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    Wednesday, October 19, 2005

    It is Better to Look Good than to Feel Good: This week is Obesity Week - there's a meeting of the North American Association for the Study of Obesity going on, and in honor of it, the Journal of the American Medical Association has devoted this week's issue to the subject of weight-loss surgery. Surprisingly, as gung-ho as the medical profession has been to curb the waist lines of other people, the data in the Journal is not as optimistic as this headline suggests. In fact, the studies published today show that obesity surgery is riskier than previously thought:

    Stomach surgery to treat obesity, which is soaring in popularity, is much riskier than had been thought, with patients facing a far greater chance of being hospitalized and dying after the operations, according to two large new studies.

    One analysis of more than 60,000 California patients found they were twice as likely to require hospitalization after the operations than before, while the second study of federal data from more than 16,000 patients nationwide found the chance of dying after being released from the hospital was significantly higher than earlier studies indicated.

    One study looked at mortality rates at one month, three months, and one year after surgery. Men older than 75 - the very elderly - had the highest mortality rates - up to 51% (women over 75 had a one year mortality rate of 40%) a year after the surgery. That's not too surprising. The very elderly are at increased risk after any surgery, and one would have to question the wisdom of performing weight loss surgery on people of that age. And in fact, they represented only 0.8% of the people in the study. Most people who had the surgery were younger - 60% fell in the age range of 35-54. Their mortality rates were considerably lower - 3-4% after one year. Hospitalization rates also increased after surgery - more than doubling for up to three years afterwards, all due to complications. That's still a fairly high mortality and complication rate for what is, after all, a cosmetic procedure.

    And it is a cosmetic procedure. Although it's sold as a means to improve health by elminating obesity, it is an option chosen overwhelmingly by women and the wealthy. (Even mothers are biased toward women when it comes to judging fatness.) If it were solely a health issue, we would expect a more equal distribution between the sexes - wouldn't we?

    UPDATE: A point from a reader:

    I read the study on the comparative risks of bariatric surgery for various populations and at the risk of revealing my abyssmal ignorance of statistical terminology, I'm confused.

    The study seems to compare death risks at various post-surgery times, between populations undergoing the surgery, i.e., under and over 65, male/female, more or less experienced surgeon. 

    Wouldn't the useful comparison be between equally obese and obesity-affected (comorbid?) people who did and did not have the surgery?  

    I wouldn't charge anything to predict that people over 65 who have surgery die more often during any specified period after it than people under 65 who have the same surgery. But if I were an obese 70 year old with cardiac problems what I'd want to know is whether I'd be more likely to die in the next year if I did have the surgery or didn't have it.  

    Does this study say this in some way I'm just not able to read? (Which is certainly possible.) I guess to compare those two populations you'd have to identify people to whom the procedure has been recommended but who declined it, or something like that. Probably not easy to do.

    The other study from California wasn't described well enough to track down.

    That is true. Finding a control group would be difficult. Anyone having abdominal surgery for any other reason would be having it to treat a more serious disease than obesity. It wouldn't be a fair comparison. A better control group would be overweight people of the same age and same weight and same health problems. It probably would be harder to find those people, and it would make the study a little more work for the researchers.

    The other article's abstract is here (the full article requires a hefty fee.) It compares the hospitalization rates for the same patients before and after the surgery. They had to be hospitalized more after having the surgery than before, usually for problems related to their surgery. That would suggest that the surgery made them sicker, not better.

    posted by Sydney on 10/19/2005 08:45:00 AM 0 comments


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