The American Heart Association has thrown its support behind bariatric surgery, saying the long-term cardiac and overall health benefits that weight-loss procedures provide to the severely obese may outweigh surgical risks.
In the first-ever scientific statement issued by the AHA to address bariatric surgery and cardiac risks, Paul Poirier, MD, PhD, director of the prevention and rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada, says weight-loss procedures lead to significant weight loss and improvements in conditions related to severe obesity, including diabetes, high cholesterol, high blood pressure, obstructive sleep apnea and cardiovascular dysfunction.
The statement defines severe obesity as a body mass index of more than 40kg/m2. "You can't be morbidly obese and be healthy," says Dr. Poirier, "even if you're free of co-morbidities."
The treatment goal for severe obesity should be an improvement in health achieved by durable weight loss that reduces life-threatening risk factors and improves the performance of daily activities, notes the statement, which points to mounting frustration over the lack of long-term successes from lifestyle modifications and drug therapy as reasons for the growing popularity of surgical options in the treatment of obesity.
While acknowledging the overall safety of weight-loss surgery, the AHA cautions that candidates need to be assessed on a patient-by-patient basis. "This is not a benign surgery," says Dr. Poirier. He believes bariatric surgery should be reserved for severely obese patients who can undergo surgery safely and have failed at attempts to lose weight using medical therapy.
Surgeons should avoid operating on patients with severe heart failure, end-stage lung disease, active malignancy, cirrhosis with portal hypertension and uncontrolled drug or alcohol dependency, notes the statement. Patients without the capacity to grasp the lifestyle change necessary to cure obesity, even after surgical interventions, are not acceptable candidates for surgery, according to the AHA.
Bariatric surgery isn't a "one-shot deal," says Dr. Poirier, adding patients "need to commit themselves" to the desire to lose weight.
Daniel Cook
