity.
• Discuss with your physician whether diet, exercise, medications or even surgery would be appropriate.
• Discuss the possible benefits of surgery, as well as the risks of surgery.
• If necessary a second opinion should be obtained if you are not loosing weight, or if all your questions are not being answered.

For more information about how to discuss these issues with your physician, see Chapter 7 “Communicating with Your Doctor” and Chapter 11 “Getting the Right Answers: Key Questions For Your Doctor” in my new book Surviving American Medicine.