Marc Bessler, obesity expert at New York-Presbyterian Hospital, explains when it is advisable for obese patients to undergo surgery.
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When is surgery advisable as a treatment for obesity? Marc Bessler: Necessary, valuable, appropriate, those are different questions perhaps. I think that once you reach a BMI of 35 and have medical problems, it’s pretty much agreed upon that at that point surgery is a valuable thing. Above a body mass index of 40 or above a BMI of 40, surgery becomes worthwhile and potentially valuable again and the reason for that is the mortality associated with being a BMI of 35 or above is double to triple the base line mortality for otherwise relatively healthy people between the ages of 20 and 55. So if you’re 30 years old and you’re more than a hundred pounds overweight, your risk of death is double what a normal weight 30 year old’s risk is and the risk of surgery is lower than your risk of dying from your disease which is obesity or overweight. Obesity is the number one cause of death after smoking, preventable death, sorry I should say that again. Obesity is the number two preventable cause of death in the United States, after smoking. So if you can get your weight down, we now know that you can reduce your risk of death due to obesity. Obesity causes heart disease, diabetes, certain cancers and people die younger from the diseases that obesity leads to and therefore weight loss we now know, if it’s maintained can cause improved health but also improved length of life. So you might say that obesity should be considered a reason for surgery if you meet those criteria, BMI of 35 with medical problems or over 40. Truth be told it’s not right for everyone and if you can’t work with it, you’re not gonna have good success. Obesity surgery is a dieting aid in truth, it doesn’t do anything magical to change that equation I told you about, intake, burning calories and the balance between the two. What it really does is help you reduce your intake, it makes you feel full sooner, it helps you control your hunger so that you can stick with fewer calories and most people find it supremely helpful. The average weight loss from the current operations is way greater than weight loss from dieting and it’s maintained long term and we can talk about the specifics of that as we go along. So surgery is indicated currently for patients with a BMI over 35 with medical problems or over 40 without. But those recommendations are a little bit outdated I believe, there’s still the currently medical acceptable numbers but we now know that diabetics have a four to five times mortality compared to non diabetics and we also know that these operations can cure or put diabetes into remission in a high percentage of patients. So that it’s possible and likely even that if you have a BMI of 30 but you’re diabetic these operations might be very valuable at getting rid of your diabetes and increasing your life span. It may also be that some of the safer operations, some of the less risk operations are appropriate for some lighter patients. So a BMI of 35 without medical problems might be appropriate for some of these operations although currently those aren’t standards of care yet. Question: What surgeries are available to treat obesity? Marc Bessler: Well that’s something you gotta really talk to a well-informed doctor or surgeon about but I’ll give you the basics. These operations are broken down vaguely into two categories, restrictive operations which are designed to restrict the amount of food and what’s called malasorbative operations or operations designed not specifically to restrict the amount of food but how your body interacts with and absorbs that food. None of these operations are pure in those categories truly. But there’s these restrictive operations, the most common of which now is an adjustable gastric band, which is a ring that goes around the top of the stomach, partitions the stomach into a small part at the top and the rest of the stomach at the bottom and the ring, the size, the diameter of the ring is controlla