AHA Issues First Scientific Statement on Bariatric Surgery
By Kerri Wachter
Elsevier Global Medical News
The American Heart Association has issued its first scientific statement on bariatric surgery for severely obese individuals with regard to cardiovascular risk factors.
The statement “is not an across-the-board endorsement of bariatric surgery for the severely obese. It is a consensus document that provides expert perspective based on the results of recent scientific studies,” Dr. Paul Poirier and his coauthors said in a press statement. Dr. Poirier chaired the group, which developed the statement on behalf the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism (Circulation 2011 March 14 [doi:10.1161/CIR.0b013e3182149099]).
While obesity is an increasing problem worldwide, the severely obese–those with a body mass index (BMI) of 40 kg/m2 or greater–are the most rapidly growing segment of the obese population, the authors noted. “It is projected that in the near future, there will be at least 31 million U.S. adults who are severely obese and may qualify for bariatric surgery.”
The National Institutes of Health has proposed that surgical therapy be offered to patients with a BMI greater than 40 or with a BMI greater than 35 with serious obesity-related comorbidities.
Appropriately indicated bariatric surgery can lead to significant weight loss, which in turn leads to improvements in a number of comorbidities, including diabetes, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction, the authors observed. In fact, data from prospective, nonrandomized, or case-control population studies have shown that bariatric surgery can prolong life in severely obese individuals.
Currently there is no consensus about which bariatric surgical procedure – restrictive, malabsorptive, or combination – is best, nor are there established criteria or algorithms to guide surgeons in choosing which procedure might best suit a given patient. Nonetheless, the researchers stated that bariatric surgery “offers the only effective long-term treatment option for the severely obese patient.” They added that it should be reserved for severely obese patients who have failed medical therapy and who have an acceptable level of operative risk.
“Bariatric procedures are generally safe; however, this is not a benign surgery,” said lead author Dr. Poirier, director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University, Quebec City. While generally rare (less than 2 percent), early complications include thromboembolism, pulmonary or respiratory insufficiency, hemorrhage, peritonitis, and wound infection. Late complications can include gastrointestinal obstruction, ulcers, incisional hernias, hypoglycemia, steatorrhea, diarrhea, bacterial overgrowth, and nutritional deficiencies of micronutrients.
The group observed that perioperative management is best achieved by an interdisciplinary team that includes a surgeon, a medical specialist, and a registered dietician. “Mental health professionals should be available to patients who struggle postoperatively with psychosocial changes,” they noted. They also recommend additional research to evaluate the potential beneficial metabolic and cardiovascular changes associated with weight loss procedures, as well as to evaluate the benefits of bariatric surgery in severely obese adolescents.
Dr. Poirier reported having no financial disclosures. Several other authors reported significant financial relationships with a number of pharmaceutical and surgical equipment companies.
Online March 24, 2011