After spending the majority of her 48 years trying, and failing, to slim down, Veronica Mahaffey was still 50 pounds overweight -- not morbidly obese by a long shot, but still far from the size she wanted. Worried about her health, she called a San Diego weight-loss surgery clinic last spring and asked for help.
She was told no.
At 185 pounds and with a body mass index of 28, the Ramona mother of four was not heavy enough to meet medical guidelines or insurance company qualifications for weight-loss surgery. Those standards require a BMI of 40 or higher, or 35 or higher for people with a related medical problem such as diabetes or sleep apnea.
"People would say, 'You look fine.' But I couldn't get into normal-size clothing. That's not fine," Mahaffey said. "And then I was told I was going to have to gain weight to qualify for surgery. That doesn't make sense."
Ultimately, she got the surgery through a clinical trial of one of several new weight-loss procedures. Now 10 pounds from her goal weight of 135, she says she looks better, feels better and is confident she'll no longer have to fight her weight.
Her experience may soon be shared by thousands of Americans.
Usually reserved for the most obese people, weight-loss surgery is unlikely to be a last-ditch option much longer. Technological advancements are turning it into a one-hour, incisionless procedure -- making it more attractive to moderately overweight adults like Mahaffey; overweight and obese teenagers; and normal-weight people with difficult-to-control diabetes. Several new procedures are already in human clinical trials.
"I see surgery playing a bigger role," said Judith Stern, a professor of nutrition and internal medical at UC Davis, ". . . because the weight-loss drugs we have now are lousy."
The need for new treatments is impossible to ignore.
A New England Journal of Medicine study published last month concluded that obesity rates would soon negate life-span gains achieved through declining smoking rates. And a report released in November from the American Public Health Assn. and other groups projected that healthcare costs related to obesity would quadruple in 10 years, accounting for 21% of healthcare spending.
Bariatric surgery, many doctors say, should be a bigger part of the solution.
"We're seeing increased disability due to obesity among a younger population," said Dr. John Baker, president of the American Society for Metabolic & Bariatric Surgery. "We can't afford to wait. As a tool to bring down costs and the burden of disease, bariatric surgeons have the most effective tool in medicine today."
Other health professionals are aghast at the idea of even more Americans yearly undergoing the surgery. Bariatric surgery rates have already doubled in the last six years, resulting in 220,000 procedures in 2008, according to the American Society for Metabolic & Bariatric Surgery. And even the simplest procedures are not without risks.
"The fact that bariatric surgery is the only efficient method of long-term weight loss is true," said Dr. Blandine Laférrere, a diabetes expert at Columbia University College of Physicians and Surgeons in New York. "But does that mean everyone who is overweight should have it? I don't think so, because none of these procedures is benign."
Many studies already attest to the effectiveness and increasing safety of the most popular weight-loss surgeries among morbidly obese people. Depending on the type of surgery used, patients lose 50% or more of their excess body weight and maintain that loss for as long as 10 years after surgery. In comparison, the most recent studies on long-term use of weight-loss medications show a typical weight loss of 5 to 22 pounds over one year with some side effects.
Other research has found that bariatric surgery cures Type 2 diabetes in a majority of patients studied, as well as improving symptoms related to sleep apnea and heart disease, such as high cholesterol and blood pressure.
"When we first started doing bariatric surgery, most of the family practitioners were very much against it," said Dr. Gregg K. Nishi, a bariatric surgeon at Cedars-Sinai Medical Center. "Now they send their patients to us in droves because we cure their medical problems. As we develop new noninvasive procedures that are safe, I think the popularity will grow."
The improvements in traditional bariatric surgery, combined with patient interest, have led to a surge in investigational new procedures, as well as discussions on whether more people could benefit from surgery.
"Investigators are working on ways to make these operations more effective, safer, less invasive and lower-cost," said Dr. Philip Schauer, director of the Bariatric and Metabolic Institute at the Cleveland Clinic.