Bariatric Surgery Benefits & Risks

It's obvious to many people who have lived with for years morbid obesity that the disease has a severe negative impact on quality of life. Because of morbid obesity, you may choose not to participate in certain activities. You may feel that you have limited career choices.

What you may not know is that morbid obesity has been found to affect the quality of your health and the length of your life.⁴  

Morbid obesity has been linked to several serious and life-threatening diseases. These medical, or co-morbid, conditions include type 2 diabetes, heart disease and high blood pressure, acid reflux/GERD, and cancer. Most of these conditions do not develop for years. So many people living with morbid obesity may have one or more of these health issues without even realizing it.

Bariatric surgery may offer you a whole new outlook on health

• One study found that gastric bypass surgery reduced the total number of co-morbid conditions of participating patients by 96%.
• Many surgeons recommended bariatric surgery as a treatment option for type 2 diabetes.¹² In some cases, resolution of type 2 diabetes occurred within days of the surgery.⁴
• A meta-analysis stated that several studies found that bariatric surgery patients felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.⁴

Type 2 Diabetes

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Type 2 Diabetes Resolved	83.8%4	47.8%4

Long-term Complications
Type 2 diabetes can be a lifelong condition. It  is an increasingly widespread health issue in the U.S. and has serious long-term consequences. You may want to compare bariatric surgery's high resolution rates for type 2 diabetes to the long-term effects of the condition.

People with type 2 diabetes are at risk for developing:

• Heart disease, or suffer strokes due to poor circulation
• Kidney disease and eventually kidney failure, which requires either a kidney transplant or dialysis
• Nerve damage which can lead to digestive problems, bladder problems, sexual dysfunction, and numbness and tingling
• Foot problems including blisters, ulcers, and poor circulation, which can lead to amputation
• Eye complications such as glaucoma, cataracts, and nerve damage, which can lead to blindness

Heart Disease and High Blood Pressure

	Gastric Bypass % of Patients	Gastric Banding % of Patients
High Blood Pressure Resolved	75.4%4	38.4%4

Long-term Complications of Heart Disease and High Blood Pressure
Heart disease and high blood pressure are related health conditions. High blood pressure indicates that your heart is straining to pump blood throughout your circulatory system and can lead to health disorders such as heart disease.

Heart disease is an umbrella term for several diseases that affect the heart and the circulatory system. Heart disease can be quite serious and fatal. You may want to compare bariatric surgery's high resolution rates for heart disease to the long-term effects of these conditions.

People living with morbid obesity are at risk for developing heart disease and high blood pressure, including conditions such as:

• Coronary artery disease which occurs when the coronary arteries become hardened and narrowed by fatty material; there are rarely any signs or symptoms, so many people with this disease have lived with it for years with the first onset of symptoms, such as a "sudden" heart attack
• Heart attack which occurs when the heart's blood supply is interrupted and can damage or completely stop the heart
  Angina which occurs when the heart does not get enough blood and feels like pressure or squeezing in the chest, shoulders, arms, neck, jaw, or back
• Arrhythmias which are irregular heartbeats, depending on the type, arrhythmias can lead to death
• Heart disease including bleeding along artery walls, hardening of the arteries, and heart attack
• Stroke which is an interruption or blockage of blood to the brain
• Kidney damage and kidney failure due to damaged blood vessels and which can require a kidney transplant or dialysis
• Vision loss due to blocked blood vessels to the eye

High Cholesterol

	Gastric Bypass % of Patients	Gastric Banding % of Patients
High Cholesterol Improved	95%4	78.3%4

Long-term Complications
Cholesterol is a soft, waxy substance found in all parts of the body. High cholesterol can be harmful and is associated with serious health conditions. You may want to compare bariatric surgery's high improvement rates for this condition to the long-term effects of high cholesterol.

People with high cholesterol are at risk for developing:

• Heart disease including hardening of the arteries (atherosclerosis), which is a principle cause of coronary heart disease, and heart attack
• Stroke which is an interruption or blockage of blood to the brain

Obstructive Sleep Apnea

Long-term Complications
Obstructive sleep apnea is a sleep disorder with symptoms of loud snoring and long pauses in breathing. Often the person with obstructive sleep apnea is unaware of their condition until they're told by a family member or friend. Obstructive sleep apnea is linked to several serious conditions and experiences. You may want to compare bariatric surgery's high resolution rates for this condition to the long-term effects of obstructive sleep apnea.

People with obstructive sleep apnea are at risk for:

• Heart disease due to low oxygen levels in blood
• Heart attack which occurs because of low oxygen levels in blood
• Daytime drowsiness which can lower job performance or lead to accidents such as serious car crashes

Acid Reflux/GERD

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Acid Reflux/GERD Resolved	98%5	32.3%13

Long-term Complications
Acid reflux, also known as GERD, occurs when the valve between the stomach and the esophagus is not working. Stomach acid splashes up into the esophagus, which can damage it and lead to painful conditions and cancer. You may want to compare bariatric surgery's high resolution rates for acid reflux to the long-term effects of this condition.

People with acid reflux are at risk for developing:

– Esophagitis, inflammation of the esophagus, which can cause difficulty swallowing, ulcers, and scarring
Barrett's esophagus which occurs because the lining of the esophagus is damaged by stomach acid and can lead to esophageal cancer
– Esophageal cancer (adenocarcinoma) is associated with a low survival rate: only 12% of esophageal cancer patients survive for more than five years⁸  

Morbid Obesity and Cancer Risks

Several studies have been conducted to examine the link between morbid obesity and cancer.

In 2001, experts at the National Cancer Institute concluded that several cancers are associated with obesity:¹⁴  

• Colon cancer
• Breast cancer (postmenopausal)
• Endometrial cancer (lining of the uterus)
• Kidney cancer
• Esophageal cancer (adenocarcinoma)

In 2003, an article in the New England Journal of Medicine estimated that obesity could account for:¹⁵

14% of all deaths from cancer in men
20% of all deaths from cancer in women

A Proven Treatment Option

Several clinical studies of bariatric surgery show that surgery improved life expectancy in patients by at least 29 to 89 percent.^6,16,17,18

A Note on Relative Risk
The charts below refer to "relative risk", which compares how likely an event is to occur to a person versus another person. The charts show how much more likely a person with morbid obesity is to develop cancer or die from cancer versus a person with a healthy weight.

The National Cancer Institute found that people living with morbid obesity are more likely to develop certain cancers than healthy-weight people:
¹⁴  

Type of Cancer	Women	Men
Esophageal cancer (adenocarcinoma)	200% higher relative risk of occurrence14	200% higher relative risk of occurrence14
Kidney cancer	84% higher relative risk of occurrence14	84% higher relative risk of occurrence14
Colon cancer	No data available	Increased risk of occurrence14
Breast cancer	50% higher relative risk of occurrence14	No data available
Uterine cancer	200% to 400% higher relative risk of occurrence14	N/A

Study in the New England Journal of Medicine found that people living with morbid obesity had significantly higher death rates from cancer than healthy-weight people:
¹⁵  

Type of Cancer	Women	Men
All types	62% higher relative risk of death15	52% higher relative risk of death15
Esophageal cancer (adenocarcinoma)	No data available	63% higher relative risk of death15
Kidney cancer	475% higher relative risk of death15	70% higher relative risk of death15
Stomach cancer	8% higher relative risk of death15	94% higher relative risk of death15
Colorectal cancer	46% higher relative risk of death15	84% higher relative risk of death15
Liver cancer	68% higher relative risk of death15	452% higher relative risk of death15
Pancreatic cancer	276% higher relative risk of death15	49% higher relative risk of death15
Non-Hodgkin's lymphoma	95% higher relative risk of death15	49% higher relative risk of death15
Multiple myeloma	44% higher relative risk of death15	71% higher relative risk of death15
Leukemia	Lower relative risk of death15	70% higher relative risk of death15
Breast cancer	212% higher relative risk of death15	No data available
Cervical cancer	320% higher relative risk of death15	N/A
Ovarian cancer	51% higher relative risk of death15	N/A
Uterine cancer	625% higher relative risk of death15	N/A
Prostate cancer	N/A	34% higher relative risk of death15

Cancer and obesity are linked, but there is hope:

• One recent study that examined the effect of intentional weight loss found that women who experienced intentional weight loss of 20 or more pounds and were not currently overweight had cancer rates at the level of healthy women who never lost weight.¹⁴
• Several clinical studies found that bariatric surgery reduced mortality in patients by 29% to 89% when compared to a group of people living with morbid obesity who had not had the surgery.^6,16,17,18

Depression

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Depression Improved	47%2	No data available

Symptoms and Signs
Clinical depression is a mood disorder during which feelings of sadness, loss, anger, or frustration interfere with everyday living for extended periods of time. This is very different from having a bad day, feeling unhappy, or just "down in the dumps."   You may want to consider bariatric surgery's improvement rates for this condition.

People with depression may experience:

• Lower quality of life
• Sadness
• Lack of interest in, and withdrawal from, usual activities
• Feelings of hopelessness
• Lack of energy
• Difficulty concentrating
• Difficulty making decisions
• Insomnia or excessive sleep
• Stomach aches and digestive problems
• Sexual dysfunction
• Thoughts of death, suicide, or self-mutilation

Osteoarthritis and Joint Pain

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Osteoarthritis and Joint Pain Resolved	41%2	No data available

Long-term Complications
Osteoarthritis is also known as degenerative joint disease. It results in the breakdown of the cartilage in the joints. Without cartilage, the bones rub against each other, and the joints become stiff and painful. You may want to consider bariatric surgery's resolution rates for osteoarthritis and the long-term effects of the condition.

People with osteoarthritis are at risk for developing:
Muscular atrophy due to the reduced range of movement caused by pain and stiffness in the joints

• Loss of mobility because osteoarthritis commonly occurs in the hips, knees, and spine, making it harder and more painful to walk and move around
• Joint swelling caused by the friction of bones rubbing against each other

Stress Urinary Incontinence

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Stress Urinary Incontinence Resolved	44%2	No data available

Symptoms and Signs
Stress urinary incontinence can be an embarrassing health issue that can disrupt social activities and careers. It is an involuntary loss of urine that may occur during physical activity, such as coughing, sneezing, laughing, and exercise. You may want to consider bariatric surgery's resolution rates for this condition.

Female Reproductive Health
You may want to consider bariatric surgery's resolution rates for these conditions and the long-term effects of reproductive health.

In a study of 28 patients with Polycystic Ovarian Syndrome who had gastric bypass surgery, the following results were reported:

	Gastric Bypass % of Patients	Gastric Banding % of Patients
Menstrual Dysfunction Due to Polycystic Ovarian Syndrome Resolved	100%19,20	No data available
Excess Hair Due to Polycystic Ovarian Syndrome Resolved	79%19,20	No data available
Restores ovulation and fertility	Yes19 5 of 5 patients (100%)	No data available

Women living with morbid obesity may experience certain reproductive health issues, such as:

• Menstrual dysfunction due to polycystic ovarian syndrome (PCOS)
• Excess hair (also known as hirsutism) due to PCOS
• Infertility

Additional Health Benefits
You may want to compare bariatric surgery's resolution rates for these conditions to the long-term effects of these health issues.

Metabolic Syndrome
Also known as syndrome X, metabolic syndrome is a group of risk factors including high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal obesity. People with metabolic syndrome are at risk for developing:

• Heart disease, including hardening of the arteries, which can lead to heart attacks and stroke
• Diabetes which can lead to kidney failure, amputation of feet, and blindness

80% of gastric bypass patients experienced complete resolution of metabolic syndrome after surgery.²¹  

Migraines
Migraines are throbbing headaches that can last up to 48 hours and are often accompanied by vomiting, nausea, loss of appetite, tiredness, and sensitivity to light and sound. While migraines are not generally considered a significant threat to overall health, they are associated with a lower quality of life. People with migraines are at risk for developing:

• Stroke, an extremely rare complication of severe migraines.
• 57% of gastric bypass patients experienced complete resolution of migraines after surgery.²  

Venous Stasis Disease
Venous stasis disease occurs when the veins have problems sending blood from the legs back to the heart. Fluid seeps out of the overfilled veins into surrounding leg tissues and cause tissue breakdown and ulcers. And because skin ulcers are the result of poor blood circulation, these wounds are often slow to heal. People with venous stasis disease may experience:

• Painful ulcers
• Rashes
• Leg pains
• Dark red or purple skin over the affected area
• Skin may become thickened, dry, and itchy

95% of gastric bypass patients experienced complete resolution of venous stasis disease after surgery.²²  

Pseudotumor Cerebri
Pseudotumor cerebri is a condition that appears to be a tumor—but it is not. The major symptom is increased pressure within the skull; other symptoms include headache, buzzing sound in the ears, dizziness, and nausea.

• Vision loss can occur with this condition.
• 96% of gastric bypass patients experienced complete resolution of pseudotumor cerebri after surgery.^22,23  

Risks and Complications
Maintaining the proper body weight is more than just a function of bariatric surgery. It is a lifelong commitment that goes beyond adjusting your lifestyle and sticking to a healthy diet.

While surgery has become a preferred option for morbidly obese individuals, there are still some uncertainties about the long-term impact of the procedures on nutrition and body systems. As such, patients will need ongoing nutritional counseling and periodic checks for anemia (low red blood cell count), B-12, folate, protein, calcium and iron levels.

Initially, these tests will be conducted every three to six months or as needed. After that, they will be required at a minimum of once a year.

References

2 Schauer P, Ikramuddin S, Gourash W, et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000 Oct;232(4):515-29.

4 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A Systematic Review and Meta-Analysis. JAMA 2004;292(14):1724-37.
5 Wittgrove A, Clark G. Laparoscopic Gastric Bypass, Roux-En-Y 500 Patients: Technique and Results, with 3-60 Month Follow-up. Obes Surg 2000 Jun;10(3):233-9.

6 Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240(3):416-24.

8 Eisen G. Capsule Endoscopy: New Applications. J Fam Pract 2005 Dec;54(12 Suppl):9-14.

12 Pories W, Swanson M, Macdonald K, et al. Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Ann Surg 1995;222(3):339-52.

13 Tolonen P, Victorzon M, Niemi R, et al. Does Gastric Banding for Morbid Obesity Reduce or Increase Gastroesophageal Reflux? Obes Surg 2006;16(11):1469-74.

14 National Cancer Institute. Obesity and Cancer: Questions and Answers. [Online] 31 June 2007. http://www.cancer.gov/cancertopics/factsheet/Risk/obesity.

15 Calle E, Rodriguez C, Walker-Thurmond K, et al. Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults. N Engl J Med 2003;348:1625-38.

16 Sowemimo O, Yood S, Courtney J, et al. Natural History of Morbid Obesity with Surgical Intervention. Surg Obes Relat Dis 2007;3:73-7.

17 Sjostrom L, Narbro K, Sjostrom D, et al. Effects of Bariatric Surgery in Swedish Obese Subjects. N Engl J Med 2007;357(8):741-52.

18 Adams T, Gress R, Smith S, et al. Long-Term Mortality after Gastric Bypass Surgery. N Engl J Med 2007;357(8):753-61.

19 Eid GM, Cottam DR, Velcu LM, et al. Effective Treatment of Polycystic Ovarian Syndrome with Roux-En-Y Gastric Bypass. SOARD 2005 Mar;1(2):77-80.

20 Dr. Joseph F. Smith Medical Library. Polycystic Ovary Syndrome. [Online] 1 August 2005. http://www.chclibrary.org/micromed/00061250.html.

21 Mattar S, Velcu L, Rabinovitz M. Surgically Induced Weight Loss Significantly Improves Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome. Ann Surg 2006;242(4):610-20.

22 Sugerman H, Sugerman E, Wolfe L. Risks and Benefits of Gastric Bypass in Morbidly Obese Patients with Severe Venous Stasis Disease. Ann Surg 2001;234(1):41-6.

23 Sugerman H, Felton W, Aristides S. Gastric Surgery for Pseudotumor Cerebri Associated with Severe Obesity. Ann Surg 1999;229(5):634-42.

30 Waller K, Shaw G, Rasmussen S, et al. Prepregnancy Obesity as a Risk Factor for Structural Birth Defects. J Arch Pediat Adolesc Med 2007;161:745-50.