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November 2007

Bariatric Surgery Leads to Longer Lives

Stanley J. Rogers, M.D.
Bariatric Surgeon
UCSF Bariatric Surgery Center

Until recently, bariatric surgery was considered merely cosmetic. However, new studies have demonstrated that the surgery is by far the most effective and permanent weight reduction treatment. Most traditional weight-loss programs focus on dietary restrictions that have a limited efficacy with a recidivism rate approaching 100 percent at one year. Medical treatments, including orlistat (Xenical) and sibutramine (Meridia), lead to a one-year weight reduction of only about 5 kg. achieved with a 1,500-calorie-per-day diet alone.

Studies recently published in the New England Journal of Medicine (N Engl J Med 2007;357:741-52 and N Engl J Med 2007;357:753-61) definitively demonstrate improved long-term survival in patients undergoing weight-loss surgery, including both gastric bypass and gastric banding. For patients who undergo these elective surgical procedures, dramatic improvements in morbid conditions are achieved, including hypertension, diabetes, hypercholesteremia, sleep apnea and arthritis. Bariatric surgery is not always possible for obese patients who have advanced fixed cardiopulmonary disease.

For patients who satisfy the rigorous weight-loss surgery preoperative evaluation and ultimately adhere to post-operative dietary restrictions, 75 percent of excess body weight will be lost within one year following surgery. Eventual success with any bariatric surgery is highly dependent on the adaptation of a new lifestyle in which patients play an active role and when eating habits are carefully modified and controlled.

Preparing Patients for Surgery

Primary care providers play a central role in managing patients with morbid obesity and preparing them for bariatric surgery. Prior to consideration for surgery, each candidate must undergo a mandatory and extensive preoperative evaluation to minimize risks associated with weight-loss surgery. These include:

  • Medical clearance and referral for bariatric surgery.
  • A detailed history and physical examination, including documentation of participation in weight loss programs and details of prior abdominal surgical procedures.
  • A thorough evaluation of cardiopulmonary risk with an echocardiogram, electrocardiogram, chest X-ray and cardiac stress test.
  • Pulmonary function tests in select patients.
  • Gastrointestinal evaluation in select patients. These include colonoscopy for patients over 50 years of age or for those with a family history of colon cancer; and upper endoscopy for patients with a history of peptic ulcer or gastroesophageal reflux disease.
  • Abdominal ultrasound to evaluate for gallstones and fatty liver disease.
  • Complete blood laboratory profile (CBC, electrolytes, liver function tests, lipid studies, TSH, prolactin and cortisol levels, hemoglobin A1C).
  • Gynecologic or prostate evaluation.
  • Nutritional assessment and counseling.
  • Evaluation by a mental health care practitioner to determine psychological fitness for weight loss surgery.

In some cases, insurance carriers insist on medically supervised weight-loss therapy prior to authorizing surgery. Primary care providers may offer the necessary supervision for these patients.

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273
Email referral.center@ucsfmedctr.org

Other Resources

UCSF Bariatric Surgery Center
Bariatric Surgery Patient Education