MN Healthcare News March 2017

Page 16


Bariatric surgery Addressing the impact of overweight By Guilford G. Hartley, MD


ore than half of all American adults have a significant problem with overweight, and are placing themselves at heightened risk of medical complications. For one in ten individuals, overweight is severe and has triggered enough medical problems to justify thinking about weight loss surgery. Problems and treatments Serious overweight often causes dangerous medical problems,

including diabetes mellitus, high cholesterol, high blood pressure, arthritis in the legs and back, and snoring with sleep apnea. While many people are aware of these problems, they may not know that severe overweight also increases the risk of certain kinds of cancer, such as cancer of the breasts, ovaries, and uterus. Some patients address overweight through combinations of diet, exercise, and medications, but these measures usually don’t work for the long term. A diet and exercise regimen helps some people to lose weight initially, but it almost never helps them keep it off. About 95 percent of those who lose weight on a diet and exercise program are back to their initial weight five years later. The U.S. Food and Drug Administration (FDA) has approved a number of medications to treat obesity, but they are not very effective, and it is not clear whether they are safe for long-term use. In addition, few insurance companies cover these medications, which can be very expensive. Significant overweight is almost always a long-term problem that requires more effective long-term treatments. Weight loss surgery is the safest and most effective treatment for severe obesity. Weight loss surgery can produce improvement in obesity-associated medical problems and, in some cases, can produce a complete remission of the problem. This is particularly important for people with diabetes mellitus type 2 (adult type diabetes), but is important for people with other problems as well. Weight loss surgery can also reduce the risk of developing cancer of the breasts, ovaries, and uterus, and can reduce the risk of death from these cancers. Most insurance covers weight loss surgery. The best candidates In our offices, we use body mass index (BMI)—a number reflecting the relationship between height and weight—to determine whether a person is overweight enough to justify surgery. Roughly speaking, men who are more than 100 pounds overweight or women who are more than 80 pounds overweight are likely candidates for weight loss surgery, but BMI is the more definitive guide. People with a BMI higher than 40 are candidates for weight loss surgery, even