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Obese males underuse surgery to lose weight

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In the Sacramento and Davis area, researchers found that even though obesity affects women and men equally, a University of California, Davis study shows that obese women are four times more likely than obese men to seek weight-loss surgery. When they do see a bariatric surgeon, male patients tend to be older, more obese and sicker than women.

A copy of the abstract of the study, “A Call to Arms: Obese Men with More Severe Comorbid Disease and Underutilization of Bariatric Operations,” published December 13, 2013 in the journal Surgical Endoscopy is available here. Could it be the men are less willing to undergo the knife if they can find a diet that they can stick with for years? Or are men more likely to be hungrier, or think eating too much is more masculine. After all, most of the TV contests on how much you can eat usually feature a group of men competing for who can eat the most and still walk away.

“It is important for men to realize that obesity poses a serious threat to their health and lifespans,” says Mohamed Ali, senior author of the study and chief of bariatric surgery at UC Davis. “A patient who is 100 pounds or more above his ideal body weight poses a therapeutic dilemma and should be referred to a surgeon.”

For the study, published in the December 2013 issue of Surgical Endoscopy, Ali and his colleagues collected information from 1,368 patients who were evaluated for bariatric surgery at UC Davis between 2002 and 2006. A vast majority of them — nearly 82 percent — were female.

Both men and women in the study were likely to be affected by weight-related conditions such as hypertension, diabetes, obstructive sleep apnea, elevated cholesterol and fat levels in the blood, gastroesophageal reflux disease, musculoskeletal peripheral disease, back pain, depression and metabolic syndrome, a combination of conditions that increases the risk of cardiovascular disease.

There were some distinctions, however, between men and women in the study. The male participants:

  • Had more weight-related health conditions as well as more serious forms of those conditions (an average of 4.54 conditions and 3.7 serious conditions for men, compared to an average of 4.15 conditions and 3.08 serious conditions for women)
  • Were more likely to have hypertension (68.8 percent versus 55.3 percent), diabetes (36.4 percent versus 28.9 percent), obstructive sleep apnea (71.9 percent versus 45.7 percent) and metabolic syndrome (20.9 percent versus 15.2 percent)
  • Had higher body mass index (BMI) measures (an average of 48.7 BMI for males compared to 46.6 BMI for females) and were more likely to have class IV obesity, which is a BMI between 50 and 59
  • Were about two years older than the females and more likely to be over 50 years of age

Even though the weight, health, quality of life, psychosocial function and lifespan of an obese male could be dramatically improved by surgical weight loss, Ali said that he and other bariatric surgeons must balance these potential benefits against the patient’s risk for post-surgical complications.

“This risk would be significantly lessened if obese males were referred to bariatric surgeons before they develop serious disease complications,” says Ali, according to the January 6, 2014 UC Davis news release, "Men do not seek obesity surgery as soon as they should." His study is believed to be the first in the U.S. to investigate gender-specific health disparities in patients seeking weight-loss surgery.

At the time of Ali’s analysis, 930 patients (70 percent) included in the study had undergone bariatric surgery, but only 14.4 percent of them were men. In addition to Ali, co-authors of the paper were Gina Farinholt, Aaron Carr and Eun Jin Chang, all from UC Davis. A grant from the Foundation for Surgical Fellowships in part funded the research. Also see another news release, "The new face of heart disease."

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