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American Heart Association

AHA support bariatric surgery

While bariatric surgery is "not benign," the benefits outweigh the risks for the seriously obese
Position paper also notes inabiltiy of other methods to deal with serious obesity

The American Heart Association (AHA) has voiced its cautious support of bariatric surgery for the severely obese, stating that it can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults.

In a scientific statement, “Bariatric Surgery and Cardiac Risk Factors”, the AHA say that while bariatric surgery is “not a benign surgery”, requiring serious lifestyle changes, the benefits can outweigh the risks for safe surgical candidates with a BMI of over 40 for whom other medical therapy techniques have failed.

“Obesity has reached epidemic proportions in the United States, as well as in much of the industrialized world,” said lead author Dr Paul Poirier, director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada. "The most rapidly growing segment of the obese population is the severely obese. The health consequences of severe obesity are profound. In comparison with normal-weight individuals, a 25-year-old severely obese man has a 22 percent reduction in his expected lifespan.”

“Substantial long-term successes from lifestyle modifications and drug therapy have been disappointing, making it important to look at surgical options,” Poirier said.

Evidence

Reviewing the scientific literature, Poirier et al report that bariatric surgery can reverse the increase in blood volume and cardiac output that results from severe obesity, reducing the stress placed on the patient’s heart. The resultant weight loss can reduce the chance of cardiac arrhythmia, which is increased by around 50% among the severely obese, and the resultant chance of a patient suffering a stroke.

The study also noted that surgery can help treat other consequences of severe obesity, including diabetes, high cholesterol, liver disease, high blood pressure, obstructive sleep apnea and cardiovascular dysfunction. Consequently, gastric bypass surgery has been found to reduce two-year mortality by as much as 40%, compared to those who do not have the operation.

The AHA’s support for bariatric surgery comes at the same time as the International Diabetic Federation released a position paper calling for bariatric surgery to be considered earlier in the treatment of obese type 2 diabetes patients. However, while the Federation advocate that surgery should be a priority among the seriously obese, the AHA hold that surgery “cannot be considered a practical response to the worldwide epidemic of diabetes mellitus”, considering the sheer scale of the problem, with 24 million people suffering from the disease in the USA alone. They conclude that surgery should only be considered after other treatment options have failed.

"The statement is not an across-the-board endorsement of bariatric surgery for the severely obese,” said Poirier. “It is a consensus document that provides expert perspective based on the results of recent scientific studies."

While the authors acknowledge that bariatric surgery is generally safe, with a 30-day mortality rate between 0.1% and 2%, they highlight the complications that can arise, including thromboembolism, pulmonary or respiratory insufficiency, haemorrhage, peritonitis, equipment malfunction, and infection. They also note that serious lifestyle changes are required, including exercise programmes, dietary changes, supplements, and follow-up meetings with the surgeons.

The study calls for more research into bariatric surgery on adults and youths, particularly the value of psychological evaluations and profiles to assess the behavioural and environmental factors that may have contributed to a patient’s obesity. The potential impact on a patient’s ability to make the dietary and behavioural changes needed to achieve the best results from surgery should also be considered.

The co-authors of the study are Marc-André Cornier, M.D.; Theodore Mazzone, M.D.; Sasha Stiles, M.D.; Susan Cummings, Ph.D.; Samuel Klein, M.D.; Peter A. McCullough, M.D., M.P.H.; Christine Ren Fielding, M.D.; and Barry A. Franklin, Ph.D.

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