Tuesday, October 23, 2007

The Elephant in the Room

All around the web, the talk is going on. Bloggers are posting about it. Message boards are talking about it. News reports are abundant. But in all this, the WLS community is strangely quiet. The message boards have nothing to say. None of the bloggers are talking about it, not even the more vocal ones. What is it I'm talking about?? THIS:

NewsDaily: Science -- Death rate higher after gastric bypass

PITTSBURGH, Oct. 16 (UPI) -- A University of Pittsburgh study found 6 percent of those undergoing bariatric surgery -- a treatment for severe obesity -- died within five years.

The study, published in the Archives of Surgery, also found the death rate for those with the surgery higher than that of the general population in the cases of heart disease and suicide.

Dr. Bennet I. Omalu, of the University of Pittsburgh, and colleagues analyzed data on all bariatric operations performed on Pennsylvania residents between 1995 and 2004. Following 16,683 operations, 440 patients -- less than 3 percent -- died. Almost 20 percent of those deaths were from heart disease.

Of the 45 deaths from traumatic causes, 16 were suicides and l4 were drug overdoses not classified as suicides. National statistics for the general population would predict only two suicide deaths among this number of individuals.

The study authors suggest mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes, high cholesterol and smoking.

Since my blog focuses on WLS and mental health, I could not let this go.

I have posted before on the statistics surrounding WLS and mental health. Two thirds of those seeking to have weight loss surgery have a history of mental illness. I'm in the process of working on a more in depth post about this. I do want to leave you with this thought. If you have already had WLS, there is nothing weak of character in obtaining follow up psych help after your surgery.

If you are seeking to have WLS, think long and hard about your decision. There is more to this study than has been reported in the news. Bariatric centers want you to believe that having the surgery will better your health and allow you to live longer. But as my fellow blogger, Sandy Szwarc, BSN, RN, CCP, JunkFood Science points out, this study shows just the opposite is true. Here is just a small sample of what the study actually proves.

Junkfood Science: JFS Special: The latest research on actual deaths seen after surgery for weight loss

Looking at the cumulative deaths according to the time after surgery, they found that nearly 3% overall had died after the first year and 6.4% of the patients were dead by the end of the fourth year after their surgeries. They also looked at long-term risks, reporting:

We also estimated the long-term mortality for individuals who had undergone surgery many years ago. For the 1995 cohort who had at least 9 years of follow-up, 13.0% had died. From the 1996 cohort with 8 years of follow-up, 15.8% had died, and from the 1997 cohort with 7 years of follow-up, 10.5% had died. For the 1998-1999 cohorts with 5 to 6 years of follow-up, the total mortality was 7.0% to 2004.

The U.S. National Center for Health Statistics of the Centers for Disease Control and Prevention data reports that the overall death rates among Americans of the same age is 0.352% — for men it is 0.44% while for women this age it’s 0.26%.

These are minuscule compared to the numbers dying after bariatric surgery. In fact, there is no data to suggest that fat people die at ten times the rate of most Americans to even approach these death rates. The most available figures are the latest estimates of deaths according to BMI led by Dr. Katherine Flegal, Ph.D., at the CDC, National Center for Health Statistics. Using NHANES I - III data, they found that among American adults of this age, those with BMIs of 35 and higher (qualifying for bariatric surgeries) had increased relative risks of dying of 25% for nonsmokers or 83% overall. (These rates are slightly higher than calculating actual deaths and estimated numbers of Americans with BMIs >35 in NHANES III. As Flegal and colleagues noted, the latest NHANES data indicates mortality rates associated with high BMIs have continued to drop since then with each NHANES.)

This equates to actual mortality rates for the most “morbidly” obese of about 0.44% to 0.64% — still not appreciably higher than the rest of the population and nowhere close to the bariatric surgical patients of comparable ages and weights in this study.

So, by best estimates, bariatric surgery likely increased the actual mortality risks for these patients in the first four years by 363% to 250%.

So read the rest of the post. That way you can make an informed decision on having WLS in the first place. Stay tuned for my more in depth look at the mental health aspect of WLS coming up soon.