Articles featuring
Vivienne Matalon M.D.
Of TLC Healthcare

An exert from The Barianician - Fall 1999 23

Complications of Rapid Weight Loss Currently, 97 million Americans (36% of the population) are classified as overweight or obese. Increased body weight contributes to a higher incidence of morbidity and mortality in this group, as a result of the development of a number of medical illnesses including cardiovascular diseases, diabetes, and osteoarthritis. Losing even a small percentage of total weight leads to an improvement in overall health. Therefore, many physicians encourage their overweight patients to undertake changes in diet, exercise, and behavior to lose the excess weight. Dieting changes the internal and external physiology of the body. Although often unrecognized and underreported, it is known that dieting, especially when associated with rapid weight loss, adversely affects the normal physiology of the gallbladder. Recent studies have shown that obese patients undergoing rapid weight loss have a 25% to 36% chance of developing gallstones within 4 months of initiating a weight loss program, Gallstones may cause pain requiring cholecystectomy. An average of 500,000 to 700,000 cholecystectomies are performed annually. Eighty percent of these are procedures are performed on patients who are obese. As a result of these findings, physicians managing patients undergoing rapid weight loss should consider intervention to prevent the formation of gallstones. Significant weight loss is associated with an increased risk of developing gallstones in obese populations already at risk. Although studies have implicated rapid weight loss as a risk factor for the development of gallstones in patients who lost weight both by dietary and surgical means, studies have been unable to show a causal relationship between weight loss and any specific gallstone pathogenesis. No significant differences were evident between patients who developed gallstones and those who did not with regard to initial body weight or amount of weight lost. Therefore, physicians are unable to predict which patients are predisposed to develop gallstones. It may be possible that weight reduction in some patients potentiates other risk factors for gallbladder disease. Available data indicate that 50% of patients who undergo rapid weight loss develop either gallstones or biliary sludge. Thus, an attempt to prevent gallstone formation during rapid weight loss appears to be warranted. Ursodeoxycholic acid (ursodiol) has been shown to be of value for preventing gallstone formation during the period of rapid weight loss. Significant weight loss improves the status of patients suffering from complications of obesity, including diabetes and cardiovascular disease. The overall health of patients undergoing a weight loss program would be further enhanced if the risk of gallstones could be reduced during this time.