Private practice with Dr Seth Bilazarian

View all posts »

Making bariatric surgery standard of practice

Jul 22, 2011 16:20 EDT


Despite lingering clinical questions—most importantly, about whether there is a mortality benefit—bariatric surgery has shown excellent outcomes for patients with a body mass index of 35 kg/m2 or above who also have accompanying comorbidities. Do you think bariatric surgery (or at least referral for discussion at a center that performs the procedure) should be a standard of practice for such patients?

See also:

Bariatric surgery reduces long-term MI risk in men, but not women  

Bariatric surgery does not improve survival  

Gastric bypass does more than just reduce weight

Episode #29: Obesity in America with Dr Thad Waites

Fat chance: How cardiologists can help tip the obesity scales





« Previous Post
Adopting ticagrelor (Brilinta): The pros and the cons
Jul 29, 2011 13:30 EDT Next post »
Simvastatin: Now what?
Jul 5, 2011 08:50 EDT



Your comments
Making bariatric surgery standard of practice
# 1 of 3
July 26, 2011 11:49 (EDT)
Colin Rose

These days we are supposed to be practicing "evidence-based medicine." There has never been a randomized, sham-operated controlled trial of any kind of gastric bypass or reduction surgery for weight loss. Why are surgeons absolved of the responsibility to prove the same safety and effectiveness of surgical treatments that is required of drug treatments?

In the not so distant past when gastrectomy and vagotomy was done to treat peptic ulcers there was no obvious side effect of weight loss but now the same sort of procedure is promoted for weight loss. Quite likely the difference is that now obese patients are told that they will have to change their food habits or suffer some fearful symptom like nausea of abdominal pain if they eat too much after the procedure and this suggestion encourages them to control their junk food addiction, the cause of their obesity. Thus the need for sham-operated controls in any trial.

The smallest diameter of the GI tract is the esophagus. Anything that will pass through the esophagus will pass through whatever is left of the stomach after bariatric surgery. Patients could eat large quantities of ice cream and not feel any symptoms. The only kind of bariatric surgery that does work physiologically is some form of small bowel bypass, in which case overeating is associated with large, foul-smelling stools, an effective negative feedback signal.

There should a moratorium on all forms of gastric bypass or reduction surgery for weight loss until a proper sham-operated controlled trial of these procedures has proved their effectiveness relative to lifestyle change alone.

See blog for furher details.
# 2 of 3
July 29, 2011 11:14 (EDT)
Frank

I agree that controlled studies should be performed with LONG TERM follow-up.  The consequences of surgery are life-long.  The complications/benefits should be assessed for the long term.  This needs to be a randomized, prospective study.

My clinical impression is that there are some fabulous successes, some modest gains, and some horrific failures-however, this may be sampling bias for the patients seen.
# 3 of 3
August 11, 2011 01:21 (EDT)
Richard David Feinman
I think this testifies to the success of the American Heart Association, American Diabetes Association and others in closing the mind of physicians to the successes of carbohydrate restriction.  A moment on the internet -- the low-carbers forums has more than 130, 000 members -- will tell you what low-carbohydrate diets are about and how they differ from the propaganda of the health agencies. AHA and ADA have really successfully reduced the options for patients but I think they have little to be proud of.

You must be a member (with full membership) to post a comment.
Already a member?
Enter your login information below:
 Remember me on this computer
Forgot your username and/or password?
        Login        
Enjoy all the benefits of theheart.org

With full membership, you can check out our educational and editorial content, search the site, receive our newsletters, join discussions, download slides and much more.

Membership is free!

    Join now for full access    
About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.