the world is sick.
I was browsing the news, when I came upon an article that disturbed me greatly. As I couldn't find it put in these terms anywhere else online, I translated it. Source, in Swedish.
Surgery best method to cure obesity
Surgery against obesity heavily reduces the risk to die in cardiovascular diseases, diabetes and cancer. Conventional treatment against obesity at Swedish health centres have, on the other hand, no effect at all.
This was proven in a study on four thousand Swedish patients with obesity, that's published in the Thursday's issue of the New England Journal of Medicine.
"The consequence would reasonably be that obesity surgery becomes common and more accepted. Today we operate about a thousand a year in Sweden. I think we need to operate five, ten times as many," says Lars Sjöström, professor emeritus at Sahlgrenska University Hospital and leader of the Swedish study.
In the same issue of the New England Journal of Medicine an American study on eight thousand patients is published as well. The results clearly point in the same direction: in the American study the mortality in the operated group dropped with forty percent, in the Swedish study with thirty percent. Diabetes as a death cause was nearly eliminated in the operated group, while the risk of dying of cancer and cardiovascular diseases went down with sixty percent.
Today there is no set limit in Sweden for how fat you should be to be operated upon. But many doctors follow the American standard, which requires a BMI, Body mass index, of 40, or 35 if you have other risk factors, such as diabetes.
"I could see the limit at 34 or 35. And if I had a patient with a BMI of 30, 31 and severe disorders, like diabetes or high blood pressure, and it couldn't be controlled through medication, then I wouldn't doubt surgery," says Lars Sjöström.
A limit at BMI 35 is also recommended by an expert group that is working on national guidelines, TT reports from the ongoing surgeon-week in Stockholm.
In the Swedish study there's been 25 surgeon centres and 480 health centres. The two thousand operated obesity patients have been followed for an average of ten years. They have been compared with an equal number of people that declined surgery. These people have instead been offered the health centres conventional treatment (exactly what it is made up of is not made clear in the study).
Those who underwent surgery with the most effective method, gastric bypass, had after ten years dropped on average 25 percent. The control people, who had been given conventional treatment, hadn't lost anything.
"This shows that Swdish health care does not have the methods that will have an effect upon obesity in the long run," says Lars Sjöström.
Three different surgery methods were part of the study. They were gastric bypass, vertical-banded gastroplasty and lap banding.
Gatric bypass was proven the most effective. Those who had gone through vertical-banded gastroplasty had, after ten years, lost an average of 16 percent in weight, and those who had gone through banding had lost 14 percent.
"When we started the study in 1987 gastric bypass was only available in Örebro. It was considered a far too dangerous procedure. Today the method is not as frightening, it can be done with laparoscopy," says Lars Sjöström.
However, it is impossible to avoid the fact that the surgery may lead to complications such as infections and blood clots, and in worst case scenario, death. And the most efficient method, gastric bypass, is slightly more dangerous. In the Swedish study, five of the 2.000 patients died from the procedure. That equals a mortality of 0,25 percent.
Lars Sjöström still wants to recommend obese people to take the risk:
"As a patient you have everything to gain. The mortality is on a steady decline. And we have measured life quality in other studies. It is unambigious: the more you lose, the better the life quality."
I found another article on it, though it was more on the basic facts. Source.
Missing Link Found: Bariatric Surgery Reduces Mortality
GOTHENBURG, Sweden, Aug. 22 -- Two research groups have provided long-awaited evidence that bariatric surgery saves lives, up to 136 per 10,000 operations.
Gastric bypass reduced all-cause mortality 40% in a study of severely obese American patients, and bariatric surgery of whatever type reduced morality 29% in a Swedish study. The results of both studies were reported in the Aug. 23 issue of the New England Journal of Medicine.
Weight loss has been well documented to reduce mortality risk factors, including incident diabetes, commented George A. Bray, M.D., of Louisiana State University, in an accompanying editorial.
But, he noted, some epidemiologic studies have suggested shedding pounds may worsen life expectancy, possibly from confounding by unintentional loss.
For a more conclusive answer, Lars Sjöström, M.D., Ph.D., of Gothenburg University here, and colleagues, conducted a prospective controlled trial.
Their Swedish Obese Subjects study included 2,010 patients who underwent bariatric surgery and 2,037 matched controls who didn't want surgery and received whatever treatment was customary at the center where they registered. This ranged from intensive lifestyle intervention and behavior modification to no treatment.
Most of the surgeries were vertical banded gastroplasties (68%). The rest were split between nonadjustable or adjustable banding similar to the lap band (19%) and gastric bypass (13%).
Participants were age 37 to 60 at enrollment from 1987 to 2001. The minimum eligible body mass index (BMI) was 34 for men and 38 for women, which was chosen before the 1991 NIH Consensus Conference recommended a cutoff of 40 (35 for patients with coexisting illnesses).
After an average of 10.9 years of follow-up and with an impressive 99.9% follow-up rate, there were 129 deaths in the control group and 101 in the surgery group. The most common causes were MI and cancer.
After adjustment for sex, age, and risk factors, all-cause mortality was 29% lower for the surgery group than for the controls (hazard ratio 0.71, P=0.01).
But because the Swedish study included primarily vertical banded gastroplasty, which is no longer commonly used, Ted D. Adams, Ph.D., M.P.H., of the University of Utah in Salt Lake City, and colleagues, looked at long-term mortality with gastric bypass surgery.
Their study included a series of 7,925 gastric bypass surgeries done from 1984 through 2002 at a single center in Utah. These cases were matched to 7,925 randomly selected control adults with a BMI of 35 or higher based on height and weight self-reported on Utah driver's license and identification card applications.
The researchers gathered data from the National Death Index and the Utah Cancer Registry.
After a mean of 7.1 years of follow-up, the adjusted death rate was 40% lower with surgery than without it (hazard ratio 0.60, 95% CI 0.45 to 0.67, P<0.001).
For specific causes, the death rates with gastric bypass versus without the surgery were:
* 52% lower for all diseases combined (P<0.001)
* 92% lower for diabetes (P=0.005)
* 59% lower for coronary artery disease (P=0.006)
* 60% lower for cancer (P=0.001)
The reduction in cancer-related deaths was surprising, the researchers said, but suggested it may be related to improved cancer screening with weight loss.
Not all the results were postitive, however. Deaths from suicide, accidents, poisonings, and other nondisease causes were 1.58 times more common among surgical patients than among controls (P=0.04).
This warrants research into "the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery," the researchers wrote.
Nevertheless, the net effect was prevention of 136 deaths per 10,000 operations, they said.
Early death rates contrasted in the two studies. In the Swedish study, early death -- occurring within 90 days of the surgery for either the patient or his matched control -- was substantially more common in the surgery group than among controls (0.25% versus 0.10%). In the U.S. study, deaths occurring in the first year were similar between groups (0.53% versus 0.52%).
But, overall the findings may argue that it is time to reevaluate BMI guidelines for bariatric surgery, Dr. Bray said in his editorial comment.
"The question as to whether intentional weight loss improves life span has been answered," he concluded, "and the answer appears to be a resounding yes."
So, basically, they're now suggesting that gastric bypass is the best one could do, especially if your BMI is over 35? Mine is around there somewhere, and I'm a size 16/18! *headdesk* Opinions, please?
Surgery best method to cure obesity
Surgery against obesity heavily reduces the risk to die in cardiovascular diseases, diabetes and cancer. Conventional treatment against obesity at Swedish health centres have, on the other hand, no effect at all.
This was proven in a study on four thousand Swedish patients with obesity, that's published in the Thursday's issue of the New England Journal of Medicine.
"The consequence would reasonably be that obesity surgery becomes common and more accepted. Today we operate about a thousand a year in Sweden. I think we need to operate five, ten times as many," says Lars Sjöström, professor emeritus at Sahlgrenska University Hospital and leader of the Swedish study.
In the same issue of the New England Journal of Medicine an American study on eight thousand patients is published as well. The results clearly point in the same direction: in the American study the mortality in the operated group dropped with forty percent, in the Swedish study with thirty percent. Diabetes as a death cause was nearly eliminated in the operated group, while the risk of dying of cancer and cardiovascular diseases went down with sixty percent.
Today there is no set limit in Sweden for how fat you should be to be operated upon. But many doctors follow the American standard, which requires a BMI, Body mass index, of 40, or 35 if you have other risk factors, such as diabetes.
"I could see the limit at 34 or 35. And if I had a patient with a BMI of 30, 31 and severe disorders, like diabetes or high blood pressure, and it couldn't be controlled through medication, then I wouldn't doubt surgery," says Lars Sjöström.
A limit at BMI 35 is also recommended by an expert group that is working on national guidelines, TT reports from the ongoing surgeon-week in Stockholm.
In the Swedish study there's been 25 surgeon centres and 480 health centres. The two thousand operated obesity patients have been followed for an average of ten years. They have been compared with an equal number of people that declined surgery. These people have instead been offered the health centres conventional treatment (exactly what it is made up of is not made clear in the study).
Those who underwent surgery with the most effective method, gastric bypass, had after ten years dropped on average 25 percent. The control people, who had been given conventional treatment, hadn't lost anything.
"This shows that Swdish health care does not have the methods that will have an effect upon obesity in the long run," says Lars Sjöström.
Three different surgery methods were part of the study. They were gastric bypass, vertical-banded gastroplasty and lap banding.
Gatric bypass was proven the most effective. Those who had gone through vertical-banded gastroplasty had, after ten years, lost an average of 16 percent in weight, and those who had gone through banding had lost 14 percent.
"When we started the study in 1987 gastric bypass was only available in Örebro. It was considered a far too dangerous procedure. Today the method is not as frightening, it can be done with laparoscopy," says Lars Sjöström.
However, it is impossible to avoid the fact that the surgery may lead to complications such as infections and blood clots, and in worst case scenario, death. And the most efficient method, gastric bypass, is slightly more dangerous. In the Swedish study, five of the 2.000 patients died from the procedure. That equals a mortality of 0,25 percent.
Lars Sjöström still wants to recommend obese people to take the risk:
"As a patient you have everything to gain. The mortality is on a steady decline. And we have measured life quality in other studies. It is unambigious: the more you lose, the better the life quality."
I found another article on it, though it was more on the basic facts. Source.
Missing Link Found: Bariatric Surgery Reduces Mortality
GOTHENBURG, Sweden, Aug. 22 -- Two research groups have provided long-awaited evidence that bariatric surgery saves lives, up to 136 per 10,000 operations.
Gastric bypass reduced all-cause mortality 40% in a study of severely obese American patients, and bariatric surgery of whatever type reduced morality 29% in a Swedish study. The results of both studies were reported in the Aug. 23 issue of the New England Journal of Medicine.
Weight loss has been well documented to reduce mortality risk factors, including incident diabetes, commented George A. Bray, M.D., of Louisiana State University, in an accompanying editorial.
But, he noted, some epidemiologic studies have suggested shedding pounds may worsen life expectancy, possibly from confounding by unintentional loss.
For a more conclusive answer, Lars Sjöström, M.D., Ph.D., of Gothenburg University here, and colleagues, conducted a prospective controlled trial.
Their Swedish Obese Subjects study included 2,010 patients who underwent bariatric surgery and 2,037 matched controls who didn't want surgery and received whatever treatment was customary at the center where they registered. This ranged from intensive lifestyle intervention and behavior modification to no treatment.
Most of the surgeries were vertical banded gastroplasties (68%). The rest were split between nonadjustable or adjustable banding similar to the lap band (19%) and gastric bypass (13%).
Participants were age 37 to 60 at enrollment from 1987 to 2001. The minimum eligible body mass index (BMI) was 34 for men and 38 for women, which was chosen before the 1991 NIH Consensus Conference recommended a cutoff of 40 (35 for patients with coexisting illnesses).
After an average of 10.9 years of follow-up and with an impressive 99.9% follow-up rate, there were 129 deaths in the control group and 101 in the surgery group. The most common causes were MI and cancer.
After adjustment for sex, age, and risk factors, all-cause mortality was 29% lower for the surgery group than for the controls (hazard ratio 0.71, P=0.01).
But because the Swedish study included primarily vertical banded gastroplasty, which is no longer commonly used, Ted D. Adams, Ph.D., M.P.H., of the University of Utah in Salt Lake City, and colleagues, looked at long-term mortality with gastric bypass surgery.
Their study included a series of 7,925 gastric bypass surgeries done from 1984 through 2002 at a single center in Utah. These cases were matched to 7,925 randomly selected control adults with a BMI of 35 or higher based on height and weight self-reported on Utah driver's license and identification card applications.
The researchers gathered data from the National Death Index and the Utah Cancer Registry.
After a mean of 7.1 years of follow-up, the adjusted death rate was 40% lower with surgery than without it (hazard ratio 0.60, 95% CI 0.45 to 0.67, P<0.001).
For specific causes, the death rates with gastric bypass versus without the surgery were:
* 52% lower for all diseases combined (P<0.001)
* 92% lower for diabetes (P=0.005)
* 59% lower for coronary artery disease (P=0.006)
* 60% lower for cancer (P=0.001)
The reduction in cancer-related deaths was surprising, the researchers said, but suggested it may be related to improved cancer screening with weight loss.
Not all the results were postitive, however. Deaths from suicide, accidents, poisonings, and other nondisease causes were 1.58 times more common among surgical patients than among controls (P=0.04).
This warrants research into "the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery," the researchers wrote.
Nevertheless, the net effect was prevention of 136 deaths per 10,000 operations, they said.
Early death rates contrasted in the two studies. In the Swedish study, early death -- occurring within 90 days of the surgery for either the patient or his matched control -- was substantially more common in the surgery group than among controls (0.25% versus 0.10%). In the U.S. study, deaths occurring in the first year were similar between groups (0.53% versus 0.52%).
But, overall the findings may argue that it is time to reevaluate BMI guidelines for bariatric surgery, Dr. Bray said in his editorial comment.
"The question as to whether intentional weight loss improves life span has been answered," he concluded, "and the answer appears to be a resounding yes."
So, basically, they're now suggesting that gastric bypass is the best one could do, especially if your BMI is over 35? Mine is around there somewhere, and I'm a size 16/18! *headdesk* Opinions, please?