Bariatric Surgery

Throw out any thoughts that weight reduction surgery is a shortcut to svelte. The surgery, performed on about 200,000 Americans a year, is a last resort to rescue people in danger of dying early from the health consequences of their extreme obesity. After years of question marks, studies now show the surgery saves lives, sustains long-term weight loss and combats -- maybe even reverses -- diabetes.

As a nation, we are obviously getting fatter and fatter. Not only are we ever more confused about how to lose weight, we're particularly fuzzy on the question of how big a role exercise plays and whether we just have to count calories. So, here's the deal. Yes, you can count calories or weigh yourself every day. If your weight is up today compared with yesterday, you ate more calories than you burned. If it's less, you burned more than you ate -- provided you didn't drink gallons of liquid the day before, which could throw the scale off. It comes down to simple arithmetic, and you've heard it before: Calories in, calories out. You will absolutely, inevitably, sadly, this-could-not-be-clearer gain weight if you eat more calories than you expend in basic metabolism -- breathing, digesting, sleeping, etc. -- plus whatever else you do, such as chasing the kids, walking, vacuuming or going to the gym. But most of us can't, or won't, do the math, probably because it's so depressing.

Doctors often advise overweight patients that losing weight may go a long way in alleviating pain from knee osteoarthritis, but the information can fall on deaf ears. Two small studies presented recently at the annual meeting of the American Academy of Orthopaedic Surgeons in San Diego this week find that dropping pounds may influence the condition. The first study focused on 19 obese adults who had knee osteoarthritis and were slated to have bariatric surgery. The study participants were surveyed at six and 12 months and reported improvement in knee pain, stiffness and function compared with the beginning of the study.

Pharmaceutical giant Allergan Inc. stands to win big from the federal government's decision to make Lap-Band weight-loss surgery available to more overweight Americans. The Food and Drug Administration on Wednesday cleared the way for marketing the procedure to patients who are significantly less obese than those who qualify now ? a decision that would make an estimated 26.4 million more Americans eligible to consider the Irvine company's device. The approval also means that, according to company officials, 45.6 million Americans meet the criteria for Lap-Band surgery.

With sales of its Lap-Band weight-loss device declining, Allergan Inc. has its eyes on a new set of potential customers -- overweight teenagers. The Irvine company has asked the Food and Drug Administration to approve Lap-Band surgeries for adolescents as young as 14, and is conducting clinical trials on teenage patients, said Cathy Taylor, a company spokeswoman. Allergan says the device -- a silicon ring fitted around the stomach to reduce food intake -- has proved a safe and effective way for obese adults to shed pounds.

Weight-loss surgery is safe and effective for most people, but complications do occur. Researchers reported Wednesday that they had devised a list of the top six risk factors. They are: The type of operation (gastric bypass or gastric band) Surgical technique (open or minimally invasive surgery) Patient gender Type of insurance Age Presence of type 2 diabetes One or more of these risk factors may increase the risk of dying before leaving the hospital, said the authors of the study, from UC Irvine.

In Wednesday's issue of the Journal of the American Medical Assn., we learn from a new study that, when it comes to bariatric surgery, surgeon experience seems to trump the quality designation of the hospital. Researchers from the University of Michigan write in their conclusion: "The frequency of serious complications among patients after bariatric surgery in Michigan is low. Rates of serious complications are inversely associated with hospital and surgeon procedure volume but not COE [center of excellence]

The country is down to onededicated, prescription obesity medication -- the not-too-pleasantXenical -- since Friday's announcement that Meridiawill be removed from the market due to an increased risk ofheart problems among people with cardiovascular disease. But, notto fear, the major gathering of experts on obesity are gatheringSaturday through Tuesday in San Diego for the  Obesity 2010 meeting . Theschedule looks packed with promising ideas aimed at reducing thegirth of Americans although, I must say, I don't see any easyfixes.

In findings that promise radical changes in the care of the 20 million U.S. patients with Type 2 diabetes, two new clinical trials have shown that weight-loss surgery brings about dramatically greater improvement of blood sugar control in obese diabetics than standard diabetes care. In both studies, even rigorously supervised regimens of diet, exercise and medications failed to bring blood sugar under good control after a year or more. In contrast, two teams of researchers - one in Italy, the other in the United States - reported that surgical procedures to reduce the size and sometimes the placement of the stomach often allowed subjects to discontinue diabetes medications within weeks.