American Heart Association Statement on Bariatric SurgeryThursday, March 17, 2011
This week the American Heart Association released a Scientific Statement on Bariatric Surgery and Cardiovascular Risk Factors in the latest issue of CIRCULATION.
Interestingly, the lead author and chair of the very distinguished panel of authors is our very own Paul Poirier from Laval University, Quebec City, Canada.
As the Statement points out:
“It is becoming clear that the pathophysiology of obesity is more complex than simply overeating and not exercising. In studies of bariatric surgery patients, appetite control and satiety appear to be key mechanisms for weight loss in gastric banding and gastric bypass patients, whereas calorie malabsorption plays a role in weight loss maintenance in the intestinal bypass operations.
All operations have advantages and disadvantages, with no clear evidence of one being the standard of care. There are currently no large-scale head-to head randomized trials comparing surgical procedures. Restrictive operations have a lower mortality with a lower rate of surgical and nutritional complications compared with the malabsorptive or combination operations. However, on average, restrictive operations require more frequent postoperative outpatient visits and are associated with a slower and lesser weight loss.”
The Statement provides a comprehensive and very balanced overview of the effects of bariatric surgery on cardiovascular risk factors including diabetes mellitus, hypertension, dyslipidemia, fatty liver disease, and sleep apnea and also discusses the proven benefit on cardiac morphology and function. Most importantly, the statement highlights the increasing evidence that bariatric surgery very significantly reduces the risks of dying from cardiovascular and non-cardiovascular complications of severe obesity.
The Statement also provides an overview of indications, caveats, complications and nutritional issues relevant to the care of these patients.
Relative contraindications to surgery include severe heart failure, end-stage lung disease, active malignancy, cirrhosis with portal hypertension, uncontrolled drug or alcohol dependency, and impaired intellectual capacity to understand and comply with the recommended lifestyle changes following surgery.
Finally, the statement also highlights a number of areas which require further research including a gaining better understanding of the neuroendrocrine mechanisms involved in the increased satiety, reduced hunger and metabolic changes associated with the different types of surgery as well as their impact on specific cardiovascular problems like peripheral vascular disease, strokes and malignant arrhythmias.
Thus, while the AHA statement clearly recognises the importance of bariatric surgery as a largely safe and effective treatment for patients with severe obesity, it also clearly defines the many areas in which further research needs to be conducted to better understand the mechanisms, long-term consequences, and outcomes with regard to improving cardiovascular health.
Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA, & on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism (2011). Bariatric Surgery and Cardiovascular Risk Factors: A Scientific Statement From the American Heart Association. Circulation PMID: 21403092
Thursday, March 17, 2011
“Finally, the statement also highlights a number of areas which require further research including gaining a better understanding of the neuroendrocrine mechanisms involved in the increased satiety, reduced hunger and metabolic changes associated with the different types of surgery . . . ” And, please, please, please, compare those with the neuroendocrine mechanisms and metabolic changes in radically weight-reduced controls who have not had surgery!!!
We need to know, honestly, what we’re dealing with here. You and I know that weight regain is not just a matter of someone choosing to return to the “fat lifestyle,” and all the bang-up social rewards there. Moreover, long-term maintenance, while odds improve statistically with time, it’s not because it gets easier, it’s because maintainers get more clever and stay ahead of the demons inside that the scientist seem uninterested in helping us identify. They’d rather let Jillian Michaels just tell us its because we don’t want to “claim our destiny” or some such nonsense. Grrrrr.
Thursday, March 17, 2011
I am collaborating with a shaman healer, using theory and research from the fields of neuroanthropology and cultural neuroscience to construct rituals that reshape neural pathways (connected with endocrine functions specifically linked to metabolism, satiety, body image mapping, etc.) It is fascinating and immensely rewarding work. Of course, no financial profits to be earned–just the pure joy of observing and personally experiencing the radical transformation of our bodies.
I haven’t actually taken flight, like the witches of old were feared to do, but during my sunrise walks (carrying about 120 lbs less than I used to haul everywhere with me) I feel like I’m gliding–effortlessly–just slightly above the ground. Good enough for me. 🙂
You gents and ladies in the white coats can keep on researching and explaining within the tired confines of your paradigms, continue cutting open the flesh of humans, and sympathizing with the those fighting their personal battles against obesity.
It is possible, however, for some of us to lay down our weapons, and join arms instead, raising voices in song, celebrating our freedom and hope.