Chirurgie bariatrique, la voie d’avenir ? (Bariatric surgery – the wave of the future?)

This morning we have our first French-language guest post from the National Obesity Summit in Montréal, Québec.  Today’s post was written by Dr Danielle Bouchard, a post-doctoral researcher in the department of endocrinology at the Université de Sherbrooke.  Along with Martin Sénéchal, Danielle writes the phenomenal blog PhD Obesité, which is definitely worth google translating if you’re not able to read french.  Don’t forget that you can follow all the discussion from the Summit itself on twitter (whether or not you have a twitter account) by following #con11 hashtag, or simply by clicking here.

In this post Danielle discusses the rather remarkable health improvements seen following bariatric (obesity) surgery.  In fact, bariatric surgery typically results in a 60-80% improvement in obesity-related comorbidities, and has a mortality rate of roughly 1% – about the same as gallbladder surgery.  Here’s Danielle!

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Depuis le début de la conférence on parle que le traitement de l’obésité doit passer premièrement par le changement des habitudes de vie, cependant aujourd’hui j’ai assisté à une session intitulée : le traitement de l’obésité et 7 des 8 présentations portaient sur la chirurgie bariatrique !  Le congrès en soit tourne autour de 2 thématiques : la chirurgie bariatrique et le poids durant la grossesse.   Je rapporterai quelques résultats intéressants sur la grossesse au cours de la semaine.

Pour ceux qui ne sont pas familiers avec la chirurgie bariatrique, il existe 4 différents types et le succès à long terme est indiscutable.  Après la chirurgie, 60 à 80 % des comorbidités seront éliminées et le risque de mortalité est autour de 1%.  Cependant, les chercheurs sont très honnêtes avec les conséquences que doivent subir les patients à court ou à très long terme.  Les patients peuvent avoir des nausées, avoir des diarrhées et avoir des problèmes intestinaux majeurs. Bref, je prédis que la chirurgie bariatrique prendra de plus en plus de place dans le traitement de l’obésité dans les années avenir, mais, j’espère que les habitudes de vies demeureront tout de même dans le décor pour ne pas arriver au point ou la seule solution devienne de subir une opération quand le surplus de poids devient indispensable !

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9 Responses to Chirurgie bariatrique, la voie d’avenir ? (Bariatric surgery – the wave of the future?)

  1. Colin Rose says:

    Operations like jejuno-ileal bypass that cause malabsorption will obviously reduce calorie input and cause direct feedback to excess consumption via diarrhea but is there any randomized, sham-operated controlled trial of any type of gastric bypass surgery proving that it adds anything to advice on lifestyle change? Is there some feedback from gastric bypass that provides an additional incentive to control appetite, like abdominal pain, nausea or vomiting? I don’t recall seeing many patients with such symptoms or significant weight loss after gastectomies that used to be performed for peptic ulcers before the advent of pharmacological treatment.

    http://medicalmyths.wordpress.com/2007/03/09/bariatric-surgery-psychic-surgery/

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    • Travis says:

      I don’t think there has been a study like that in humans (I don’t think any ethics board would allow it to pass), but there have been several in animals that compare bypass to sham surgery, and they suggest that bypass surgery is still the clear winner.

      http://goo.gl/12x4b

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449984/

      Gastric bypass seems to impact gut hormones like PYY that impact satiety, and those changes aren’t seen in sham-operated animals.

      Lifestyle modification is efficacious (e.g. it works in the best-case scenario) but not very effective over the long-term for many individuals, at least with respect to weight loss. Surgery is also much faster and effective in dealing with diabetes in particular. So in situations where weight loss or diabetes need to be dealt with rapidly, surgery seems like a better option. And as I mentioned in my response to WRG, lifestyle modification is still a huge part of this surgery. But lifestyle modification on its own comes nowhere close to surgery in terms of average weight loss or resolution of diabetes.

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      • Colin Rose says:

        Your first link is broken. The other refers to a case-controlled, non-randomized observational surgical study of Roux-en-Y. The rat study used jejuno-iliel bypass which is not the usual procedure in humans. No hormonal changes were seen with gastric bypass which is the most common procedure in humans.

        It is absolutely essential and perfectly ethical to perform sham operated controlled studies in humans when the utility of an operation per se is not known. Why should operations avoid the necessity to prove efficacy and safety that is required of drugs? If it is ethical to do placebo controlled trials with drugs, then it is ethical to sham-operated controlled trial of operations.

        If it were obvious that gastric bypass was causing abdominal pain or nausea if too much food was eaten (which it doesn`t) then no controlled trial would be necessary. As it stands, post surgery patients are reequired to make the same difficult choice to control their junk food addiction as are patients treated with lifestyle change alone. It is possible that the operation induces a fear that something unconfortable will happen if they eat ice cream, for example, but there is no physiological reason why it should. That is why sham operated controls are necessary. We could be wasting $billions on these procedures that could be much better spent on treatment of junk food addiction.

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  2. WRG says:

    Nausea, diarrhea, major intestinal problems…and then she goes on to say that she predicts bariatric surgery will play a increasing role in the the treatment of obesity. That doesn’t sound very good to me. Yes, she also hopes that lifestyle changes will also play a role so that bariatric surgery does not become the only solution, but really, from all that I’ve read from actual people who’ve had the surgery, the rate of side effects and problems is still much too high to make this surgery an easy, logical first choice.

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    • Travis says:

      I think most physicians would agree with you that bariatric surgery isn’t an easy or logical first choice for many people. But the problem is that lifestyle change doesn’t always work in situations when large weight loss is necessary, and there really isn’t anything that compares bariatric surgery when it comes to resolving diabetes (we still don’t really understand why bariatric surgery is so effective at resolving diabetes).

      I come from an lifestyle background (I’ve literally published a paper on “Lifestyle treatment of the metabolic syndrome”) so I’m certainly not one to advocate for surgery over lifestyle intervention in all situations. And of course this surgery does require people to make many dramatic lifestyle changes both before and after the procedure (one of the comments made by the presenter was that many patients still don’t really understand/believe what they are getting into – up to 20 vitamin supplements/day – when they sign up for the surgery). The issue is that right now there are people who would stand to have longer and healthier lives if they were able to get the surgery, but unfortunately they are unable to access it. It’s not a panacea, but in an area with few effective treatments, it makes sense to make bariatric surgery more accessible for those individuals who stand to benefit from it.

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  3. Pascale Bellemare says:

    La chirurgie bariatrique….et oui, ça semble la solution miracle…mais moi j’en ai vu des clients qui avaient subit cette chirurgie et qui n’ont pas modifié leurs habitudes de vie et qui on reprit le poids perdu par la chirurgie…

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  4. yes i agree with you. The name surgery is a ghost for many people.

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  5. The weight loss surgery may not be necessary for people with average weight gain but it is a boon to heavy weight people. Sometimes it saves life of people having serious weight problems.

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  6. Oleana Ichim says:

    Buna
    Recomand cu incredere aceasta clinica pentru rezolvarea oricarei probleme de estetica.

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