Dr. Peter Hallowell, director of bariatric surgery at the University Health System, is the lead author of a study which recently concluded that long term outcomes for obese patients who undergo gastric bypass are better than outcomes for similar patients who do not.
Candidates for gastric bypass either weigh 100 pounds more than their ideal body weight, have a body mass index over 40 or have a BMI over 35 in addition to medical problems like diabetes and heart disease, according to Hallowell.
“The gastric bypass operation makes your stomach a lot smaller,” Hallowell said. “We staple off the most proximal part of the stomach and make it into a pouch. We hook the upper part of the small intestine back into the lower part, and disconnect the small stomach pouch and connect it to the lower part of the intestine.”
Hallowell explained that this surgery reduces the amount of food a patient can consume by reducing the size of their stomach and bypassing much of the intestine. According to the NIH Medline Plus Encyclopedia, a patient who undergoes gastric bypass will feel full after eating less food, and the calories from the food consumed will not be fully absorbed.
Recent research also indicates that gastric bypass surgery can initiate hormonal changes beneficial in helping people lose weight and keep it off, Hallowell said. A study by Dr. Blandine Laferrere, of St. Luke’s Hospital of New York, found that hormonal changes in patients who underwent gastric bypass improved insulin secretion and glucose tolerance. Gastric bypass may benefit patients with obesity related medical problems.
“Patients who have gastric bypass die less frequently from diseases like heart disease, diabetes and cancer,” Hollowell said. “There may be some in effect in helping prevent diabetes, but the link is not yet proven.”
Patient outcome data was plentiful for one to two years after surgery but not for 10 years or more. The gold standard for any such study is to use randomized clinical trials, Hallowell said. However, randomization is impossible because surgery is the patient’s choice. The next best approach, propensity matching — which finds patients from 10 years ago who are as similar as possible except for the fact that half chose gastric bypass and half did not — was used.
“I think that it helps us fill in the gaps,” Hallowell said. “That gives more evidence that this procedure should be offered to more people who are morbidly obese. It’s not treated as any other medical disease, and there are significant limitations for people morbidly obese to get this kind of therapy.”
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