For the morbidly obese at imminent risk of life-threatening obesity-related complications, weight loss surgery can be acutely life-saving. However, its extraordinary initial efficacy, like any other lose-weight-quick scheme, is clearly attenuated over time as many patients find they can eventually consume at or near their pre-bypass level.
I once met a clinical psychologist whose job was to counsel prospective gastric bypass patients about the lifelong modifications in diet and lifestyle long term post-surgical success mandates. She herself had undergone the procedure a few years prior to our acquaintance and shared with me that she could only eat ½ of an oreo immediately following her surgery, but had managed to easily work her way up to half of a package (in one sitting) by the end of the first year.
Perhaps more concerning than the stomach’s gradual return to gluttony acceptance, are the procedure’s post discharge complication rates. According to the HHS’ Agency for Healthcare Research and Quality (AHRQ), four of every ten patients encounter complications with rates rising over time. The AHRQ conducted a study (Medical Care, August 2006) of adverse post-surgical developments and included up to 6 months post-surgery in their observation period. According to their findings the 5 most common problems were: dumping-syndrome nearly 20% (characterized by vomiting, diarrhea, sweating, rapid pulse); anastomosis complications 12% (leaks/structures); abdominal hernias 7%; infections 6%; and pneumonia 4%.
In additional to pain and suffering, these complications came with additional medical costs averaging over $11,000 more than those who did not experience complications within the first six months. Patients that required re-hospitalization during the study observation period incurred an additional $37,000 more in medical costs compared to those that did not require re-hospitalization. In addition to potential complications, there is also the added burden of dealing with the ugly reality of massive amounts of extra skin. According to a spokesperson for the American Society of Plastic Surgeons “Bariatric surgery isn’t just a commitment to weight loss. It often requires an additional two years of body contouring surgeries to help the patient’s skin fit his or her new body.”
Long term studies in the efficacy, morbidity, mortality and cost-effectiveness of bariatric surgery are called for.
