Bariatric Surgery

Last year, over 175,000 patients had bariatric surgery. This surgery is generally seen as a last resort, for people with a BMI over 40 or over 35 and a co-morbid illness. As the surgery becomes more common, I worry about the repercussions. During medical school, I assisted on three gastric bypasses. One had a standard recovery, one had a painful and long recovery necessitating additional surgeries, and the third died on post-op day three. While I know that obesity is a major factor in many diseases and losing weight is incredibly difficult, it must be remembered that this is an elective procedure!

Time summarizes a report by NEJM. Between 1984 and 2002, over 15,000 obese patients were studied, half of whom had gastric bypass. In a mean follow up of 7 years, the group that had surgery was:
92% less likely to die from diabetes
59% less likely to die from coronary artery disease
60% less likely to die from cancer

Another study in Sweden of 4000 patients, half who received surgery had a 10 year mean follow-up. In the 10 years, the study group had:
24% decrease in all cause mortality
58% increase in mortality from accidents and suicide

I don't know what the answer is. I don't want anyone to die from an MI, or to suffer from diabetes complications. However, I'm not sure this is the answer. Even with the nutrition and psychological counseling most bariatric centers provide, surgery only perpetuates the idea of a quick fix. In addition, like most of the treatment in medicine today, the cures have side effects that may be worse than what they are treating, and that can't be taken lightly.