Lifestyle change key for obesity surgery success (Reuters)

NEW YORK (Reuters Health) - Anyone thinking about havingweight loss surgery should be sure to do their homeworkbeforehand, and must understand they need to dramaticallychange the way they eat for the surgery to be successful,advises the head of the U.S. government agency responsible forresearch on health care quality and patient safety.

"People who succeed and lose weight and keep it off eatvery, very differently," Dr. Carolyn Clancy, director of theAgency for Healthcare Research and Quality (AHRQ) in Rockville,Maryland, told Reuters Health. "Essentially, you've got to eata whole lot less."

Clancy has written about the realities of operations topromote weight loss, known as bariatric surgery, in the latestissues of Nursing for Women's Health and Health for Women, bothpublished by the Association of Women's Health, Obstetric andNeonatal Nurses.

Bariatric surgery has skyrocketed in popularity, Clancynoted in an interview, but just a fraction of people who couldbenefit most from the surgery have gotten it. According toAHRQ, evidence for the procedure's benefits is strongest forpeople with body mass indexes (BMIs) of 40 or higher, orindividuals with BMIs of 35 or greater who have a seriousmedical condition, such as diabetes or severe sleep apnea.

Nevertheless, she added, the surgery "is not risk free, andI think it's really important for all people, women and men, toknow about the risks and to be very clear about what they'regetting into."

For example, Clancy said, 7 percent of people who undergothe surgery need to be rehospitalized for complications. Fourout of 10 will develop complications within 6 months of thesurgery. These complications include nausea, cramps andvomiting due to overeating.

People should also seek out a surgeon and health care teamthey can communicate with effectively, because post-surgicalfollow-up care is just as important as the procedure itself,Clancy added. If you don't "click," or you feel your surgeonisn't hearing your concerns, she advised, look elsewhere.

People may want to seek out bariatric surgery programsdesignated as Centers of Excellence by the American Society forMetabolic and Bariatric Surgery (http://www.asbs.org/), Clancysuggested.

Finally, she said, people need to find out before havingthe surgery whether or not their insurer covers it. Some willrequire documentation that a person has made a serious effortto lose weight by other means before they will pay for theprocedure.

SOURCE: Nursing for Women's Health, February/March 2008.