Marc Bessler, obesity expert at New York-Presbyterian Hospital, talks about the biggest misperceptions about weight management.
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What are the biggest misperceptions about weight management surgery? Marc Bessler: First of all I think the biggest misconception about overweight and obesity is that it’s the patient’s fault. This is truly a disease, now you’re right like we said before, you could eat less but that’s like telling somebody who has diabetes to control their sugar by just not taking in sugar and of course we tell 'em to do it but it’s very hard to do. Your body is mismanaging these things and so obesity is a disease, it is not the individual’s fault, it takes super human will power to keep obesity under control for the long term and that’s why these surgeries make sense. That these are very dangerous operations, I think 20 years ago the mortality rate of these operations were in excess of two percent. So of every hundred people that came in the operating room, two didn’t leave the hospital anyway, that’s not the case anymore. In a center of excellence, in a place that does this really well and a lot of it, the mortality rate for gastric bypass is about three in a thousan and the mortality rate for a lap band is less than one in a thousand. So these operations are much safer than they used to be. So much so that the risk associated with having the operation is way less than the risk of death from that operation over the ensuing years. Sorry, so much so that risk of having the operation is way less than the risk of having obesity for the ensuing years and you gain back not only the dollars put into it but the risk put into it over five years or so. Yet the other common misconception is that they always fail and people regain their weight back, some of the older operations didn’t work that well and some percentage of patients do gain weight back still but most don’t. With gastric bypass, I’d say 85 percent of patients maintain long term significant weight loss and with the lap band it’s probably close to the same just not as dramatic a weight loss. Topic: Top experts working weight management surgery Marc Bessler: Well that’s tough, I think that I hate to be specific about any institution, I think there’s centers of excellence, there’s two organizations that are documenting centers of excellence in weight loss surgery, that’s the American College of Surgeons and something called the surgical review corporation. A center that is documented as a center of excellence by those at least has more than the basics that they need to do this. A center that has one of these designations probably has long term follow up, so that’s really important and the surgeon’s probably have at least a minimum amount of experience doing this so that’s important. But truly you want somebody who’s done 500 or a thousand of these operations, the learning curve goes on probably to about 250 operations and then some. You want somebody who’s offering you all types of operations, not somebody who’s selling just one type or somebody who does 99 precent one type of operation because they’re probably trying to fit you into their operation, not find the best operation for you and you want some place that has a program for long term care and management and if you have all those three components you’re probably in a place that’s safe. What should the public know about weight management surgery? Marc Bessler: Well I think that the most important thing to know is that right now less than two percent of people who qualify for surgery are having it. In most places that’s because patients really aren’t choosing it, I think there’s misconceptions about the risk and the benefits of this operation. These operations save lives, they make people have better quality of life, they make people healthier, they make people live longer. But there is some up front risk and you need to be at a center of excellence as we talked about, a place that does these really well to minimize that risk and overall the benefit is definitely there for almost everyone who qualifies