CHICAGO -- Obese patients who underwent surgical treatment for weight loss had significant reductions in the components of the metabolic syndrome one year after surgery, according to an article in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
According to the article, obese patients are at risk for numerous health problems, including diabetes, hypertension, hyperlipidemia (high cholesterol), sleep apnea, osteoarthritis and other illnesses. Hypertension, dyslipidemia, glucose intolerance (a hallmark of diabetes) and obesity together represent a disorder called the metabolic syndrome. People with the metabolic syndrome are at an increased risk for developing diabetes mellitus and cardiovascular disease and have higher death rates, the article states.
Wei-Jei Lee, M.D., Ph.D., of En-Chu Kong Hospital, Taipei, Taiwan, and colleagues determined the prevalence and characteristics of patients enrolling in a surgical weight loss program who met the criteria for the metabolic syndrome and examined the efficacy of surgically induced weight loss on the treatment of the metabolic syndrome.
From December 1, 1999 through March 31, 2002, 645 morbidly obese patients enrolled in a surgical weight loss program and were followed up for one year after their surgeries. Of the patients, 337 (52.2 percent) met criteria for the metabolic syndrome. Patients with the metabolic syndrome tended to be older (31.5 years vs. 28.1 years), and were more likely to be male (127 [37.7 percent] of 337 men vs. 81 [26.3 percent] of 308 women). Laparoscopic vertical banded gastroplasty (which limits food intake by creating a small pouch in the upper stomach) was performed in 528 patients (81.9 percent) and laparoscopic gastric bypass (surgery that causes food to bypass much of the intestinal tract, thereby limiting absorption of calories) was performed in 117 patients (18.1 percent).
There was significant weight loss in both groups, but patients who underwent laparoscopic gastric bypass lost significantly more weight (average 38.4 kilograms vs. 35.1 kilograms) and achieved a lower body mass index than patients who underwent laparoscopic vertical banded gastroplasty. In patients with the metabolic syndrome, the average weight loss one year after surgery was 38.2 kilograms, or 31.9 percent of their initial body weight. These patients had a substantial reduction in blood pressure and blood glucose, triglycerides and total cholesterol, resulting in a 95.6 percent resolution of the metabolic syndrome one year after surgery. The researchers also report that the metabolic syndrome was resolved in 95 percent of patients who underwent laparoscopic vertical banded gastroplasty and in 98.4 percent of patients who underwent laparoscopic gastric bypass surgery one year after the surgeries.
"The metabolic syndrome is prevalent in 52.2 percent of morbidly obese individuals enrolling in an obesity surgery program," the authors write. "Significant weight reduction one year after surgery markedly improved all aspects of the metabolic syndrome and resulted in a cure rate of 95.6 percent. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with the metabolic syndrome." (Arch Surg. 2004;139:1088-1092. Available post-embargo at archsurg.com)
Editor's Note: This study was supported by a grant from En-Chu Kong Hospital, Taipei, Taiwan, and a grant from the National Science Council of the Republic of China, Taipei.
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