Weight Loss Surgery: Is It For You? (cont.)

Is Surgery the Solution?

According to Georgeann Mallory, RD, LD, executive director of the American Society for Bariatric Surgery, about 103,000 Americans will undergo weight loss surgery in 2003 -- a four-fold increase over just five years earlier -- and the results of the procedure can be impressive.

"The average weight loss with the surgery is about two-thirds to three-fourths of an individual's excess weight," says Elliot Goodman, MD, founding surgeon of the Montefiore Center for Weight Reduction Surgery and assistant professor of surgery at the Albert Einstein School of Medicine in the Bronx, N.Y.

But weight loss surgery has always been considered a last-resort measure, reserved for the severely obese whose options are growing thin, having tried in vain to repeatedly lose weight with diet, exercise, and weight-loss drugs. To determine if you're a candidate for this surgery, doctors will use a calculation called the body mass index, or BMI, as a guide.

Individuals with a BMI of 40 or greater -- which translates to about 100 pounds or more of excess body weight -- are prime candidates for the surgery. For obese individuals with serious medical conditions (e.g., diabetes, severe sleep apnea), the BMI guidelines for surgery drop to 35 to 39.9.

If you have serious heart or lung problems, however, many bariatric surgical centers would turn you away. The same is true if you're over a certain age (some programs rarely perform surgery on patients in their 60s or older). Some may also refuse to perform the surgery if you weigh more than 450 or 500 pounds, although others are more flexible in the patients they'll accept and have good success records with higher-risk cases.

Patients who weigh 500 pounds, for example, are definitely at greater risk when undergoing the weight-loss operation, says Philip Schauer, MD, the director of bariatric surgery at the University of Pittsburgh. "But surgery is literally life-sparing for them. For someone that size, it's the only option."

And what if you don't meet the BMI criteria? Some bariatric surgeons are debating whether the generally accepted BMI thresholds should be relaxed because of the documented health benefits of weight loss surgery, thus offering the procedure to individuals with more moderate obesity. With so many serious medical problems associated with being overweight -- including heart disease, high blood pressure, stroke, joint problems, gallbladder disease and some types of cancer -- the risks of obesity may need to be weighed in the decision-making process, say some surgeons.

Certainly not everyone agrees that the surgery should be available to those who don't meet the current BMI guidelines. "Although you could make an argument to liberalize the criteria for some patients, I feel strongly that anything outside of the National Institutes of Health guidelines should only be done in a research study," says Mitchell Roslin, MD, chief of obesity surgery at Lenox Hill Hospital in New York City.