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In going through my piling system, I happened on the August New England Journal Of Medicine, 2007. The two lead articles were long-term studies of bariatric surgery patients and their survival rates compared with same-sized people without that surgery. The editorial’s writer, Dr. George Bray of Louisiana State University, summarized the results well: “Thus, the question as to whether intentional weight loss improves life span has been answered, and the answer appears to be a resounding yes.”
The first study was from Sweden, called the Swedish Obese Subjects (SOS) study. It paired a group of men with a Body Mass (Mess?) Index, or BMI, of 34 and higher, and women of 38 and higher who had bariatric surgery — 2,010 subjects — with a group the same size and age who didn’t have surgery, 2,037 people. After 10 years, weight losses ranged from 14 percent to 25 percent among the surgery group and 2 percent among control subjects.
There were 101 deaths in the surgery group and 129 in the control group. The most common causes of death were heart attack (with surgery 13, control group 25) and cancer (29 with surgery, 47 control group). Interestingly, as the years went by, newer surgery techniques were used. Along with open-incision gastric bypass, also used were laparoscopic bypass, a more or less permanent vertical-banded gastroplasty, and simple banding that could be reversed more easily. Weight loss and survival were better with the more permanent types.
The second study was a retrospective one that looked back at results of just gastric bypass in 9,949 subjects from 1984 to 2002, compared with 9,628 non-surgery obese subjects. The authors commented that the SOS study had 68 percent of the surgeries as vertical-banded gastropasty, which results in less weight loss and now is done infrequently. During a mean/average 7.1-year follow-up, there was an overall 40 percent reduction of mortality for all causes. It was down 56 percent for coronary artery/heart attack disease, 92 percent for diabetes, and 60 percent for cancer.
Many obese people have an impaired quality of life for a variety of reasons. Other studies have shown significant improvement for these facets also with surgery.
I have had personal experience in medical school with gastric bypass. For my junior year six-week surgery rotation, I got to be on the “Fat Squad.” Dr. Ed Mason, a very quiet, intellectual, thoughtful surgeon, had devised the gastric bypass, which is a modification of an ulcer operation, called the Bilroth II. I was in on 12 of these, in the second or third row from the body. It was a learning experience to give respect for what obesity can impair.
It is pointless to recount the obesity epidemic the world is undergoing for some reason. The common thought is that surgery is not necessary for something we should be able to control. It ain’t that easy, apparently. So, desperate measures for desperate times, as the saying goes.
The word bariatrics (Greek: baros, weight and iatreia, medical treatment) is that branch of medicine or surgery concerned with the management of obesity and allied diseases. Bariatric surgery isn’t perfect. Some people learn how to eat around the tiny tummy created by the operations and gain weight back. It can become a tool to instill some control involuntarily and retrain habits. Small portions, small people. Simple thermodynamics: calories in, calories out.
But I have a theoretical question: Do electrons contain calories? We are fed and feed ourselves a surfeit of electronic satisfaction with “screen time” being restricted by parents, cell phones hanging off belts and ears in ones and twos, iPods inserted into perhaps any open orifice to electronically satisfy and satiate our souls.
Maybe smaller portions of iPods would be an alternative to gastric bypass? It would at least allow your brain to function freely and independently, reducing your CMI, Cranial Mass Index, a measure of intracranial electronic obesity, to normal.
