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Men, substance users less likely to have weight-loss surgery

By Ronnie Cohen

NEW YORK, (Reuters) - A one-size-fits-all approach to weight-loss surgery may be keeping obese men, substance users and older people out of the operating room, a new study suggests.

The study analyzed data from a Canadian program intended to encourage obese people to undergo weight-loss surgery. More than half the patients dropped-out without having the operation, researchers found.

Men, smokers, drinkers, drug users and people age 60 and older were the most likely to quit the program before having the operation, senior author Dr. Fayez Quereshy from the University of Toronto in Ontario told Reuters Health in a telephone interview.

More than one-third of U.S. adults are obese and cost an estimated $147 billion a year in medical care, according to the Centers for Disease Control and Prevention.

Weight loss operations, formally known as bariatric surgery, are known to cut obesity-related disease and healthcare costs. Prior research has shown they result in substantial weight loss and can reverse the course of some related diseases (see Reuters story of December 24, 2013 here: http://reut.rs/1BDFesE).

In some studies, the surgery has been more effective in helping obese people shed weight than diet, exercise, therapy and drugs (see Reuters story of October 31, 2013 here: http://reut.rs/1z2YCLN).

The operations reduce the size of the stomach so patients can eat only small amounts of food. Doctors recommend the procedures for people who are severely obese or moderately obese with serious weight-related health problems.

But while bariatric surgery is becoming increasingly popular, the drop-out rate has also been growing, the authors write in the Journal of the American College of Surgeons.

In the current study, they examined the records of 1,664 patients referred to the bariatric-surgery program between 2008 and 2011. Patients ranged in age from 19 to 80, with an average age of 48. They waited an average of nearly 15 months to have the surgery, the authors write.

Body mass index (BMI), a ratio of weight to height, was higher than 40 in nearly nine of every ten people. A BMI of 40 would be roughly equivalent, for example, to a height of 5 foot 2 inches (157 cm) and a weight of 218 pounds (99 kg), or a height of 6 feet (183 cm) and a weight of 294 pounds (133 kg).

About one in every 13 people had a BMI above 60, roughly equivalent to a height of 5 foot 2 inches and a weight of 330 pounds (150 kg),

Most patients – 74 percent – referred to the program were women. Men were not only less likely to be referred, they were also nearly half as likely to undergo the surgery.

Heavier patients were more likely to have the operation and older patients (i.e., those over 60) were less likely, the study found.

Distance from home to the program appeared to have no impact on attrition.

Smokers, drinkers and other substance users were more likely to quit before surgery. The study did not determine if they left the program on their own or were refused treatment. Substance abusers must demonstrate prolonged abstinence to be eligible for weight-loss surgery, the authors write.

Knowing which patients are dropping out should help administrators tailor future bariatric-surgery services, Quereshy said.

The best way to most efficiently move more patients through the system, he believes, would be to tailor the care for certain groups of people. For example, he suggested, patients with limited social networks should be connected to social workers early on.

“In environments where resources are scarce and obesity-related complications carry a significant cost burden and patient complications, we need to think of novel ways to reduce wait times, patient dropouts and disappointments while improving satisfaction,” Quereshy said.

Bariatric surgeon Dr. Erik Dutson, from the University of California, Los Angeles, said the study’s message rings just as true in America as it does in Canada. He was not involved with the current study.

“If we are going to continue to look at bariatric surgery as the gold standard for weight loss, then we should keep our eyes open about preemptively anticipating problems with patients and make special care considerations for certain subgroups,” Dutson said.

Bariatric surgery is not risk-free. Gastric-bypass operations, for example, carry the risk of blood clots, breathing problems, heart attacks, strokes, infections and allergic reactions to anesthesia, according to the National Institutes of Health.

Still, Dutson believes that bariatric surgery is the safest way to reduce obesity and prevent related complications, such as diabetes. He described the operation as safer than a gall bladder removal.

“It’s ironically safer to undergo an operation than to not undergo an operation,” he said.

SOURCE: http://bit.ly/1p7pDN9 Journal of the American College of Surgeons, online August 11, 2014.

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