Weight-loss Surgeons Now Can Identify Highest-risk Patients Before Surgery: Leading Bariatric Surgeon Discusses New Assessment Tool’s Role in Making Procedure Even Safer

Bariatric surgery is one of the fastest growing segments of elective surgeries in the U.S., climbing from just 10,000 procedures in 1995 to an estimated 200,000+ this year alone. As more and more Americans choose surgery to address obesity, a new study shows that, by assessing patients using five key indicators, surgeons can identify those most at risk of mortality before performing the procedure.

Brooklyn, NY (PRWEB) May 26, 2007 — Bariatric surgery - procedures that modify the size and capacity of the stomach in an effort to help obese patients lose weight - is one of the fastest growing segments of elective surgeries in the U.S., climbing from just 10,000 procedures in 1995 to an estimated 200,000+ this year alone. As more and more Americans choose surgery to address obesity, a new study shows that, by assessing patients using five key indicators, surgeons can identify those most at risk of mortality before performing the procedure.

“Obesity itself is a primary factor in several of the leading causes of death in this country, including heart disease, stroke and some cancers,” notes Dr. Piotr J. Gorecki, MD, F.A.C.S, Medical Director of the Brooklyn Center for Advanced Laparoscopy and Director of the Bariatric Surgery Program at New York Methodist Hospital, “This means the long-term health risks associated with obesity itself usually far outweigh the immediate risks involved in bariatric surgery,” Dr. Gorecki adds. “However, finding effective ways to reduce even the smallest chance of death is a key focus of every surgery, and the new risk assessment protocol is a powerful way to further that goal.”

Five Barometers for Successful Surgery
The new risk assessment tool focuses on five crucial factors: BMI, age, gender, blood pressure and risk of developing blood clots in the lungs. It was first developed by a Duke University bariatric surgeon who, with colleagues at the medical center, applied its standards to the records of more than 4,400 bariatric surgery patients at three separate hospitals. The researchers found that being male, being over 45, having a Body Mass Index over 50, having high blood pressure and/or having a high risk of blood clots in the lungs were all associated with a higher risk of death following bariatric surgery. What’s more, having multiple risk factors was associated with a higher mortality rate. For example, surgery-related deaths occurred in eight of the 2,166 patients classified as low risk (0-1 risk factors), 26 of the 2,142 patients in the medium-risk group (2-3 risk factors), and three of the 125 patients classified as high risk (4-5 risk factors). Patients in the high-risk category made up less than 3% of the study group, but their risk of death was six times that of patients with no risk factors.

“Performing this risk assessment prior to bariatric surgery is less of a tool to discourage the highest-risk patients from having surgery, but instead a barometer to aid the surgical team and the patient in preparing for the surgery,” Dr. Gorecki explains. For example, patients identified as falling into four or five of the high-risk categories might require specialized monitoring or care during and after surgery, or surgeons and anesthesiologists might modify their procedures to ameliorate the risks.

“The message here is that patients should not wait until their weight and health status are dire before seeking the help of a bariatric surgeon,” Dr. Gorecki adds. “Patients with no risk factors in the study - those who were under 45 with a BMI under 50, with controlled blood pressure and low risk of developing blood clots in the lungs - only had a .2%-.3% risk of surgery-related death,” he notes, adding, “That’s a far lower risk than the overall long-term health risks of obesity itself.”

Surgical rate grows - as does obesity rate
Although considered elective, bariatric surgery is becoming more and more necessary as obesity rates in the U.S. continue to soar - particularly among the extremely obese. The RAND Corporation’s recent study on obesity in the U.S. revealed that the number of obese Americans - with a BMI over 30 - rose 24% between 2000 and 2005. However, the rate of morbid obesity - defined as a BMI over 40 - surged up 50% during the same time period. And, in the category of extreme morbid obesity - with a BMI over 50 - the numbers grew by a staggering 75% over the same five-year timeframe.

“Clearly, bariatric surgery is a valuable option for those morbidly obese patients who have had no success with traditional weight loss programs, and need medical intervention to help them achieve a healthier weight for longevity and disease prevention,” Dr. Gorecki notes. In fact, federally-funded health insurance policies Medicare and Medicaid have recognized bariatric surgery as a medically necessary surgical procedure for the morbidly obese. While considered a major abdominal procedure with serious risk, Dr. Gorecki points out that New York Methodist Hospital has been named a “Center of Excellence” by the American Society of Bariatric Surgery for its commitment to quality and its high success rates for patient satisfaction. He adds that prospective bariatric surgery patients at NYM undergo a rigorous screening process to ensure that the surgical option is warranted, and that less invasive options for weight loss have been exhausted.

According to Dr. Gorecki, there are two most common types of bariatric surgery. The first, Roux-en-Y Gastric Bypass Procedure, involves creating a small stomach pouch that serves as a reservoir and connects directly to the intestine (gastric bypass). The second is Laparoscopic Gastric Banding, also called Lap-Band. For this procedure, surgeons make a small laparoscopic incision and insert an adjustable band to restrict the size and capacity of the stomach. The entire procedure is done without stapling or cutting into the stomach. In addition, adjusting the band - which is done regularly during the weight loss period - does not require additional surgery. While both procedures limit the amount of food that a person can consume, gastric bypass has been shown to produce greater and more sustained weight loss than Lap-Band.

Bio:
Dr. Piotr J. Gorecki, MD, F.A.C.S is a leading advanced laparoscopic surgeon with extensive practice in bariatric and foregut surgery. An assistant professor of surgery for Weill Medical College at Cornell University, Dr. Gorecki is the Chief Division of Laparoscopy, the Medical Director of the Brooklyn Center for Advanced Laparoscopy and the Director of the Bariatric Surgery Program at New York Methodist Hospital. He did his residency at New York Methodist Hospital which is affiliated with Cornell University College of Medicine and his fellowship in Minimally Invasive Surgery at Mayo Clinic. Dr. Gorecki has lectured and written widely on bariatric and laparoscopic surgery. He is current a member of the American Medical Association, the American College of Surgeons, Society of the American Gastrointestinal Endoscopic Surgeons, American Society for Bariatric Surgery and The Society of Laparoendoscopic Surgeons. More information about Dr. Gorecki and about the bariatric surgery program at NYM can be found at www.nym.org.

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End of press release

Related post: Predicting the Risk of Weight Loss Surgery 

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A recent article on the Detroit News website covers the story of Vanessa Bell Armstrong, famed gospel singer and weight-loss surgery patient. Vanessa underwent a gastric bypass surgery a few years ago, and since then she has lost nearly 60 pounds.

Story excerpt:

Now, shortly after releasing her latest album, “Walking Miracle,” Armstrong is publicly discussing the surgery for the first time. While Armstrong wasn’t 100 pounds overweight, the usual benchmark for the surgery, she qualified because of her high Body Mass Index (BMI) and other health issues.

Read the full story

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Let me preface this article announcement by saying that a surgeon’s experience should always be a higher priority than the cost of bariatric surgery. The same goes for any type of surgery, for that matter.

Now with that public service out of the way, I would like to share a new article with you that explains bariatric surgery costs. I hope you find it helpful.

Read the article here

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UAMS Neurologists Report on Link Between Gastric Bypass Surgery and Neurological Conditions

LITTLE ROCK – A decade-long study by neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock has found a link between the increasingly popular weight-loss surgery known as gastric bypass and several serious neurological conditions.

Katalin Juhasz Pocsine, M.D., associate professor in the UAMS Department of Neurology, is lead author of the study, which was published online May 22 in the medical journal Neurology (www.neurology.org/cgi/content/abstract/68/21/1843). The study concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and may develop a variety of neurological symptoms.

“The frequency of operations for treatment of obesity is rapidly growing in the United States,” Juhasz Pocsine said. “These procedures are usually successful in reducing weight, but they are not without risk. Many of the complications patients experience affect the nervous system, and they are often disabling and irreversible.”

More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients, a link between the surgery and their neurological condition was found.

All of the patients involved in the study had previously undergone the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.

Additional authors include UAMS Department of Neurology faculty members Sami I. Harik, M.D., department chairman and professor of neurology; Stacy A. Rudnicki, M.D., associate professor of neurology; and Robert L. “Lee” Archer, M.D., associate professor of neurology.

The 26 people involved in the study were followed for several years by UAMS physicians and represent the largest compilation of gastric bypass patients with neurological complications ever reported.

“As is evident from our findings, the neurological complications of bariatric surgery involve most parts of the nervous system, and frequently more than one,” Juhasz Pocsine said. “The conditions experienced by our patients spanned most regions of the nervous system from the cerebral cortex to the peripheral nerves.”

Symptoms of the patients in the study included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.

Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.

“Attention should be given to long-term intake of vitamin and mineral supplements to prevent some of these complications and to avoid severe and rapid weight loss,” Juhasz Pocsine said. “Patients should be made aware of the symptoms that herald these neurological complications, and physicians should attend to the wide-based nutritional deficiencies as early as possible.”

UAMS is the state’s only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state’s largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children’s Hospital, the VA Medical Center and UAMS’ Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit www.uams.edu.

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Khaliah Ali, Daughter of Muhammad Ali, Leads Obesity Health Education Campaign

After Losing More Than 100 Pounds, Ali Shares Her Fight With Obesity to Educate Others About the Emotional and Physical Impact of the Disease

IRVINE, Calif., May 22 /PRNewswire/ — Khaliah Ali, fashion designer,
author and daughter of former heavyweight champion Muhammad Ali,
experienced a life-changing “moment of truth” the year after her son was
born. At 335 pounds, more than 100 pounds heavier than her father’s best
fighting weight, Ali feared her battle with weight would prevent her from
seeing her son grow up. Like others who are more than 100 pounds
overweight, this “moment of truth” drove Ali to recognize the severity of
her fight with obesity and seek a solution.

To view the Multimedia News Release, go to:
http://www.prnewswire.com/mnr/momentoftruth/25719/

Now more than 100 pounds lighter, Ali has teamed up with ObesityHelp, a
leading resource for obese individuals, and Allergan, Inc., the makers of
the LAP-BAND(R) Adjustable Gastric Banding System for the “Moment of Truth” obesity health education campaign. This campaign aims to help the millions of individuals who are more than 100 pounds overweight recognize the
physical and emotional impact obesity has on their lives and motivate them
to engage in discussions with their healthcare professionals about
appropriate, safe and effective weight-loss solutions.

“It took me more than 30 years to reach my ‘moment of truth’ and
realize the impact obesity had on my life both physically and emotionally.
Until then, I was constantly fighting my weight, trapped in an endless
cycle of diets and exercise, and humiliated by the misperception of others
that I simply lacked will power,” states Ali. “No matter how hard I tried,
I was losing the fight against obesity and feeling a deep sense of shame
and helplessness. I truly felt like a part of me was dying inside.”

Ali is not alone in her fight, as obesity continues to be a growing
national epidemic. In the United States, approximately 60 million adults
are obese and 9 million are severely obese.(1) This chronic disease is
caused by any one or a combination of environmental (social and cultural),
genetic, physiologic, metabolic, behavioral and psychological factors and
in 2000 cost this country an estimated $117 billion in direct and indirect
costs.(2, 3, 4) Unfortunately, these costs are not expected to decrease
anytime soon. A RAND study, recently published in Public Health, analyzed
data collected between 1986 and 2005 in the United States from a household
telephone survey.

The results showed that the prevalence of individuals with a self-reported Body Mass Index (BMI) over 30 (classified as obese) increased by 24 percent between 2000 and 2005, but the prevalence of those with a self-reported BMI over 40 (classified as morbidly obese) increased by 50 percent.(5) In addition, people who are significantly overweight or obese face serious health consequences, including increased risk for Type 2 diabetes, heart disease, stroke, high blood pressure, sleep apnea and
premature death.(1, 6)

Like Ali, many individuals cycle through ineffective diets and despite
consistent efforts to lose weight, many struggle for years or sometimes a
lifetime with obesity. In 2004, tipping the scales at more than 270 pounds,
Ali fought back with the help of the LAP-BAND(R) System procedure, the only
FDA-approved adjustable gastric band for use in weight reduction for
severely obese adults, and ended her battle with obesity.

“I now have the tool I need to win my fight against obesity and achieve
sustained weight loss,” states Ali. “By sharing my journey, it is my hope
to help others reach their own ‘moment of truth’ and see the possibility of
life without obesity.”

While obesity is now recognized by leading government health
authorities, such as the Centers for Disease Control and Prevention (CDC)
and National Institutes of Health (NIH), as a disease, unfortunately,
treating this disease remains a challenge.(7, 8 ) The NIH has reported that
people in weight-loss programs lose only about 10 percent of their body
weight and gain most of it back within five years.(9) For people who are
morbidly obese, or more than 100 pounds overweight, weight-loss surgery has
become a clinically-accepted effective treatment option for long-term
weight control.(10) According to a report published by the Agency for
Healthcare Research and Quality, data strongly supports surgical treatment
as a superior option for weight loss and to help control co-morbidities
associated with excess weight, like Type 2 diabetes and hypertension, in
morbidly obese patients.(11, 12)

“Obesity is the greatest national health issue facing this country;
yet, there is a tremendous lack of knowledge among the obese and primary
care physicians about safe and effective weight-loss options,” said George
Fielding, M.D., Associate Professor of Surgery at New York University
School of Medicine and Ali’s surgeon. “It’s critical that those fighting
the battle with obesity understand the fight is not hopeless and
proactively speak with their doctor about a weight-loss treatment that will
work for them. Obesity is a disease and needs to be identified as such by
both the medical and patient communities.”

“Many ObesityHelp community members share the experiences Khaliah
highlights in her moment of truth and weight-loss journey,” said Eric
Klein, founder of ObesityHelp. “A vicious cycle of unsuccessful dieting
very often leaves many individuals feeling helpless. It is our hope that
this campaign will help the millions of individuals struggling and living a
life compromised by obesity to identify their pivotal moment, and begin
their journey to find a solution.”

Consistent with the Prochaska and DiClemente’s behavioral change model,
a “moment of truth” experience, such as having a child or the humiliation
of not fitting into a restaurant chair, often triggers individuals to take
action to overcome obesity. In an effort to help others identify their
personal turning point and assist them in finding a solution, the “Moment
of Truth” self-assessment tool was developed. To learn more about Khaliah’s
story, the “Moment of Truth” campaign and to access the self-assessment
tool, go to http://www.momentoftruth.org.

About ObesityHelp, Inc.
ObesityHelp is a leading resource dedicated to the education,
empowerment and support of all individuals affected by obesity, along with
their families, friends, employers, surgeons and physicians. ObesityHelp
provides a comprehensive program of support and education as well as
assistance in locating whatever resources it takes to overcome this
life-threatening condition. The organization has an active community that
communicates online through its Web site at http://www.obesityhelp.com and through
a regular program of conferences and workshops conducted around the
country.

The “Moment of Truth” campaign is an educational initiative, sponsored
by Allergan, Inc.

NOTE: As with any surgery, there are possible risks and complications
with the LAP-BAND(R) System, including but not limited to infection,
nausea, vomiting, band slippage and obstruction, and in rare cases, gastric
perforation and reoperation. You can find more risk information by visiting
http://www.lapband.com or by calling 1-877-LAP-BAND.

To view the Multimedia News Release, go to:
http://www.prnewswire.com/mnr/momentoftruth/25719/

(C) 2007 Allergan, Inc. Irvine, CA 92612. (R) and (TM) marks owned by
Allergan, Inc.

(1) American Obesity Association. AOA Fact Sheets. Health effects of
obesity. Available at
http://www.obesity.org/subs/fastfacts/obesity_US.shtml.
(2) American Obesity Association. Obesity Surgery. Available at
http://www.obesity.org/treatment/obesity.shtml. Accessed 1/18/07.
(3) CDC. Diseases and Conditions. Available at
http://www.cdc.gov/node.do/id/0900f3ec8000e035. Accessed 3/9/07.
(4) U.S. Department of Health and Human Services. The Surgeon General’s
Call To Action To Prevent and Decrease Overweight and Obesity in
2001. http://www.cdc.gov/nccdphp/dnpa/pdf/CalltoAction.pdf.
Accessed 2/23/07
(5) Sturm R. Increases in morbid obesity in the USA: 2000-2005. Public
Health (2007), doi:10.1016/
j.puhe.2007.01.006
(6) Ahroni JH, Montgomery KF, Watkins BM. Laparoscopic Adjustable Gastric
Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of
Life at One Year,” Obesity Surgery 2005; 15:641-647.
(7) CDC. Diseases and Conditions. Available at
http://www.cdc.gov/node.do/id/0900f3ec8000e035. Accessed 3/9/07.
(8) American Obesity Association. AOA Fact Sheets. Available at
http://www.obesity.org/treatment/obesity.shtml. Accessed 1/18/07.
(9) NIH Technology Assessment Conference Panel. Methods for voluntary
weight loss and control. Ann Intern Med 1993; 119 (7 pt 2):764
(10) American Obesity Association. AOA Fact Sheets. Health effects of
obesity. Available at
http://www.obesity.org/subs/fastfacts/obesity_what2.shtml.
(11) Shekelle PG, Morton SC, Maglione M, Suttorp M, Tu W, Li Z, Maggard M,
Mojica WA, Shugarman L, Solomon V. Pharmacological and Surgical
Treatment of Obesity., Evidence Report/Technology Assessment No. 103.
(Prepared by the Southern California-RAND Evidence-based Practice
Center, under Contract No. 290-02-0003.) AHRQ Publication No.
04-E028-1. Rockville, MD: Agency for Healthcare Research and Quality.
July 2004.
(12) Muscelli E, Mingrone G, Camastra S et al. Differential effect of
weight loss on insulin resistance in surgically treated obese
patients. Am J Med 2005; 118: 51-7.

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