Hazards found in obesity surgery

By the time Linda Culpepper found her way to the Vanderbilt University Medical Center, she was in an alarming state. Her hair was falling out, her skin was flaking and her muscles had wasted so much that it was hard for her to walk. She had frequent attacks of diarrhea and could rarely eat without vomiting.

"She was a shadow of a human being," said her daughter, Susan Gritton.

Gordon Jensen, director of the Vanderbilt Center for Human Nutrition in Nashville, Tennessee, diagnosed her condition as life-threatening malnutrition, admitted her to the hospital and ordered intravenous feeding immediately.

The cause of the malnutrition was complications from weight-loss surgery performed at another hospital, specifically a gastric bypass, a procedure that closes most of the stomach and shortens the small intestine, often leading to weight losses of 100 pounds, or about 45 kilograms. That is the operation that has strikingly transformed celebrities like the television weather forecaster Al Roker, the singer Carnie Wilson and the comedian Roseanne Barr.

Successful cases like theirs, combined with a growing epidemic of obesity, have led to soaring demand for the surgery. In 1995, just 20,000 weight-loss operations were performed in the United States. Last year, there were 103,000, and this year 144,000 are projected.

The surgery has become big business, and medical centers have been scrambling to start programs.

The rapid growth worries experts like Jensen, as well as some insurers and government officials, who fear that inexperienced surgeons and inadequate screening and follow-up may harm patients.

In the last year, Jensen said, he has seen a "tremendous surge" in patients like Culpepper who have complications from the surgery or have not been taught how to change their eating habits to adjust to the drastic changes in their digestive systems. Most of the patients had surgery at smaller hospitals that were not equipped for the problems, he said, adding that he sees as many as one such case a week.

A recent study suggests that the overall death rate is twice the figure of 0.5 percent to 1 percent that is usually cited, and higher still if a surgeon lacks experience.

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