Weight-loss Surgery Warning Hints it’s Really Not a Simple Decision
If you had to choose between the risks of doing nothing about your weight and dying from one of the more common eventual comorbidities of obesity, or the risk of dying from liver failure but being thinner, which would you choose? A recent article from The Times of India hints that weight loss surgery is really not such a simple decision after all.
It’s an eye-catching article title―”Weight-loss surgery may cause liver failure,” as was recently reported in the online edition of The Times of India. Yes, we all know that as with any type of surgery there are specific risks. But with rapidly rising numbers of the morbidly obese and the not-so-morbidly obese opting for bariatric surgery, why haven’t we heard more about this possibility the past few years? The quick answer: because it is not common. But it does happen and here is what you should know.
The Times of India article reports that out of a large number of bariatric surgeries (approximately 2,000 per year in India) performed the past one-and-a-half years, that at least three patients developed life-threatening liver disease after their surgery. The point of the article was not to say that weight-loss surgery is dangerous; but rather, that patients need to know that if they are obese that the chances are that their livers are already damaged and may become even more damaged following the surgery.
For starters, here is what the typical bariatric patient can expect will happen: Because of the anatomical changes made to the gastrointestinal tract following surgery, patients have to go through a restrictive diet consisting of multiple phases. Typically, the first phase consists of clear liquids for 2-3 days, followed by completely low-fat and high-protein formula liquid meals for 2-4 weeks. After that, a soft or grinded diet including very soft protein-rich foods, such as egg, low-calories cheese, and lean meats such as chicken, cow, pork, or fish is recommended the next 2-4 weeks after hospital discharge. And then, finally, a more normal diet may be started 8 weeks or more after surgery.
One of the most common problems with changing the anatomy of the digestive tract is that it messes up the normal absorption of essential vitamins, minerals and other nutrients needed to maintain good health―and taking a multi-vitamin is not going to fix the problem.
The reason for this is that different regions of the digestive tract are responsible for absorbing specific nutrients; therefore, by-passing or eliminating those regions through surgery significantly decreases those nutrients making it into the bloodstream. So, careful nutritional monitoring is needed for the rest of a patient’s life as well as the expectation of developing gall bladder problems.
Less common, but still a problem is how the liver is affected after bariatric surgery. Researchers have found that nearly everyone who is morbidly obese has what they call “nonalcoholic fatty liver disease (NAFLD.)” NAFLD is when fat gets deposited inside 5% or more of your liver cells leading to hepatic steatosis and inflammation causing the liver cells to balloon and become injured resulting in cell death and scaring that is typically referred to as a “cirrhotic liver.”
One way to treat or lessen the effects of NAFLD is to lose weight. And that can be accomplished rather quickly through bariatric surgery as many studies show. However, here’s the kicker: in at least some cases, the liver does not respond well to rapid weight loss and becomes cirrhotic in response. So, a patient who is morbidly obese could be starting out with a damaged liver to begin with, and then worsen their liver health following bariatric surgery—which is what The Times of India article was really warning readers about.
So what are your options? You could refuse to have bariatric surgery and try again to lose weight through safer means such as increased exercise and a controlled diet. But if you are one of many who just cannot lose weight without the aid of surgery, giving up and not having the surgery is a poor choice.
In spite of the warning about potential liver failure following bariatric surgery, the data shows that significantly more obese patients benefit from bariatric surgery than those who do not have the surgery. Remember, only a very small percentage of patients experience near-fatal liver disease due to bariatric surgery.
The Times of India article quotes a recommendation by Dr. S. K. Sarin from the Institute of Liver and Biliary Sciences (ILBS)―a state-run hospital for gastrointestinal illnesses in Delhi― that any patient going for a weight-loss surgery must consider having a complete assessment of their liver condition before going under the knife.
"Liver function test (a simple blood test looking at liver enzyme levels and other biomarkers of health) may not give the real picture. Doctors should ideally use a fibroscan with extra lobe or MR spectroscopy to rule out cirrhotic liver," said Dr. Sarin.
However, even that may not give a clear picture of your liver health. According to an informative article on Medscape about liver disease and bariatric surgery, researchers have found that even doing biopsies of patients' livers can yield misleading results in determining just how healthy or damaged a liver may really be.
While all of this may sound like the old “damned if you do, damned if you don’t,” the take home message is that while bariatric surgery has all of its lauded successes, it does have its caveats. The point is that all patients should do as much research as they can, and then take their questions and concerns to their surgeon before deciding to have bariatric surgery―especially if you decide to save on costs by trying medical tourism for a weight loss procedure.
For more details about how the liver and bariatric surgery are linked, check out the referenced informative article on Medscape.
The Times of India “Weight-loss surgery may cause liver failure”