Facing the Risks
The risk of death from weight loss surgery is low, but severe complications can and do occur. Bariatric surgery carries a mortality rate of about 0.5 percent – equivalent to rates associated with total knee replacement surgery. That means one in 200 people who have bariatric surgery will die within three days of the operation. Although the cause could be directly related to the surgery, it also could be related to the patient’s obesity. People who are obese are more likely to have blood clots after surgery, regardless of what kind of surgery they undergo.
Complications may occur long after the patient leaves the hospital, too. A recent study by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality showed that within six months of undergoing bariatric surgery, up to 40 percent of people experience complications as varied as hernias, infections, pneumonia, leakage of gastric juices and dumping syndrome – an unpleasant phenomenon usually triggered by the consumption of too much food or sugar. The contents of the stomach are rapidly released, causing diarrhea, nausea, sweating and weakness.
A more serious long-range complication includes the formation of scar tissue around the band used in lap-band procedures, says Dr. Jamal. “Any time you put a foreign body inside a human, the body may reject it over the long term,” he says. “Removing the band can be difficult because sometimes it erodes into the stomach’s tissue, and when the scar tissue is removed, it doesn’t heal well because it doesn’t have a good blood supply, so infection may occur.”
“Bariatric surgery may also necessitate future plastic surgery to remove excess skin left behind after a massive weight loss. Most often this is necessary in older patients who have less elasticity in their skin, or those who were morbidly obese and had more weight to lose,” says Dr. Jamal.
Change in Attitude
The medical community is becoming more accepting of weight loss surgery due, in large part, to that 2004 review paper published in JAMA. Its extensive review of studies found that those morbidly obese people who don’t respond well to dieting and medications do respond well to surgery.
In 2005, a group of surgeons from Virginia Commonwealth University Health System, Richmond, led by Dr. Jamal, studied the impact of both obesity-related problems and bariatric surgery–related complications. They concluded that the risks associated with obesity are far greater than the risks associated with the surgery. The result? Physicians are more likely to approve surgery so that the life-threatening complications caused by obesity can be eliminated.
Insurers have come along more slowly than the medical community, to be sure, but the industry’s willingness to pay the costs of surgery for weight loss is changing.
“Insurance companies are realizing obesity is a disease and that bariatric surgery is a treatment, not a cosmetic operation,” says Dr. Jamal.
