For most people who are severely obese, lifestyle approaches to weight loss alone generally are not enough. —Dr. Ted Adams, lead author of the study
SALT LAKE CITY — At 270 pounds, Chris Stevenson was in no shape to donate a much-needed kidney to his twin brother, let alone climb the six flights of stairs to his office.
The 61-year-old diabetic had also almost given up on seeing his 20-plus grandchildren grow into adulthood.
But that was before he had gastric bypass surgery.
"It's nice to fit into some skinny clothes, but my emotions play into it as well," said Stevenson, who now weighs around 190 pounds. "Maybe I've prolonged my life another 15 to 20 years by doing this. That has some significant substance to it — knowing I can be around and be a part of their life and enjoy my posterity for many more years."
A Utah-based study and one of the first of its kind in the United States has shown that, for severely obese individuals (those with a body mass index greater than 35), gastric bypass surgery can lead to long-term health impacts that may be unobtainable with diet and exercise alone.
The procedure creates a smaller stomach pouch for food and allows it to bypass a section of the small intestine, resulting in less of it being absorbed into the bloodstream.
"For individuals who have such high body mass indexes, I have always felt that for most of those individuals, there is likely a higher genetic factor, something that is part of their physiology that makes it difficult for them to lose weight," said Dr. Ted Adams, lead author of the study and clinical and research director for the Intermountain Health and Fitness Institute at LDS Hospital.
Adams' research was published Tuesday in a special obesity-related edition of the Journal of the American Medical Association.
Patients can expect to lose about 100 pounds in one to two years following Roux-en-Y gastric bypass surgery. Adams, who also works as a professor of cardiovascular genetics at the University of Utah, said patients are keeping the majority of the weight off, even after six years.
Surgical patients in the study lost an average of 34.9 percent of their initial weight two years after surgery and kept off 27.7 percent six years after surgery. Nearly all of the subjects maintained more than 10 percent of their weight loss, and 76 percent kept off 20 percent.
By contrast, patients who did not have the surgery stayed at the same weight, regardless of any treatments or programs in which they may have been involved.
"The benefits go way beyond weight loss," Adams said. "We also found that patients who had the surgery were less likely to develop serious health problems like diabetes, high blood pressure and high cholesterol."
Stevenson, who is 5 feet 9 inches, said "it is a lot easier to exercise" after losing 90 pounds.
He has been as low as 165 pounds but said he is "a flagrant violator" of the healthy and regimented diet those who have the surgery must be committed to follow. He takes supplemental vitamins and minerals to maintain his health, but nary a prescription medication is contained in his routine, which wasn't the case before surgery.
Stevenson had been a "full-blown diabetic," needing insulin injections up to three times a day, as well as other medications. His mother died from complications of Type 2 diabetes, and three brothers also have been afflicted with the disease, including one who ultimately received a kidney transplant from his identical twin brother.
"I was of the mindset that once you have it, you've got it for the rest of your life," Stevenson said.
Various research taught him otherwise, and he decided to get the surgery in 2009 — after gaining 20 pounds just to qualify for insurance coverage of the procedure.
"I have never had an ounce of medication since that day," he said. "The diabetes was gone."
The results are similar for 62 percent of the study's 1,156 subjects, ages 18 to 72, who were recruited from throughout Utah using the U.'s Utah Health Family Tree Program.
Six years after surgery, their diabetes remains in remission, according to the research. Less than 8 percent of individuals who do not undergo surgery experience the same result.
Dr. Steven Simper, a bariatric surgeon at Rocky Mountain Associated Physicians and LDS Hospital, said gastric bypass surgery was originally thought to facilitate a change in behavior that would result in weight loss.
However, altering the gastrointestinal tract actually changes a person's metabolism and the enteral hormones that regulate it, Simper said.
"We have looked at obesity as a behavioral disease for over 100 years, and we've made zero progress in treating it," he said, calling obesity instead an environmental genetic disease.
"There are so many things in our environment that are poisoning us … it is easier to blame the patient for having the disease," Simper said. "The real answer to obesity is prevention, but that has to start early and has to be population-wide and is really going to take some fundamental changes to take effect."
While gastric bypass surgery is fast becoming the most popular surgery in the world, Utah has one of the largest populations of bariatric surgery patients in the country, according to the U.S. Centers for Disease Control and Prevention.
Many Utahns also are very willing to participate in clinical studies, and not many Utahns end up leaving the state, making for optimal conditions when looking to follow up for research purposes, Simper said.
He said the latest study further enhances the validity of gastric bypass surgery.
"It certainly shows, at least, that the glass is half full," Simper said. "(Gastric bypass surgery) is showing a profound effect in people's lives."
Patients who undergo bariatric surgery should weigh the risks and benefits, and be committed to eat a balanced and healthy diet, as well as participate in regular physical exercise, Adams said.
"We discourage the idea that this is a fix-all," he said. "This is a treatment that has been shown to be successful, but to maximize success long-term, you need to have in place good activity and dietary practices."
Adams said doctors and patients can make a more informed decision about the surgery knowing that there are continued benefits even six years out.
"It's a major surgery. It's a major change in lifestyle. And it is expensive," Adams said. "Patients have to be quite committed."
The study arose out of a continuous inquiry from patients to know the long-term effects and outcomes of gastric bypass procedures, information that isn't readily available, Adams said. He and his colleagues have received funding from the National Institutes of Health to continue the study another four years and will apply for additional funding after that.
"My sense is that surgery patients will continue to have better health outcomes than the control groups," Adams said, adding that in-depth research will likely help to encourage insurance companies to cover the procedure for more people.
Only the Swedish Obese Subjects study has followed subjects longer than Adams’, but the overseas research involves primarily patients who had gastric banding procedures and only a small percentage of gastric bypass patients.
Further research on gastric bypass surgery, which is one of the most popular procedures conducted worldwide, also may have an impact on insurance coverage, making the surgery available to a larger percentage of individuals.
According to the U.S. Centers for Disease Control and Prevention, more than one-third of all adults in America are obese, and obesity is a factor in some of the leading causes of preventable death, including heart disease, stroke, Type 2 diabetes and certain types of cancer.
Stevenson is working on the last 15 pounds, but he's able to enjoy the foods he likes, in moderation, and ride a road bike and exercise.
"It doesn't matter what the charts say," he said. "It's where you really feel good and look good; that's where you need to be. I'm much more cognizant of the overweight people around me — at the mall, at work and at the airport. They struggle.
"Knowing what those people are going through, I don't even want to think about going there again."