This week’s Journal of the American Medical Association has a study done by investigators at our Cincinnati Children’s Hospital that showed that closing K through 12 schools in March for corona virus resulted in 62% fewer cases and 58% fewer deaths. This shows that though children don’t get or die of or transmit the virus as much as adults, there are many other issues involved. Nobody has any idea what this tells us about what will happen when we re-open schools now but because there are many ways that this will happen determined by many local school districts we have another big natural experiment underway.
Be that as it may there were also three other pieces in this week’s JAMA that review the state of the art of bariatric surgery as of right now. We’ve written a lot about bariatric surgery but I always learn new stuff.
Although bariatric surgery is currently recommended more than ever before very few candidates choose to make this choice. There is strong evidence that bariatric surgery is effective and safe and results in abundantly more weight loss that is way more durable than not getting the surgery for obesity. Also it cures or prevents the complications of obesity – type 2 diabetes, hypertension, abnormal cholesterol levels, osteoarthritis, sleep apnea, fatty liver disease and cancer – and it cuts death rates in half. The lack of uptake of bariatric surgery must be because it seems too drastic and dangerous and expensive and insurance companies impose often unreasonable requirements and restrictions.
This is not to say that the risks of bariatric surgeries are zero. The biggest risk perhaps is the fact that up to a third of bariatric surgery subjects will eventually need another surgery though for many reasons not always related to the first surgery. But this kind of weight loss surgery still results in better outcomes and life extensions and is cheaper in the long run than avoiding it.
The relatively newer procedure, the sleeve gastrectomy, is now more common than the classic Roux-en-Y gastric bypass (RYGB) because it is simpler and gets almost as good results and maybe has fewer complications and need for later re-surgeries. The adjustable gastric band procedure and other kinds of bariatric surgeries have largely been abandoned because of their inferiority to sleeve gastrectomy and RYGB. The weight loss average is 19% for the sleeve gastrectomy and 26% for RYGB. The long term failure rate, defined as getting back to within 5% of whatever you weighed before you got the surgery, is 14% for sleeve gastrectomy and 4% for RYGB. An almost fourfold difference in failure rate sounds bad but a 86% long term success sounds plenty good enough.
All patients who get this kind of surgery should take vitamins and be followed closely for nutritional deficiencies and complications. Ideally they should all be part of ongoing study by the surgeons who are doing them. I always say that the best way to learn to be a good cook is to eat what you make. And I still have so many questions.
1. Arterburn DE et al. Benefits and risks of bariatric surgery in adults. A Review. JAMA. 2020;324(9):879-87.
2. Yijun C, Zhaoping L, Dutson E. Primary care treatment of patients following bariatric surgery in 2020. JAMA. 2020;324(9):888-9.
3.Brajcich BC, Hungness ES. Patient page. Sleeve gastrectomy JAMA. 2020;324(9):908.
This writer’s opinion is their own and not the opinion of this newspaper
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.