U.S. weighs obesity surgery options
Studies show no method works without also changing lifestyle

(AP) -- As more people abandon New Year's resolutions to lose weight and
turn to obesity surgery, doctors are debating which type is safest and
best.

And researchers are uncovering some surprising trends.

The most common method in the United States -- gastric bypass, or
stomach-stapling surgery -- may be riskier than once thought. Yet surgeons
still favor it for people who need to lose weight fast because of heart
damage or other serious problems.

A gentler approach favored in Europe and Australia -- an adjustable stomach
band -- can give long-term results that are almost as good and with far
fewer risks. It may be the best option for children or women contemplating
pregnancy, and is reversible if problems develop.

A radical operation -- cutting away part of the stomach and rerouting the
intestines -- is increasingly being recommended for severely obese people.
It gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three
options.

But regardless of which method is used, studies show an inescapable
reality: No surgery gives lasting results unless people also change eating
and exercising habits.

"The body just has many ways of compensating, even after something as
drastic as surgery," said Dr. Louis Aronne, director of the weight loss
program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in
bariatrics, as this field is known. The group's recent annual conference in
Vancouver featured many studies on surgery's long-term effects.

Obesity is a problem worldwide. About 31 percent of American adults -- 61
million people -- are considered obese, with a body-mass index of 30 or
more. That's based on height and weight. Someone 5-foot-4 is obese at 175
pounds; 222 does it for a 6-footer.

Federal guidelines say surgery shouldn't be considered unless someone has
tried conventional ways to shed pounds and is at least 100 pounds over
ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related
medical problem like diabetes or high blood pressure.

More people are meeting those conditions. A decade ago, less than 10,000
such surgeries were done in the United States. That ballooned to 70,000 in
2002 and more than 170,000 in 2005, says the American Society for Bariatric
Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y
gastric bypass, or the adjustable band, which is rapidly gaining fans.
Either can be done through a big incision, or laparoscopically with tiny
instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the
stomach and connected to the small intestine. People eat less because the
pouch holds little food, and they absorb fewer calories because much of the
intestine is bypassed. They must take protein and vitamin supplements to
prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far
longer in Europe and Australia where it is dominant. It accounted for 17
percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to
tighten it and restrict how much food can enter and pass through the
stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent
for gastric bypass. One recent study of Medicare patients found deaths a
year after gastric bypass as high as 3 to 5 percent.

The band's reversibility makes it a better choice for children, some
doctors say.

"It's becoming more well-known and more accepted. Patients like it because
it's less invasive. It's an easier surgical procedure. It's safer," said
Georgeann Mallory, executive director of the bariatric society.

"To me it is a very straightforward decision," said Dr. Paul O'Brien,
director of the Centre for Obesity Research and Education at Monash
University in Melbourne, Australia. "I would strongly recommend that the
consumer consider the safest effective procedure first," which is the band,
he said.

American doctors have preferred bypass operations because they produce
faster, greater weight loss. But new research by O'Brien and others calls
that into question.

Combining results on 23,638 patients in 43 published studies, they found
that bypasses beat bands for the first three years but were comparable
after seven years, with excess weight loss of 55 percent for bypass and 51
percent for bands.

That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at
the University of Texas Southwestern Medical Center and chief of bariatric
surgery for the Department of Veteran's Affairs national system.

"I really was not enthusiastic about bands until I came to Dallas from Los
Angeles and saw the results from the group that I joined, which where quite
good," he confessed. "What you can accomplish in a year with a gastric
bypass you can accomplish in five years with a laparoscopic band."

Results would improve if Americans copied the Australians and included in
the price of the band any future adjustments, Livingston said.

"A key to the success of banding procedures is the followup and working
with a patient on their compliance," he said. "When they come in and
they've sort of fallen off the wagon, you adjust the band. It really has an
amazing effect."

Bands also appear safer for women attempting pregnancy. Several years ago
in Massachusetts, a woman and her 8-month-old fetus died of complications
18 months after gastric bypass surgery. Other pregnancy-related deaths have
been reported.

In contrast, another study O'Brien and colleagues presented at the obesity
meeting found that pregnancy outcomes for women with stomach bands were
comparable to normal-weight women, and better than for obese women without
bands.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New
York City, did a band operation in October for Long Islander Donna Dotzler,
who weighed 279 pounds, but wants to do a more drastic surgery for her
husband.

"I gave up on New Year's resolutions maybe five years ago," said Jim
Dotzler, who weighs 479 pounds. "I'm a smart guy. If this were a matter of
willpower, I'd have taken care of this a long time ago."

The operation Roslin has advised for him is BPD, which stands for
biliopancreatic diversion, with or without a second procedure called a
duodenal switch. Studies show it can cause loss of up to 80 percent of
excess body weight for at least as long as 10 years afterward.

Surgeons remove three-fourths of the stomach to leave a sleeve- or
banana-shaped organ that is connected to the small intestine, bypassing
more of it than a standard gastric bypass does. It can be done in two
operations a year apart to reduce its severity and the chances of death,
which can be as high as 5 percent.

The "switch" preserves a valve that controls release of food into the
intestines from the stomach. These operations account for nearly 5 percent
of U.S. obesity surgeries and are growing.

On the horizon are other approaches, like vagus nerve stimulation, to
control impulses to eat, and new drugs like rimonabant, which blocks a
pleasure center in the brain that makes people want to munch.

"I see the future as combined therapy," with surgery, medication and other
approaches used simultaneously, said Aronne, the obesity society president.
"Time will tell what works out best."