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Expert Q&A

	By David L. Fay, M.D. Family Physician Associate Director, Waukesha Family Practice Residency Program

I am 5 feet tall and weigh 225 pounds. I am considering gastric bypass surgery to correct the problem due to very high cholesterol (300) and a history of heart problems in my family. Is this a good idea?

Obesity is largely defined by a Body-Mass Index (BMI) of more than 30 kg/m2; being overweight is considered 25 to 29.9 kg/m2. To obtain one's BMI, divide weight in pounds by 2.2 for weight in kilograms (kg). Then divide the height in inches by 39.37 and square the result for body area in square meters (m2). Finally divide kg by m2 for BMI.

In your case the result is 44.

All evidence-based weight loss recommendations begin with calorie reduction and daily exercise. Drugs are not recommended unless the BMI is greater than 30 (or greater than 27 in patients with diabetes or high blood pressure). Unfortunately, drugs have not shown long-term benefit.

Regarding surgery, evidence-based weight loss recommendations from the National Institutes of Health, National Heart, Lung and Blood Institute state: "Surgery may be considered for severely obese patients who do not respond to medical treatment because such individuals are at high risk for the comorbidities associated with obesity. Surgical treatment of clinically severe obesity usually consists of operations to restrict caloric intake (e.g., vertical banded gastroplasty) or to combine caloric restriction with some degree of malabsorption..."

They do not define "severely obese," but this is generally meant as BMI of greater than 30. There have been some recent reports of major complications, such as liver and kidney failure, malnutrition, arthritis and kidney stones. There is a 5 percent to 8 percent chance of a major complication and a 1 percent chance of dying from the procedure.

Given the above, it is essential to carefully consider this relatively drastic step and to get at least two surgical opinions. In my opinion, this surgery should be undertaken only if the potential benefits clearly outweigh the risks."

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