In 2002, approximately 5% of American adults were morbidly obese , defined as having a body mass index (BMI, a measure of weight in relation to height) of 40 or higher. And the prevalence of morbid obesity is increasing. While numerous medications and weight-loss programs to treat obesity exist, bariatric surgery (such as Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty ) has by far the best long-term success rate for morbid obesity. Bariatric surgery works by reducing food intake and/or interrupting digestion to achieve substantial weight loss, which can improve health, longevity, and quality of life. The number of bariatric surgeries in the US has increased over time, from 4,925 in 1990 to 12,541 in 1997.

A new study in the October 19, 2005 issue of the Journal of the American Medical Association found that the number of bariatric procedures performed is dramatically increasing, but complication rates are remaining stable.

About the Study

Researchers used data on bariatric surgeries for obesity management from the Nationwide Inpatient Sample (NIS), a large database representing 20% of inpatient admissions to acute care hospitals in the US. They identified trends in rates of procedures and surgery-related complications, and patient characteristics (e.g., sex, zip code income level, type of insurance).

The researchers found that the estimated number of bariatric surgeries increased from 13,365 in 1998 to 72,177 in 2002, and was projected to have been approximately 102,794 in 2003. The majority of patients were female, and this trend increased from 81% in 1998 to 84% in 2002. The proportion of patients living in the highest zip code income level (over $44,999 per year) increased from 32% in 1998 to 60% in 2002. And the proportion of patients with private insurance increased from 75% in 1998 to 83% in 2002. Rates of complications remained stable over time. The rate of unexpected re-operations ranged from 6% to 9%. Pulmonary complications (e.g., pneumonia , respiratory failure) occurred in 4% to 7% of patients. One to two per 1,000 patients died while in the hospital for bariatric surgery.

This study is limited because the data used did not include a number of potentially important variables, including race or BMI.

How Does This Affect You?

These findings suggest that bariatric surgery procedures for obesity are dramatically increasing. If the rate of growth continues, there will be approximately 130,000 bariatric procedures in 2005, and as many as 218,000 in 2010. The disproportionate number of people of higher socioeconomic status (indicated by high-income zip codes and use of private insurance) having bariatric surgery may be indicative of a number of factors. It could simply be that more affluent individuals have the resources to act on their desire to be thin and healthy and deal with financial disruption that major surgery causes in their lives.

If you are considering bariatric surgery, the good news is that despite the dramatic increase in number of procedures performed, complications have remained stable and relatively low. It is important to carefully weigh your individual risks and benefits of the procedure with your doctor, and be sure you are doing it for the right reason—to improve your health.