Is Weight-Loss Surgery for You?

Surgery to reduce or bypass the stomach has risks, but so does extreme obesity.

Obesity among American women is leveling off, according to data from the National Health and Nutrition Examination Survey (NHANES), a periodic assessment of American diet and health. Researchers with the Centers for Disease Control and Prevention (Atlanta, Ga.) which conducts the survey, found that the percentage of obese women did not increase between 1999 and 2004. This marks the first such slowdown in more than 25 years.

Only time will tell if this is a watershed moment in the obesity epidemic. In the meantime, America has a lot of weight to lose. More than 60 percent of women are overweight and 33 percent are obese, so putting on the brakes is not enough. Besides, NHANES data also showed that more women than ever have entered a weight category called severe or extreme obesity, once called morbid obesity because of its health effects.

Extreme obesity is defined as a body mass index (BMI) of 40 or more, roughly equivalent to being 80 pounds overweight for women (100 for men). Of the more than 6 million Americans in this group, women outnumber men by more than two to one.

Obesity is associated with a range of conditions that affect women, including infertility and menstrual difficulties, stress incontinence, type 2 diabetes, hypertension, gallbladder disease, osteoarthritis, sleep apnea, heart disease and stroke, as well as cancers of the endometrium, breast and colon. Extreme obesity further heightens all of these risks while making physical activity -- an important weight-loss and health strategy -- nearly impossible.

What to Do

Research has shown that diet and weight-loss medications are of little use to people with extreme obesity. Their best chance for long-term weight reduction and improved health is surgery to promote weight loss (called bariatric surgery). Even more than a decade after surgery, 90 percent of those who have undergone gastric bypass, the most common bariatric procedure, manage to keep off an average of 50 percent of the excess weight. The result is cure or improvement in diabetes, sleep apnea, degenerative arthritis and hypertension, and a reduction in major cardiovascular risk factors, including cholesterol.

Surgeons have been doing bariatric surgery for more than 50 years, but the number of people undergoing the procedure (most of whom are women) has soared -- from 36,700 in 2000 to 171,000 in 2005, according to figures from the American Society for Bariatric Surgery. The surge has been influenced not only by the growing number of extremely obese people, but also by improved surgical techniques and high-profile success stories, such as NBC television weatherman Al Roker's loss of 100 pounds after gastric bypass in 2002.

Like all major operations, bariatric surgery has risks -- and extreme obesity adds to those risks. Surgical treatment also requires lifelong medical monitoring and major changes in diet and lifestyle. But for most people with extreme obesity, the health benefits far outweigh the risks.

What's Involved

Guidelines from the National Institutes of Health (Bethesda, Md.) recommend bariatric surgery only for highly motivated people with a BMI of 40 or more and no success or only temporary success with other approaches to weight loss. Less severely obese people may also be candidates if they have an obesity-related health problem, such as type 2 diabetes, heart disease or sleep apnea. Only experienced bariatric surgeons should perform the surgery (research suggests it's best to choose one who has performed at least 100 procedures), and patients should receive extensive medical, nutritional and counseling services before and after surgery.

Bariatric techniques promote weight loss by various mechanisms, not all of them fully understood. Some procedures, such as gastric banding, restrict food intake by making the stomach smaller. Roux-en-Y gastric bypass restricts food intake and also changes the absorption of some fats and other nutrients. But stomach restriction and preventing nutrient absorption aren't the whole story.