Bariatric surgery should be considered for active-duty military personnel
A study of active-duty military personnel in Canada, who underwent bariatric surgery, has found that surgery was safe, effective and improved deployability without impairing military careers. The study authors from the Royal Canadian Medical Services, Canadian Armed Forces, Ottawa and Laval University, Québec City, Canada, concluded that the results were relevant to the military of many industrialised countries. The outcomes were reported in the paper, ‘Bariatric Surgery Should Be Offered to Active-Duty Military Personnel: a Retrospective Study of the Canadian Armed Forces’ Experience’, published in Obesity Surgery.
The military is not immune to the obesity epidemic with most Western militaries estimating obesity rates ranging from 10 to 20%. Indeed, the Canadian Armed Forces (CAF) estimates that nearly half of its regular force personnel are classified as overweight and a quarter as living with obesity. The Canadian Armed Forces (CAF) approved bariatric surgery in 2005 for active-duty military personnel, however, the outcomes of weight loss, resolution of obesity-related comorbidities and impacts of bariatric surgery on military careers. The authors retrospectively reviewed the perioperative data, long-term bariatric results and military outcomes of 108 CAF active-duty military personnel who underwent bariatric surgery in Canada over a 61-month period.
From the study group of 108 patients (follow-up data was available for 106), 66.7% were male, the mean age of the patients was 42 and the mean pre-operative BMI was 43.6. Roux-Y gastric bypass (RYGB) was the most common operation (n=59), followed by sleeve gastrectomy (SG) (n=29) and adjustable gastric band (AGB) (n=20). Revision surgery was performed in five patients: three patients had their AGB removed and transformed into RYBG (2) or SG (1), and two SG were converted to a RYGB. No revision surgery was performed for weight gain. There was no mortality.
Seven RYGB (6.5%) patients had early major complications within 30 days of surgery and nine patients (8.7%) had late major complications, most of which were related to AGB. Minor early and late complications occurred in 11 (10.2%) and 22 (20.4%) patients, respectively.
Follow-up ranged from four to 60 months, with a mean last follow-up of 31.3 ± 18.5 months. All bariatric procedures significantly reduced body weight (101.3 ± 22.5 kg, p<0.0001) and BMI (33.7 ± 6.3 kg/m2, p<0.0001). Hypertension remission or improvement was observed in 91.2%, diabetes in 85.7%, sleep apnoea in 43.1% and dyslipidaemia in 42.9% of cases. In 43.6% of patients, GERD subjectively resolved or improved, However, 6 (8.7%) developed GERD, three RYGB, one SG, and two AGB.
Occupational factors improved or remained unchanged in 24.5% and 57.8% of the patients, respectively. Fifty-one patients (47.2%) were released from service on medical grounds. Of these, 16 patients were released before their surgery. The main causes for medical releases were post-traumatic stress disorder (PTSD), musculoskeletal disorders and mental health issues. One patient was directly released because of postoperative complications, which was an anastomotic leak complicated by a gastro-gastric fistula. Fifteen patients (13.9%) were deployed postoperatively.
Deployed personnel had a significantly greater weight loss at their last follow-up (37.5 ± 15.6 kg, p<0.05) and a tendency for higher TBWL (27.3 ± 9.1%, p=0.06) than those who were not deployed (28.1 ± 15.6 kg and 21.5 ± 11.1%). Based on medical categories (G/O factors), the combined deployable and possibly deployable status increased from 35.4% before surgery to 47.9% postoperatively.
“To the best of our knowledge, this is the largest series of bariatric surgeries performed in active-duty military personnel to date…the data show that it is not detrimental to military careers and may improve deployability. If offered earlier, this could help prevent irreversible medical conditions and avoid members from being medically released,” the authors concluded. “The retention of trained personnel and experience is critical to armed forces. We suggest that these results may be relevant to the military of many industrialized countries. Bariatric surgery should be considered for all active military personnel who meet the standard surgical indications for the management of obesity.”
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