Surgeons to discuss bariatric surgeries

Diabetes, heart disease and high blood pressure are among the ills that can improve when someone who is severely overweight has bariatric surgery. The procedures are becoming increasingly popular, in part because they're less invasive and safer, according to experts who will address the topic during the Deseret News/Intermountain Healthcare Hotline Saturday.

The most common bariatric surgery is gastric bypass, which dates back to the '80s. But it is now usually done as a minimally invasive, laparoscopic procedure, said Dr. Sherman Smith, director of bariatric surgery at LDS Hospital.

Smith and Dr. Rodrick McKinlay, general and bariatric surgeon at LDS and St. Mark's Hospital, will take confidential phoned-in questions from 10 a.m. to noon. The phone number is 1-800-925-8177. You can also e-mail hotline@desnews.com.

People who are morbidly obese may have related diseases, such as diabetes and high blood pressure. And most of those who are extremely heavy may have to lose weight before they can effectively exercise, Smith said.

There's "good scientific evidence" that surgery to help people who have been unable to reduce weight through diet and exercise impacts those diseases. Research published in the New England Journal of Medicine in 2007 found a 40 percent reduction from all causes of death in patients who had the surgery compared to comparable patients who did not. Diabetes-related deaths dropped the most, but cancer and heart disease deaths decrease significantly as well. There was a slight increase in accidental deaths and he theorized that might even reflect that people who had the surgery became more active.

The surgeries are not a first-resort step to conquer obesity, the doctors said. While complications are infrequent, they can be serious, even deadly. And unless a patient follows recommendations regarding lifestyle changes, there's real risk of regaining the weight with both gastric banding and gastric bypass.

A typical bariatric surgery patient might be someone with a body mass index — a ratio based on weight and height — of 40 or more. Normal BMI is 19 to 25. With complicating factors like poorly controlled respiratory issues, diabetes or high blood pressure, bariatric surgery might be considered for someone with a 30 to 35 BMI. Insurance companies that cover the procedures (not all do) typically have requirements of steps someone must have already tried to lose weight or comorbidities they must have to qualify.

Smith said there are limits on how much a person can weigh and safely have surgery. Someone weighing more than 550 to 600 pounds would need to lose some weight before considering it. The risk of complication is just too high.

McKinlay said risks and benefits have to be weighed carefully in choosing to have bariatric surgery and then in picking which procedure. Ultimately, the patient decides what he wants, because there are real differences between them. And though they spend time on the potential downside of surgery, he said, when you talk about things that can happen, you need to also consider a typical afternoon clinic with people who've been through an operation. They come in with tales of how good they feel, he said.

Tomorrow: The surgeries — and what to expect.

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