Benefits of Bariatric Surgery Outweigh Risks in Obese Adults

Bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults, according to a new scientific statement from the American Heart Association (AHA; Dallas, TX, USA).

The AHA statement is a consensus document that provides expert perspective based on the review of recent scientific literature. The statement-writing committee found that, when indicated, bariatric surgery leads to significant weight loss and improvements in the health consequences of being overweight, such as diabetes, high cholesterol, liver disease, high blood pressure, obstructive sleep apnea (OSA) and cardiovascular dysfunction. Recent studies have suggested that bariatric surgery prolongs life in the severely obese, although there is little data on bariatric surgery in certain populations, such as adolescents, even though these patients are already undergoing the procedure at many centers.

However, the surgery has historically carried an operative mortality risk between 0.1% and 2.0%, and complications include pulmonary embolus, anastomotic leaks, bleeding, anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation. Patients must make lifelong behavior changes, such as supplement use, and follow up with the surgical team. The authors find that the value of psychological evaluations and profiles in bariatric surgery cases is uncertain, and suggest that psychological evaluations should assess the behavioral and environmental factors that may have contributed to a patient's obesity, as well as the potential impact on a patient's ability to make the dietary and behavioral changes needed to achieve the best results from surgery.

The scientific statement further suggests some other issues must be researched, such as the impact of bariatric surgery on factors that may regulate appetite such as gastrointestinal peptides, ghrelin, cholecystokinin, and many other neuroendocrine factors that may differ, depending on the surgery approach used. Available data also suggest that procedures performed in centers of excellence do not necessarily yield better outcomes than bariatric procedures performed at lower-volume centers, indicating that the importance of procedure volume and operator expertise needs further study. The statement was published in the March 14, 2011, issue of Circulation.

"Bariatric procedures are generally safe; however, this is not a benign surgery,” said lead author Paul Poirier, MD, PhD, of Laval University Hospital (Quebec City, Canada). "At the moment, bariatric surgery should be reserved for patients who can undergo surgery safely, have severe obesity and have failed attempts at medical therapy.”

Related Links:
American Heart Association
Laval University Hospital