Tip: Obese patients weigh surgery odds
Two-thirds of Americans are either overweight or obese, and it starts shockingly early. Research last April found almost one in five 4-year-olds already was obese. (Oct. 19, 2006) Credit: AFP/Getty Images
As older Americans get fatter, they are also getting sicker. Being severely overweight significantly raises the risk for a wide range of health problems, especially diabetes.
Bariatric surgery is often a last and best hope for obese patients. The two most common types of surgery are gastric bypass and the newer, less invasive laparoscopic gastric banding, also known as lap band.
"About 40 to 45 percent of the patients I deal with have some form of diabetes, mostly Type 2," says Dr. Alan Geiss, director of the Center for Bariatric Surgical Specialties at Syosset Hospital. "The weight is a causative factor."
In fact, a new study published in the June issue of Archives of Surgery found that bariatric surgery on patients with diabetes can reverse and even cure the disease. But not everyone qualifies for the procedure. The American College of Surgeons says, "Not all persons who are obese or who consider themselves overweight are candidates for bariatric surgery." The association says the procedure should be used "for prevention of the pathologic consequences of morbid obesity" and never for solely cosmetic reasons.
Bariatric surgery is typically approved for those with a body mass index (BMI) of 40 or above, or those with BMIs of 35-39.9 if they have weight-related health conditions such as diabetes. BMI is calculated by a formula using your height and weight. Anyone with a BMI above 25 is considered overweight, and those with BMIs 30 or higher are considered obese. (BMI readings are not gender specific.) You can calculate your BMI at the National Institutes of Health website, nhlbisupport.com/bmi.
While the cutoff for bariatric surgery has historically been a BMI of 35, that may be changing. "Presently, that's controversial," Geiss says, "but I think in the future, if it looks like that is a sustainable cure [because of the weight loss] for diabetes, they may lower the BMIs just for people with Type 2 diabetes."
As for age cutoffs, most surgeons, including Geiss, do not recommend gastric bypass surgery for people 60 and older. But there is no age restriction for lap-band surgery. "Lap band on a selective basis has been shown to be very safe in the older patient, as long as the risks are evaluated," Geiss says. Geiss, who has performed more than 5,000 bariatric surgeries, has successfully done lap-band procedures on patients in their 70s, he says.
Medicare will usually cover most of the costs of bariatric surgery as long as the patient has a BMI of 35 or higher and has other weight-related health problems.
