Survey Report: It's a Toss-Up for Bariatric Surgery as First-Line Therapy

Respondents to a MedPage Today survey were almost equally split over whether bariatric surgery should be first-line therapy for obesity, but most of those who said Yes did so with reservations.

An American study has shown that gastric bypass reduced all-cause mortality by 40% and Swedish researchers found bariatric surgery of any type reduced morality by 29%. (See: Missing Link Found: Bariatric Surgery Reduces Mortality)

In light of those studies, both published in the New England Journal of Medicine, we asked MedPage Today visitors whether bariatric surgery should be elevated into first-line therapy for obesity.

Of the 697 respondents, 52% said Yes, but seven out of 10 of those who voted in the affirmative would suggest surgery first only for patients are morbidly obese.

Morbid obesity is typically defined as being 100 pounds or more over ideal body weight or having a body mass index of 40 or higher.

The 48% who said No believe that bariatric surgery should be a last resort after diet and exercise.

Noted one respondent, "there needs to be a serious plan of pre-surgery attempts to gain control. I think we need a standardized plan offering different proven diet and behavioral plans with long term efficacy studies."

An endocrinologist expressed concern about the long-term complications of gastric bypass surgeries, the lack of durable results, and the inability to adjust or reverse the procedure.

"It's like buying a car with a factory-set throttle," he said.

"Laparoscopic banding is much safer, adjustable, reversible, does not cause malnutrition (except by limiting intake), and it appears to result in greater long-term weight loss," he continued. "However, long-term experience is still limited, and some bariatric surgeons are highly critical of it."

"Diet and exercise are for everyone, not just the obese, but they are rarely sufficient for long-term significant weight loss," he said. "For most patients, lifelong treatment with a combination of medical therapies may be the best option."

The National Institutes of Health recommends bariatric surgery only for individuals with a BMI of 40 or greater (35 for patients with coexisting illnesses) who have failed other treatments.