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The American Heart Association has issued its first scientific statement on bariatric surgery for severely obese individuals with regard to cardiovascular risk factors. The statement appeared online in the journal Circulation on March 14.
The group makes no specific recommendations on bariatric surgery in the statement. Instead, the authors review the latest data on the indications for bariatric surgery, the different types of surgery, possible complications, the potential improvement in cardiovascular risk factors associated with bariatric surgery, and the need for multidisciplinary postoperative management.
"The statement is not an across-the-board endorsement of bariatric surgery for the severely obese. It is a consensus document that provides expert perspective based on the results of recent scientific studies," Dr. Paul Poirier and his coauthors said in a press statement. Dr. Poirier chaired the group, which developed the statement on behalf the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism (Circulation 2011 March 14 [doi:10.1161/CIR.0b013e3182149099]).
While obesity is an increasing problem worldwide, the severely obese – those with a body mass index (BMI) of 40 kg/m2 or greater – are the most rapidly growing segment of the obese population, the authors noted. "It is projected that in the near future, there will be at least 31 million U.S. adults who are severely obese and may qualify for bariatric surgery."
The National Institutes of Health has proposed that surgical therapy be offered to patients with a BMI greater than 40 or with a BMI greater than 35 with serious obesity-related comorbidities.
Appropriately indicated bariatric surgery can lead to significant weight loss, which in turn leads to improvements in a number of comorbidities, including diabetes, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction, the authors observed. In fact, data from prospective, nonrandomized, or case-control population studies have shown that bariatric surgery can prolong life in severely obese individuals.
While there are three categories of bariatric surgical procedures – restrictive, malabsorptive, and combination – there is currently no consensus about which procedure is the best overall option. There are also no established criteria or algorithms to guide surgeons in selecting the best procedure for a given patient.
"Despite the lack of consensus, it is clear that obesity surgery today offers the only effective long-term treatment option for the severely obese patient," the group wrote. However, "currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present."
"Bariatric procedures are generally safe; however, this is not a benign surgery," said lead author Dr. Poirier, who is director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University, Quebec City. While generally rare (less than 2%), early complications include thromboembolism, pulmonary or respiratory insufficiency, hemorrhage, peritonitis, and wound infection. Late complications can include gastrointestinal obstruction, ulcers, incisional hernias, hypoglycemia, steatorrhea, diarrhea, bacterial overgrowth, and nutritional deficiencies of micronutrients.
The group observed that perioperative management is best achieved by an interdisciplinary team that includes a surgeon, a medical specialist, and a registered dietician. "Mental health professionals should be available to patients who struggle postoperatively with psychosocial changes," the group noted.
While the value of psychological evaluations and profiles in bariatric surgery cases is uncertain, the authors suggest that psychological evaluations should assess the behavioral and environmental factors that may have contributed to obesity and may impact a patient’s ability to make the dietary and behavioral changes needed following bariatric surgery.
The group recommends additional research on different bariatric surgical procedures to evaluate the impact of the beneficial metabolic and cardiovascular changes associated with weight loss procedures. In addition, more research is needed to evaluate the benefits of bariatric surgery in the severely obese adolescent population.
Dr. Poirier reported having no financial disclosures. Several other authors reported significant financial relationships with a number of pharmaceutical and surgical equipment companies.
The AHA statement on bariatric surgery and cardiovascular risk factors "recognizes that there’s more and more of a consensus among professional medical societies that the role of bariatric surgery is becoming a little clearer. It is framed within the context of cardiovascular risk reduction and is supported by the availability of long-term evidence of safety and efficacy," Dr. Jeffrey I. Mechanick said in an interview. "This is a good review ... that is based on science."
Dr. Mechanick noted that three recent changes highlight the growing relevance for bariatric surgery among severely obese individuals. "If you now look at the FDA’s modus operandi with antiobesity drugs – and for that matter diabetes drugs – they all now have to have studies that are powered to detect cardiovascular risk, so that they don’t fall prey to the same problems that we saw with Avandia or Meridia, for instance. As a result of this, you have fewer antiobesity drugs now making it through the pipeline."
Another change is that "GI surgeries – surgeries that have typically been used for weight loss – are now being looked at for the management of diabetes," he said. While this is a highly controversial issue, there are some data that suggest patients who have diabetes – particularly diabetes that has been difficult to control – might benefit from bariatric surgery even if they do not meet the current thresholds for bariatric surgery for weight loss. For example, an individual with a BMI of less than 30 and very bad diabetes might be a candidate for bariatric surgery in the future.
The third component is the FDA’s recent change in the threshold for reimbursement for laparoscopic adjustable gastric banding. Previously, reimbursement for such procedures generally required that an individual have a BMI greater than 40 or a BMI greater than 35 and at least one obesity-related comorbidity, noted Dr. Mechanick. However, the new FDA indication for laparoscopic adjustable gastric banding is for weight loss in individuals with a BMI greater than 35 or with a BMI greater than 30 and at least one obesity-related comorbidity.
Dr. Mechanick is a clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Medical Center in New York. He has received speaker honoraria from Abbott Nutrition and Sanofi-Aventis U.S.
The AHA statement on bariatric surgery and cardiovascular risk factors "recognizes that there’s more and more of a consensus among professional medical societies that the role of bariatric surgery is becoming a little clearer. It is framed within the context of cardiovascular risk reduction and is supported by the availability of long-term evidence of safety and efficacy," Dr. Jeffrey I. Mechanick said in an interview. "This is a good review ... that is based on science."
Dr. Mechanick noted that three recent changes highlight the growing relevance for bariatric surgery among severely obese individuals. "If you now look at the FDA’s modus operandi with antiobesity drugs – and for that matter diabetes drugs – they all now have to have studies that are powered to detect cardiovascular risk, so that they don’t fall prey to the same problems that we saw with Avandia or Meridia, for instance. As a result of this, you have fewer antiobesity drugs now making it through the pipeline."
Another change is that "GI surgeries – surgeries that have typically been used for weight loss – are now being looked at for the management of diabetes," he said. While this is a highly controversial issue, there are some data that suggest patients who have diabetes – particularly diabetes that has been difficult to control – might benefit from bariatric surgery even if they do not meet the current thresholds for bariatric surgery for weight loss. For example, an individual with a BMI of less than 30 and very bad diabetes might be a candidate for bariatric surgery in the future.
The third component is the FDA’s recent change in the threshold for reimbursement for laparoscopic adjustable gastric banding. Previously, reimbursement for such procedures generally required that an individual have a BMI greater than 40 or a BMI greater than 35 and at least one obesity-related comorbidity, noted Dr. Mechanick. However, the new FDA indication for laparoscopic adjustable gastric banding is for weight loss in individuals with a BMI greater than 35 or with a BMI greater than 30 and at least one obesity-related comorbidity.
Dr. Mechanick is a clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Medical Center in New York. He has received speaker honoraria from Abbott Nutrition and Sanofi-Aventis U.S.
The AHA statement on bariatric surgery and cardiovascular risk factors "recognizes that there’s more and more of a consensus among professional medical societies that the role of bariatric surgery is becoming a little clearer. It is framed within the context of cardiovascular risk reduction and is supported by the availability of long-term evidence of safety and efficacy," Dr. Jeffrey I. Mechanick said in an interview. "This is a good review ... that is based on science."
Dr. Mechanick noted that three recent changes highlight the growing relevance for bariatric surgery among severely obese individuals. "If you now look at the FDA’s modus operandi with antiobesity drugs – and for that matter diabetes drugs – they all now have to have studies that are powered to detect cardiovascular risk, so that they don’t fall prey to the same problems that we saw with Avandia or Meridia, for instance. As a result of this, you have fewer antiobesity drugs now making it through the pipeline."
Another change is that "GI surgeries – surgeries that have typically been used for weight loss – are now being looked at for the management of diabetes," he said. While this is a highly controversial issue, there are some data that suggest patients who have diabetes – particularly diabetes that has been difficult to control – might benefit from bariatric surgery even if they do not meet the current thresholds for bariatric surgery for weight loss. For example, an individual with a BMI of less than 30 and very bad diabetes might be a candidate for bariatric surgery in the future.
The third component is the FDA’s recent change in the threshold for reimbursement for laparoscopic adjustable gastric banding. Previously, reimbursement for such procedures generally required that an individual have a BMI greater than 40 or a BMI greater than 35 and at least one obesity-related comorbidity, noted Dr. Mechanick. However, the new FDA indication for laparoscopic adjustable gastric banding is for weight loss in individuals with a BMI greater than 35 or with a BMI greater than 30 and at least one obesity-related comorbidity.
Dr. Mechanick is a clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Medical Center in New York. He has received speaker honoraria from Abbott Nutrition and Sanofi-Aventis U.S.
The American Heart Association has issued its first scientific statement on bariatric surgery for severely obese individuals with regard to cardiovascular risk factors. The statement appeared online in the journal Circulation on March 14.
The group makes no specific recommendations on bariatric surgery in the statement. Instead, the authors review the latest data on the indications for bariatric surgery, the different types of surgery, possible complications, the potential improvement in cardiovascular risk factors associated with bariatric surgery, and the need for multidisciplinary postoperative management.
"The statement is not an across-the-board endorsement of bariatric surgery for the severely obese. It is a consensus document that provides expert perspective based on the results of recent scientific studies," Dr. Paul Poirier and his coauthors said in a press statement. Dr. Poirier chaired the group, which developed the statement on behalf the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism (Circulation 2011 March 14 [doi:10.1161/CIR.0b013e3182149099]).
While obesity is an increasing problem worldwide, the severely obese – those with a body mass index (BMI) of 40 kg/m2 or greater – are the most rapidly growing segment of the obese population, the authors noted. "It is projected that in the near future, there will be at least 31 million U.S. adults who are severely obese and may qualify for bariatric surgery."
The National Institutes of Health has proposed that surgical therapy be offered to patients with a BMI greater than 40 or with a BMI greater than 35 with serious obesity-related comorbidities.
Appropriately indicated bariatric surgery can lead to significant weight loss, which in turn leads to improvements in a number of comorbidities, including diabetes, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction, the authors observed. In fact, data from prospective, nonrandomized, or case-control population studies have shown that bariatric surgery can prolong life in severely obese individuals.
While there are three categories of bariatric surgical procedures – restrictive, malabsorptive, and combination – there is currently no consensus about which procedure is the best overall option. There are also no established criteria or algorithms to guide surgeons in selecting the best procedure for a given patient.
"Despite the lack of consensus, it is clear that obesity surgery today offers the only effective long-term treatment option for the severely obese patient," the group wrote. However, "currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present."
"Bariatric procedures are generally safe; however, this is not a benign surgery," said lead author Dr. Poirier, who is director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University, Quebec City. While generally rare (less than 2%), early complications include thromboembolism, pulmonary or respiratory insufficiency, hemorrhage, peritonitis, and wound infection. Late complications can include gastrointestinal obstruction, ulcers, incisional hernias, hypoglycemia, steatorrhea, diarrhea, bacterial overgrowth, and nutritional deficiencies of micronutrients.
The group observed that perioperative management is best achieved by an interdisciplinary team that includes a surgeon, a medical specialist, and a registered dietician. "Mental health professionals should be available to patients who struggle postoperatively with psychosocial changes," the group noted.
While the value of psychological evaluations and profiles in bariatric surgery cases is uncertain, the authors suggest that psychological evaluations should assess the behavioral and environmental factors that may have contributed to obesity and may impact a patient’s ability to make the dietary and behavioral changes needed following bariatric surgery.
The group recommends additional research on different bariatric surgical procedures to evaluate the impact of the beneficial metabolic and cardiovascular changes associated with weight loss procedures. In addition, more research is needed to evaluate the benefits of bariatric surgery in the severely obese adolescent population.
Dr. Poirier reported having no financial disclosures. Several other authors reported significant financial relationships with a number of pharmaceutical and surgical equipment companies.
The American Heart Association has issued its first scientific statement on bariatric surgery for severely obese individuals with regard to cardiovascular risk factors. The statement appeared online in the journal Circulation on March 14.
The group makes no specific recommendations on bariatric surgery in the statement. Instead, the authors review the latest data on the indications for bariatric surgery, the different types of surgery, possible complications, the potential improvement in cardiovascular risk factors associated with bariatric surgery, and the need for multidisciplinary postoperative management.
"The statement is not an across-the-board endorsement of bariatric surgery for the severely obese. It is a consensus document that provides expert perspective based on the results of recent scientific studies," Dr. Paul Poirier and his coauthors said in a press statement. Dr. Poirier chaired the group, which developed the statement on behalf the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism (Circulation 2011 March 14 [doi:10.1161/CIR.0b013e3182149099]).
While obesity is an increasing problem worldwide, the severely obese – those with a body mass index (BMI) of 40 kg/m2 or greater – are the most rapidly growing segment of the obese population, the authors noted. "It is projected that in the near future, there will be at least 31 million U.S. adults who are severely obese and may qualify for bariatric surgery."
The National Institutes of Health has proposed that surgical therapy be offered to patients with a BMI greater than 40 or with a BMI greater than 35 with serious obesity-related comorbidities.
Appropriately indicated bariatric surgery can lead to significant weight loss, which in turn leads to improvements in a number of comorbidities, including diabetes, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction, the authors observed. In fact, data from prospective, nonrandomized, or case-control population studies have shown that bariatric surgery can prolong life in severely obese individuals.
While there are three categories of bariatric surgical procedures – restrictive, malabsorptive, and combination – there is currently no consensus about which procedure is the best overall option. There are also no established criteria or algorithms to guide surgeons in selecting the best procedure for a given patient.
"Despite the lack of consensus, it is clear that obesity surgery today offers the only effective long-term treatment option for the severely obese patient," the group wrote. However, "currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present."
"Bariatric procedures are generally safe; however, this is not a benign surgery," said lead author Dr. Poirier, who is director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University, Quebec City. While generally rare (less than 2%), early complications include thromboembolism, pulmonary or respiratory insufficiency, hemorrhage, peritonitis, and wound infection. Late complications can include gastrointestinal obstruction, ulcers, incisional hernias, hypoglycemia, steatorrhea, diarrhea, bacterial overgrowth, and nutritional deficiencies of micronutrients.
The group observed that perioperative management is best achieved by an interdisciplinary team that includes a surgeon, a medical specialist, and a registered dietician. "Mental health professionals should be available to patients who struggle postoperatively with psychosocial changes," the group noted.
While the value of psychological evaluations and profiles in bariatric surgery cases is uncertain, the authors suggest that psychological evaluations should assess the behavioral and environmental factors that may have contributed to obesity and may impact a patient’s ability to make the dietary and behavioral changes needed following bariatric surgery.
The group recommends additional research on different bariatric surgical procedures to evaluate the impact of the beneficial metabolic and cardiovascular changes associated with weight loss procedures. In addition, more research is needed to evaluate the benefits of bariatric surgery in the severely obese adolescent population.
Dr. Poirier reported having no financial disclosures. Several other authors reported significant financial relationships with a number of pharmaceutical and surgical equipment companies.
FROM CIRCULATION