Will WLS Resolve All Common Co-Morbid Conditions?December 18, 2017
The decision to undergo weight loss surgery is a complicated one, which is why it should also be an informed one. Patients who arrive at these crossroads often face more than just extra weight. Co-morbidities associated with obesity include diabetes, hypertension, high cholesterol and other chronic medical conditions. One of the questions regularly asked about is will WLS resolve all common co-morbid conditions.
Does WLS Resolve All Common Co-Morbid Conditions?
Appropriate weight loss surgery candidates have often tried diets, exercise, and medications without success. The ideal surgical candidate is a committed, determined individual who desires a clear path to a healthy lifestyle free from these conditions.
The good news is that after surgery, as the weight comes off*, most patients see a resolution of obesity-related co-morbid conditions.
Obesity and Clinical Guidelines
Obesity is often defined as a body mass index (BMI) of ≥35. Clinical guidelines published in 2013 from the American Heart Association/American College of Cardiology make further distinctions based on waist circumference and other conditions. Typically, recommended weight loss treatment for obese individuals and overweight individuals with one or more indicators of increased cardiovascular disease (e.g., diabetes, pre-diabetes, hypertension, dyslipidemia**, elevated waist circumference) or other obesity-related co-morbid conditions.
For individuals with a BMI of ≥40 or a BMI ≥35 with obesity-related co-morbid conditions, the guidelines recommend weight loss surgery for individuals “motivated to lose weight” who have “not responded to other interventions to achieve health outcome goals.” The guidelines are based on evidence indicating that “bariatric surgery leads to improvements in both weight-related outcomes and many obesity-related co-morbid conditions.” The guidelines go on to state that bariatric surgery “should be considered an adjunct to lifestyle treatment: behavioral treatment, appropriate dietary modification, and physical activity.”
Types of Weight Loss Surgery Procedures
Gastric Bypass (RNY)
Gastric bypass surgery or Roux-en-Y is the original bariatric surgery and has been performed for decades. During this procedure, the surgeon creates a small pouch in the stomach and the GI tract is reconstructed to bypass some of the small intestine. The procedure is complex; patients lose between 60 to 80 percent of their body weight, and complications can include vitamin deficiencies. It requires life-long vitamin supplementation and dietary adherence.
Vertical Sleeve Gastrectomy (VSG)
In laparoscopic gastric sleeve surgery (a.k.a. sleeve gastrectomy), the surgeon removes approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana. The “sleeve” procedure induces rapid and significant weight loss that comparative studies find similar to Roux-en-Y gastric bypass: Weight loss of >50 percent for 3-5+ years, and weight loss comparable to that of gastric bypass with maintenance of >50 percent. Gastric sleeve surgery is a non-reversible procedure.
The sleeve procedure has grown in popularity due to patient preference; it is less invasive and typically requires a shorter hospital stay and faster recovery* compared with bypass surgery.
Lap-Band® and Gastric Balloons
Less invasive and noninvasive procedures such as the Lap-Band® or balloons are available; however, surgical outcomes for weight loss and resolution of obesity-related co-morbid conditions are superior to these interventions. No head to head studies compare the bypass to sleeve surgery to determine which procedure is more effective in reversing co-morbidities associated with obesity.
Other Obesity-Related Co-Morbidities
In addition to diabetes and cardiovascular risks, other obesity-related co-morbidities include stroke, sleep apnea, gallbladder disease, hyperuricemia and gout, and osteoarthritis. Certain cancers are also associated with obesity, including colorectal and prostate cancer in men and endometrial, breast, and gallbladder cancer in women.
The evidence is slowly gathering to indicate that the risk of some of these obesity-related co-morbid conditions can be mitigated by weight loss surgery. For example, a recent study published by Pratyusha Priyadarshini and colleagues in New Delhi, India, looked at 27 individuals with sleep apnea who underwent weight loss surgery (22 sleeve, 5 bypass). Results indicated statistically significant improvement in sleep apnea after 3 and 6 months based on the Epworth Sleepiness Scale health questionnaire and overnight polysomnography.
Co-Morbidities and Insurance Coverage for WLS
Patients and their doctors are not the only ones concerned with obesity-related co-morbid conditions. Insurance companies look at this data to make coverage decisions. Insurance policies vary, but many companies stipulate that the insured have a BMI above 35 with one or two co-morbidities. The Obesity Action Coalition offers a resource for patients to work with insurance companies to negotiate coverage, when possible.
Anecdotal evidence of the benefits of weight loss surgery abounds in online forums and on social media sites. The best advice for anyone considering weight loss surgery—as well as for those who are on the post-operative weight-loss journey— is to surround yourself with a support network. Sharing your experience with peers, and listening to their experience, is a powerful tool. Finding a good bariatric program that offers a support group is a key to success in achieving your health goals, whether that is strictly weight reduction or includes avoidance or resolution of diabetes, cardiovascular disease, hypertension, high cholesterol or other chronic conditions.
* Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if bariatric surgery is right for you.
** A high level of lipids (cholesterol, triglycerides, or both) carried by lipoproteins in the blood.
ABOUT THE AUTHORStelios Rekkas, MD, FACS, is a general surgeon with a focus on minimally invasive surgery and bariatric surgery. He specializes in minimally invasive surgeries that can provide less scarring and pain and may offer a quicker recovery for his patients. He is one of the few surgeons in Florida that performs robotic surgery using the da Vinci® Surgical System. Dr. Rekkas is board certified in general surgery and completed an accredited bariatric surgery fellowship. He is also the Director of Bariatric Surgery at Manatee Memorial Hospital.