Researchers report that a newer operation, the duodenal switch, produced substantially better weight loss in super-obese patients (BMI greater than 50) than gastric bypass, the standard operation. Three years after surgery, 84% of duodenal switch patients had lost more than half of their excess weight, compared to 60% of those treated with gastric bypass.

“While there is no single ideal bariatric procedure that can be applied to all severely obese patients, we have generally recommended the duodenal switch for those with a BMI greater than 50,” said study author Vivek Prachand, M.D., assistant professor of surgery at the University of Chicago.

The super obese make up only a fraction of the U.S. obesity pandemic, but their ranks are increasing faster than any other group. When the term was coined in 1987, fewer than one in 2,000 adults in the United States met the criteria of a BMI greater than 50.

A normal BMI is 18.5 to 24.9. From 25 to 29.9 is considered overweight. Thirty or above is considered obese; 40 and above is morbidly obese.

The prevalence of the super-obese has quintupled since then, to one in 400 U.S. adults in 2000, which adds up to more then 50,000 people in the U.S.

 

At the same time, bariatric or weight-loss surgery has increased from about 16,000 cases in 1992, to 63,000 in 2002, to 171,000 in 2005.

The most common surgical procedure for these patients—more than 80 percent of all bariatric operations in 2002—is the gastric bypass, which involves stapling off a large portion of the stomach to make overeating difficult, and rerouting the intestines to reduce the absorption of calories.

The duodenal switch — fewer than eight percent of all bariatric procedures performed nationwide — leaves a slightly larger stomach pouch but makes even more drastic alterations to the intestines to limit absorption, particularly of fats and starches.

Source: University of Chicago Hospitals 

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