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Studies of Weight-Loss Surgery by the Journal of the American Medical AssociationClick to get the PDF Version for printing, saving, and sharing.* Key
Issues and Questions
Background:
The October 19, 2005 issue of the Journal of the American Medical
Association (JAMA) describes and critiques some recent studies of patient
outcomes for large groups of weight loss surgery patients in California. One of
the studies, “Early mortality among Medicare beneficiaries undergoing
bariatric surgical procedures,” is available (at no charge) at http://jama.ama-assn.org/cgi/content/full/294/15/1903. A fact:
The
studies indicate that weight-loss surgery, while safe for the vast majority of
patients, can be fatal for as many as 4.6% of patients, especially if they are
elderly or suffer from advanced morbid obesity, cardiac disease, high blood
pressure, or diabetes. The studies make it clear that prospective
patients must continue to carefully balance the benefits of successful surgery
against the risk of dying from the surgery, as well as the risk of premature
death and greatly reduced quality of life due to untreated morbid obesity,
diabetes, high blood pressure, or heart disease. A fact:
The
studies found that weight-loss surgery patients are more apt to have
gastrointestinal complications requiring hospitalization during the first year
after surgery. By the third year, patients are more likely to require certain
surgical procedures to correct health problems, which resulted from morbid
obesity, such as knee replacements. Significantly, the recent studies did not calculate the monetary
savings that result from the cure of diabetes, heart disease, or high blood
pressure.
In addition, despite previous studies that revealed substantial savings
after the fifth year, the recent studies did not examine patients beyond
the third year. A fact:
As
with many other health care studies, the JAMA studies found that patients fare
better when treated by surgeons and hospitals that routinely perform weight-loss
surgery. Patients must choose their
surgeons and hospitals carefully and obtain a clear understanding of how many
weight-loss procedures they perform annually and their clinical outcomes. A fact:
All
of the recent JAMA studies relied on insurance claims data rather than
information developed from patient diagnoses. None of the studies used
comparison groups. Consequently, the JAMA
studies support very limited conclusions. The
reality:
Unfortunately,
the recent studies did not take into account the terrible burdens imposed on
morbidly-obese individuals and their families by their disease, such as the
inability to work, take care of themselves, or provide for their families. The
studies didn’t address the individual and societal benefits of returning
patients to healthy and productive lives. For all of these reasons, the JAMA
studies, while increasing our understanding of the risks of weight loss surgery,
fall short of providing a complete and accurate picture of the potential
benefits of the surgery. "Bariatric surgery today remains a fundamental therapy for morbidly obese patients."
--Wolfe & Morton, 2005, “Weighing in on Bariatric Surgery”, JAMA, p. 1963
Click to get the PDF Version for printing, saving, and sharing.* *You must have Adobe Acrobat to open this file.
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