BOSTON -- Gastric bypass surgery is curing morbidly obese patients of diabetes, hypertension, hyperlipidemia, and insulin resistance--to the bafflement of a leading surgeon who performs the operation.
"If you get rid of the obesity, all of these things improve, and some of them go away even before patients lose the weight," Dr. Frank G. Moody said at a symposium on treating gastroin-testinal disorders sponsored by Boston University. "Diabetes disappears real quickly, as does the insulin resistance. And that's what I don't understand."
Dr. Moody, director of the University of Texas Obesity Study Group, Houston, questioned whether bariatric surgery itself causes metabolic changes. "Why does gastric bypass work? We don't know yet," he said, describing patients who lost their appetite for several months afterward.
"We tell people, 'You've got to eat,'" he recounted, speculating whether hormones, maldigestion, and/or dumping syndrome might play a role. "They walk out 400 pounds, but they're not hungry. That's baffling."
The results are fairly consistent, according to Dr. Moody. At his center, patients have lost about two-thirds of excess weight the first year and have kept more than 60% of it off 5 years later. Multiple studies show that most patients have resolution or improvement in comorbidities, including asthma and sleep apnea as well as conditions related to metabolic syndrome.
Dr. Moody spoke the same week Brigham and Women's Hospital in Boston put a moratorium on bariatric surgery following the death of a patient. He presented data collated from 11 controlled trials in which 3 (0.5%) of 607 patients had died and 28 (4.6%) suffered major wounds.
Patients need to be warned that the surgery has risks but should also be counseled that the risks of not operating are greater. "Just losing weight is not the purpose of the surgery," Dr. Moody said. "It is to lose the …