DrTed home page Site Additions Invisalign Info Menu Orthodontic Jaw Wiring Arrange a Consultatation Lingual braces
NEW YORK TIMES: Sunday November 24, 2002, Editorial Page
Surgery to treat severe obesity is expanding at a rapid rate, and no wonder. Although gastrointestinal surgery is a last-ditch remedy, it is the only proven technique for taking off lots of weight and keeping it off lots of weight and keeping it off. That can be a boon for some super-heavy patients, but it is a sad commentary on the failure of medical science to find a less drastic approach to the nationís bulging weight problem.
Congressman Jerrold Nadler and the NBC weatherman Al Roker are the latest obese celebrities to reveal that they turned to surgery after years of failing to lose weight on one diet after another. Mr. Nadler, who peaked at 338 pounds, has dropped more than 60 pounds since his surgery in August. Mr. Roker, who peaked at 320 pounds, has lost more than 100 pounds since his operation in March. Both hope to shed far more weight and end up in the normal range for their heights.
There are two main types of obesity surgery. One approach uses staples or bands to section off a small pouch in the stomach, limiting the amount of food that can be eaten at one time. The other approach combines stomach restriction with a partial bypass of small intestine to reduce the area for absorbing calories and nutrients. Both operations lead to weight loss in almost all patients, but the combined approach is more effective.
Patients who have the most popular intestinal bypass operation typically lose a huge amount of weight in the first two years, regain some of it and then stabilize. One study showed an average weight loss after 14 years of 100 pounds, more than half the average patientís excess weight. An analysis by researchers at Dartmouth Medical School found that the gastric bypass operation could increase life expectancy by two to three years on average.
Buoyed by these successes, the volume of operations in this country has tripled in recent years, from fewer than 20,000 in 1995 to an estimated more than 60,000 this year. The surge is fueled by the rising number of obese Americans, improved surgical techniques, celebrity testimonials and an increasing willingness by insurance plans to pay for the surgery as a cheaper alternative to treating the ailments associated with gross obesity. The operations typically cost $20,000 or more.
But both kinds of operations carry risks, killing one in every 100 to 200 patients by some estimates. Many patients develop nutritional deficiencies or require follow-up surgery. And even after shedding a lot of pounds, many patients remain far above their ideal weights. The operation is recommended only for those who are severely obese (100 pounds overweight for men, 80 pounds for women) or slightly less obese with complicating conditions like diabetes. Surgery is a last resort for those who simply cannot take the weight off any other way. A better solution, perhaps a new miracle pill, will require a better understanding of the biological roots of extreme obesity.
November 20, 2002