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Five key characteristics may single out those patients most at risk for fatal complications from gastric bypass weight-loss surgeries, researchers report.
Gastric bypass surgery is a procedure performed on the morbidly obese to help them lose weight by manipulating the size of their stomachs. After surgery, patients' stomachs can only hold small amounts of food, preventing overeating and stimulating more quickly the feeling of fullness.
While considered a safe procedure, gastric bypass does come with risks.
"Our findings show that for the low-risk group of patients, gastric bypass surgery is a very safe option. For those patients in the highest risk category, we should look at performing lower-risk or a number of smaller procedures to reduce the potential risk," study author Dr. Eric DeMaria, director of bariatric surgery at Duke University Medical Center, said in a prepared statement.
However, before this study, there was "no clinically useful system to help determine which patients would be at highest risk of dying after gastric bypass surgery," DeMaria said. "We developed a scoring system that is based on five easy-to-identify patient characteristics that can help us decide whether or not a specific patient is a good candidate for surgery and what the probable risks would be."
To devise the scoring system, a team of Duke surgeons studied data on outcomes of 2,075 bariatric surgery patients treated at Virginia Commonwealth University in Richmond between 1995 and 2004.
Thirty-one of the patients died within 90 days of their surgery. Based on these patients' histories, the researchers found that five characteristics increased the risk of death or complications from bariatric surgery:
BMI (body mass index -- a calculation of weight versus height) of higher than 50. The normal range is between 18.5 and 25.
Being male.
Hypertension -- the condition is typically related to cardiovascular diseases, which can also increase risk.
Pulmonary embolus [clot] risk -- if patients have had or are at risk for having a blood clot in the lung, their risk may be increased.
Being over the age of 45.
"In using our system, each one of the five characteristics is worth one point. Those patients with a score of zero are at the least risk, while those with five points are at the highest risk," DeMaria said.
Only three of the 957 patients in the study who were classified as low-risk died -- a mortality rate of just 0.31 percent -- while 19 out of 999 (1.9 percent) medium-risk patients died. In contrast, nine out of the 119 high-risk patients died -- a mortality rate of 7.56 percent, the researchers noted.
The findings could have implications for treatment decision-making, DeMaria said.
"Many people see gastric bypass surgery as an option to use only when all other approaches to weight loss have failed," he explained. "However, our system shows that this strategy may need to be reconsidered. If patients put off surgery while they attempt other therapies that ultimately don't work, over time, they risk moving into a higher-risk category as they gain more weight, get older or develop hypertension. In these cases, delays can make surgery even riskier."
DeMaria presented the results of the study and the new scoring system at the annual meeting of the American Society for Bariatric Surgery, in San Francisco.
More information
Head to the Columbia University Department of Surgery to read more about gastric bypass surgery.
Lack of Sleep Can Pack on the Pounds
July 7, 2006 04:03:13 PM PST By Alan Mozes HealthDay Reporter
If an improved diet and extra trips to the gym fail to help shed those excess pounds, a growing body of research is shining light on a new way to get to a new you: Do nothing.
Do nothing, that is, but sleep.
As millions of Americans move through life weary and sleep-deprived, scientists are uncovering more and more evidence that insufficient slumber may cause hormonal shifts that boost both hunger and appetite -- particularly for fat-laden carb catastrophes like jelly-filled donuts and super-sized fries.
"We all need to be aware there is a relationship between sleep and obesity," says J. Catesby Ware, chief of the division of sleep medicine at Eastern Virginia Medical School, and director of the Sleep Disorder Center at Sentara Norfolk General Hospital in Norfolk, Va.
Ware and his colleagues found signs of this link in a recently completed study of more than 1,000 men and women that indicated those who reported sleeping less also weighed more.
He is now in the midst of new research focusing on another group of 1,000 individuals that is quantifying specific daily sleep habits, with preliminary data reinforcing his previous observation -- less sleep equals a bigger belly.
"There are a number of research studies that all support the thesis that too little sleep leads to weight gain," Ware said. "How that happens is still somewhat unclear, but there are hormonal secretions that are affected with sleep loss that apparently affect appetite and eating."
Other researchers are working to unravel the mechanism behind the mystery.
Eve Van Cauter, a professor of medicine at the University of Chicago, recently found that when 12 healthy men in their 20s were instructed to sleep just four hours a night for two nights straight, they reported an increase in feelings of hunger by 24 percent.
What's more, Cauter and her colleagues noted that levels of the hormone leptin, which delivers feelings of satiation to the brain, decreased by 18 percent among the men.
Conversely, levels of the hormone ghrelin, which sparks hunger, shot up 28 percent -- prompting cravings for candy, cookies and cake.
Dr. Phyllis Zee, a professor of neurology at the Northwestern University Feinberg School of Medicine, said that while researchers continue to be stymied by the exact nature of the sleep-weight connection, the relationship is undeniable.
"This kind of short-term sleep deprivation study supports the relationship we see in the larger population-based studies, which shows that if you restrict sleep, the hormonal and metabolic profiles begin to resemble those of people who are pre-diabetic, while bringing about autonomic changes that can be related to the development of cardiovascular disease," added Zee, director of the Sleep Disorders Center at Northwestern Memorial Hospital in Chicago.
According to several polls by the National Sleep Foundation, many Americans of all ages barely meet or fail to meet the minimal daily sleep requirements most physicians and researchers recommend.
In its most recent 2005 survey, the NSF found that more than 70 percent of adults over the age of 18 get less than eight hours of sleep a night on weekdays -- and 40 percent get less than seven hours.
A 2003 poll found that, on average, American adults between the ages of 18 and 54 sleep just 6.7 hours a night during the week, and seven hours a night on weekends.
Among older adults -- those between 55 and 84 -- 13 percent sleep less than six hours a night during the week, while 11 percent have a similar sleep pattern on weekends.
Against such a national backdrop of sleep deprivation, researchers concur that the battle of the bulge may ultimately best be waged beneath the sheets.
"Between seven and eight hours seems to be a fairly magical number for sleep duration," said Zee. "People who report, on average, getting between seven and eight hours of sleep are the ones who appear to have the lowest risk" of weight gain.
Ware agreed: "By sleeping more, you gain on all fronts. If you are obese and are trying to lose weight, it's almost a no-brainer."
