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Stomach Stapling
June 2000

Q. What do you think of stomach stapling for morbidly obese people? What options are available? What are some good web sites for information on stomach stapling procedures?

A. Thank you for your inquiry on obesity treatment. Surgical treatment for obesity is a very serious decision, and certainly not the first treatment to be tried, but may be lifesaving for some individuals. Let's review some general information on the subject first.

Weight control problems are considered to be epidemic in the U.S. Definitions of obesity vary. A common measure used by health professionals is body mass index (BMI) but this is difficult to calculate for most people. Your doctor may have a chart to clarify this for you: the formula is (height measured in meters) 2 divided by weight in kilograms, which yields a number . A BMI higher than 27 or 28 is considered obese, meaning the person is more than 20% above their ideal weight. Using such a definition, nearly one third of adults over age 20 would be considered obese. Some studies indicate the percentage of obesity is even higher among African-American and Hispanic populations.

In addition to the cosmetic problems of obesity, the condition is associated with a high risk for hypertension, diabetes, heart disease, orthopedic problems, and depression. So it is certainly a public health problem deserving attention. Unfortunately, there is still much we don't know about obesity and its treatment. There is strong evidence of genetic factors playing a role; a child with two obese parents has an 80% chance of becoming obese. Some medications and medical conditions can cause obesity, but in the majority of affected persons, no such cause can be found.

Initial treatment consists of dietary changes to reduce calorie intake, and increases in regular exercise to burn more of the calories stored as fat. A good goal would be to walk briskly for 30 minutes most days of the week, if there are no medical reasons preventing this. Some individuals do well by participating in a supervised diet and exercise program. These are often available through local hospitals, sponsored by health insurance companies, or available through commercial programs such as Weight Watchers. In addition to this approach, various medications are available to either help appetite suppression or decrease absorption of calories.

Long term effectiveness and safety issues remain in question. Your doctor can advise whether these may be helpful to you. Unfortunately, all treatment programs have limited success for maintaining the weight loss that is achieved.

Surgical procedures are considered if these other approaches have failed and the obesity is severe. Two such approaches are available, gastroplasty ("stapling") and gastric bypass. In both such procedures, the idea is that the food simply bypass the majority of the stomach lining where digestion takes place. Both procedures have risks and side effects, but can be effective if the patients are carefully selected and supervised. A surgeon with a lot of experience in the procedure and the long-term follow-up of patients should do the procedure.

So obesity is a complicated, frustrating, but important topic. We are hopeful that future research will yield better and safer treatments!

HELPFUL WEBSITES:

  1. http://www.obesity.org/
  2. http://www.niddk.nih.gov/health/nutrit/nutrit.htm
  3. http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm
MEDICAL ARTICLES:
  1. Baltasar A, Bou R, Arlandis F, Martinez R, Serra C, Bengochea M, Miro J.
    Vertical banded gastroplasty at more than 5 years.
    Obes Surg. 1998 Feb;8(1):29-34.
  2. Cowan GS Jr. The Cancun IFSO Statement on bariatric surgeon
    qualifications. International Federation for the Surgery of Obesity.
    Obes Surg. 1998 Feb;8(1):86
  3. Schmitz MK, Jeffery RW. Public health interventions for the prevention and treatment of obesity.
    Med Clin North Am. 2000 Mar;84(2):491-512, viii.
  4. Balsiger BM, Murr MM, Poggio JL, Sarr MG.
    Bariatric surgery. Surgery for weight control in patients with morbid obesity.
    Med Clin North Am. 2000 Mar;84(2):477-89. Review.

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