WEIGHT LOSS SURGERY
HISTORY/EXISTING CONDITION:
Gastrointestinal surgery for the purpose of weight loss has been performed on hundreds of thousands of patients since 1954. The most common surgical procedures for weight loss have been jejunoileal bypass (intestinal bypass), gastric bypass, and horizontal or vertical gastroplasty (stomach stapling). Other gastrointestinal surgical techniques have included biliopancreatic diversion, jejunocolic bypass, stomach wrap, and truncal vagotomy. Many procedural variations were developed by modifying surgical techniques without prior testing.
The most common justifications for performing gastrointestinal surgery are improved health, increased longevity, better psychosocial adjustment, and a decrease in the economic costs of obesity. Health is assumed to improve through a decrease in comorbidity factors associated with obesity - such as hypertension, non-insulin dependent diabetes (NIDDM), and sleep apnea.
Weight-loss surgery researchers consistently fail to consider the value of non-invasive treatment for comorbidity factors. The scientific community has not provided convincing evidence that gastrointestinal surgery increases life expectancy or improves overall health. Until such evidence exists, theories about the economic benefits of weight-loss surgery are meaningless. The economic cost of multiple surgeries, repeated hospitalizations, and medical treatment for life long iatrogenic complications has never been systematically compared to non-surgical treatments, such as fitness enhancing activities, support groups and psychotherapy, can effectively increase many fat patients' sense of well-being.
Currently, the most frequently performed procedure, vertical banded gastroplasty, results in weight loss of about 20% within 18-24 months. Because weight regain is common within two to five years after operation, doctors plan "staged surgery". Second and third operations are performed as the weight is regained, despite evidence that mortality and morbidity rates associated with reoperation are higher than those with primary operations.
There are more than 60 documented complications of gastrointestinal surgery, as described in Dr. Paul Ernsberger's "Report on Weight Loss Surgery: Techniques, Complications, Case Studies" and the National Institutes of Health 1991 abstracts on "Gastrointestinal Surgery for Severe Obesity". Complications which can be fatal include peritonitis due to leaks in the digestive tract; pulmonary embolism; liver disease; kidney disease; cancer of the stomach, esophagus, pancreas and bowel; and vascular thrombosis. Other possible complications are wound infections, hernia, dehiscence, stomal stenosis, marginal ulcers, pulmonary problems, deep thrombophlebitis, pouch and distal esophageal dilation, persistent vomiting, cholecystitis, micronutrient deficiencies, and dumping syndrome. Many of these complications result in several hospitalizations and follow-up surgeries. Moreover, medical complications from weight loss surgery may take 10 years or more to develop, yet because procedures are modified so frequently, follow-up studies are usually limited to two to five years or less.
NAAFA'S OFFICIAL POSITION:
There is no conclusive evidence that gastrointestinal surgery for weight loss increases longevity or improves overall health. There are a tremendous number of deaths and severe complications associated with weight-loss surgeries. Since non-invasive treatments for comorbidity factors exist, the presence of comorbidity factors is not a valid justification for surgery. Therefore, the National Association to Advance Fat Acceptance condemns gastrointestinal surgery for weight loss under any circumstances. Until all weight loss surgeries are discontinued, NAAFA urges that such surgeries be restricted to controlled studies conducted by trained medical researchers. Further, NAAFA believes that the psychosocial suffering that fat people face is more appropriately relieved by social and political reform than by surgery.
NAAFA ADVOCATES:
- The introduction, passage, enactment, and enforcement of local, state,
and federal legislation which limits or controls the weight loss surgery
industry.
- That all gastrointestinal weight loss surgeries be discontinued.
- That private, commercial, or government third party payers discontinue
payment of any weight loss surgery.
- That as long as weight loss surgery continues, it be confined to controlled
scientific investigations, and that researchers follow NAAFA's "Guidelines
for Weight Loss Surgery Researchers".
- That surgeons not perform variations of existing surgical procedures
or new weight loss operations on human subjects.
- That as long as weight loss surgeries continue to be performed outside
of controlled scientific studies, that all surgeons voluntarily comply with
NAAFA's "Guidelines for Weight-Loss Surgeons".
- That friends and family of fat people offer emotional support and
advise anyone considering weight loss surgery to carefully examine the hazards
and complications of such surgeries.
- That all patients be required to undergo psychological counseling
before having weight loss surgery performed.
- That fat people avoid weight loss operations and consider alternate solutions to their problems, such as support groups, psychotherapy, and fitness-enhancing activities.
NAAFA RESOLVES TO:
- Educate the public regarding the hazards, side effects, mortality
rate, and long-term ineffectiveness of gastrointestinal weight loss surgeries.
- Provide information and emotional support to patients who have already
undergone gastrointestinal weight loss surgeries in dealing with ensuing
nutritional, mental and physical health problems.
- Provide information and emotional support to fat people considering
gastrointestinal weight loss procedures to assure that such a major medical
decision is based on "informed consent".
- Establish a referral service to allow potential recipients of these
operations to converse with patients who have undergone similar procedures
at least five years previously.
- Represent past and potential patient's interests at medical gatherings
on gastrointestinal weight loss surgery and, whenever possible, present
an educated alternative viewpoint at such conferences.
- Conduct surveys and personal interviews to study factors that lead
people to consider and to have weight loss surgeries.
- Create programs and services which provide better options than surgery for the health and psychosocial problems that fat people face.
Last Revised: 5/30/93
First Issued: 5/30/93
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