Medical Mondays: Advances in Weight Loss Surgery -- August 3, 2009 -- Dr. Charles Morton - NewsChannel5.com | Nashville News, Weather & Sports

Medical Mondays: Advances in Weight Loss Surgery -- August 3, 2009 -- Dr. Charles Morton

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Advances in Weight Loss Surgery
Dr. Charles Morton
August 3, 2009

 

Weight Loss Surgery: Pros and Cons

As a treatment for severe obesity, bariatric weight loss surgery's popularity is growing. When diet and exercise fail the more than 60 million Americans considered obese, surgery, for some, can literally be lifesaving.

But it isn't for everyone. While generally safe, bariatric weight loss surgery (also called weight loss surgery) has risks. And losing weight after bariatric surgery is far from automatic; it takes commitment to lifelong changes in eating patterns and lifestyle.

According to the National Institutes of Health, weight loss surgery might be a choice for you if you meet the first or second of the following criteria and criteria three, four, and five:

Bariatric Weight Loss Surgery: Are You a Candidate?

1. A body mass index (BMI) greater than 40.

For example, your BMI is greater than 40 if you are:

  • Five feet six inches tall and weigh more than 248 pounds,
  • Five feet nine inches tall and weigh more than 270 pounds, or
  • Six feet tall and weigh more than 295 pounds.

You can calculate your body mass index using a BMI calculator on WebMD.  

2. Your BMI is greater than 35, and you have obesity-related health problems that may improve with weight loss.

Obstructive sleep apnea, severe arthritis, and diabetes are several conditions that may benefit from even a small weight loss. Weight loss surgery can dramatically reverse these health problems when caused by obesity.

3. You can demonstrate that traditional weight loss programs like diet and exercise haven't worked.

It's by far preferable to lose weight without surgery's risks. Weight loss surgery should be considered a last resort after traditional methods fail. Some centers may require you to show you have made serious efforts to lose weight.

4. You are ready to commit to permanent lifestyle changes after surgery.

Weight loss surgery is no quick fix. Ideally, surgery is only the beginning of a new healthy lifestyle.

5. You understand the risks and benefits of bariatric weight loss surgery.

As with any surgical procedure, it's essential to be well-informed before considering weight loss surgery -- knowing and accepting the risks as well as the benefits.

Bariatric Weight Loss Surgery: Benefits

The primary benefit of weight loss surgery is easy to understand: weight loss!

  • Gastric bypass surgery causes an average loss of 61% of excess weight.
  • Gastric banding surgery causes slightly less -- an average of 47% of excess weight lost.

Improvements in general health are also common. Obesity-related medical conditions usually improve or even go away after weight loss surgery, including:

  • Diabetes
  • Severe arthritis
  • Obstructive sleep apnea
  • High blood pressure

About 95% of people report improved quality of life after weight loss surgery. Some studies also suggest people live longer after weight loss surgery, compared to equally obese people who do not have surgery.

Bariatric Weight Loss Surgery: Risks

Yet weight loss surgery carries real risks. As many as 10% of people have complications afterward. Usually problems are only unpleasant or inconvenient, and might cause some pain and discomfort, or require additional surgeries, including:

  • Nausea, vomiting, and diarrhea
  • Wound infections
  • Abdominal hernias

Serious complications do occur after weight loss surgery. Although rare -- happening about 3% of the time -- they can sometimes be life-threatening:

  • Blood clot to the lungs (pulmonary embolism)
  • Leaks in the new gut connections
  • Bleeding ulcers
  • Heart attacks

About 1 in 400 people die from weight loss surgery complications at thirty days. The risk is higher for people over age 60. Having bariatric surgery at a center with very experienced surgeons reduces this risk.

Even after successful weight loss surgery, other problems are common:

  • Gallstones, often requiring gallbladder removal
  • Vitamin deficiencies or malnutrition, from poor absorption
  • Excess skin, requiring surgical removal (body contouring)

After Bariatric Weight Loss Surgery

Weight loss surgery should be the beginning of a new and healthy lifestyle. To make the most of the surgery and to maximize results, people need to:

  • Break the binge habit

Nearly all severely obese people have unhealthy eating habits. A common problem is "binge eating." After weight loss surgery, eating large amounts of food at one sitting can make you sick. For many people, learning to eat small, frequent meals is a challenge.

  • Eat healthy and take vitamins

Eating junk food or neglecting to take vitamin supplements can cause serious malnutrition after weight loss surgery. This can cause bone disease, loss of muscle tone, and low blood counts (anemia).

  • Exercise

Keeping weight off is far easier when a person is active. In addition, exercise reduces rates of many diseases, including cancer and cardiovascular disease. To maintain weight loss in the long term, exercise is essential.

Such profound changes in lifestyle don't happen automatically or easily for most. Many weight loss surgery centers offer behavioral counseling programs to help people make the transition into their new and healthy lifestyle after surgery

  

Preparing for Weight Loss Surgery

People who consider weight loss surgery are often at the end of their ropes. Traditional methods of diet and exercise have had no effect, and this procedure is a last resort. But it's a big leap to go from thinking about weight loss surgery to getting on the operating table.

People need to be aware, in great detail, of the risks and benefits of weight loss surgery. After all, any operation carries some risk, and can cause a great deal of anxiety. So prepare carefully if you are considering weight loss surgery. You should be physically and mentally ready. Most of all, you should be committed to changing your lifestyle and keeping the weight off to ensure a healthier life.

Here are a few questions to ask yourself:

  • Have you truly tried to lose weight through diet and exercise?
  • Will your insurance cover weight loss surgery?
  • Are you prepared for the psychological exam many surgeons require?
  • Have you looked into support groups to help you adjust after weight loss surgery?

Don't rush into weight loss surgery. Typically, two years pass from the time a person first thinks about having weight loss surgery to the time they make the commitment to have it done. Talk to family and friends, talk to the surgeon and people at the hospital. Approach this major decision thoughtfully.

First Steps Toward Weight Loss Surgery

More than 60 million obese people are living in the U.S., according to the American Obesity Association (AOA), and about 9 million are severely obese. Weight loss surgery, also called bariatric surgery, can be successful when diet and exercise have failed, and a person's health is on the line. Overweight is the second leading cause of preventable death in the U.S., after smoking, according to the AOA.

First, people contact their insurance company to learn if they are covered for the surgery. Then they should contact their primary care doctors to get documentation of their struggle with obesity. Many insurance companies want to know that a primary care doctor has tried to help the patient lose weight with psychological counseling, diet, and an exercise plan for at least five years.

While there are other options, such as personally financing weight loss surgery, they are costly: The National Institute of Diabetes and Digestive and Kidney Diseases states that a typical weight loss operation can run from $20,000 to $35,000.

With such a hefty price tag on weight loss surgery, it pays to ensure that your doctor documents your battle with obesity early on, to open up options down the road.

When you've crossed all your t's and dotted all your i's in the insurance category, it is time to find a first-rate surgeon and hospital.

Finding a Bariatric Surgeon for Your Weight Loss Surgery

When you're looking for a surgeon, ask the following questions:

  • Is he or she board-certified by the American Board of Surgery?
  • Is the surgeon a member of the American Society of Bariatric Surgeons?
  • How many of the surgeon's patients have died from weight loss surgery? The average death rate is less than 1%.
  • How often do his/her patients have complications? What side effects are most common?
  • What is the surgeon's success rate?

Clearly, the surgeon you find should be well experienced in the area of weight loss surgery. Research shows that the more experienced the surgeon, the lower the risk of death during or after the surgery. Ideally, you should look for a surgeon who has performed at least 100 weight loss surgeries.

Go beyond researching mere numbers and statistics; you will also need a support system. Look for a center or hospital that offers educational seminars to people considering weight loss surgery, so you can learn more about the actual procedure, the benefits, and the risks. Also look for support groups that you can turn to before and after your operation.  

Next, start preparing yourself physically and mentally; this is crucial to successful weight loss surgery.

Preparing for Weight Loss Surgery

It's important to understand that weight loss surgery is not a cure for obesity. And while bariatric surgery is a powerful tool in the fight against obesity, it's not a quick fix. Weight loss surgery is part of a long process, and requires a lifelong commitment to follow up with doctors, a regular exercise program, and healthy eating.

When you understand and accept that, it's time to start meeting with doctors -- a lot of them.

You probably will meet with a number of doctors to assess your health before weight loss surgery, including a heart doctor, a lung doctor, and other specialists.  Your doctors may ask you to lose some weight before surgery to show your commitment to change, and to improve your health. Some surgeons ask people to try to lose 15 to 30 pounds before surgery.

Your doctors may also require you to quit smoking before surgery - both for your long-term health and to lessen the likelihood of problems from your operation. Smokers face a higher risk of complications, such as pneumonia, from surgery.

You may also meet with a nutritionist to learn the elements of healthy eating, and how your eating habits need to change before and after the surgery. Often, people who get into the proper nutritional mindset before surgery -- eating smaller portions, eating slowly, paying closer attention to the nutritional makeup of meals -- adapt better to life after surgery.

Understanding the Risks of Weight Loss Surgery

Understanding the possible outcomes of weight loss surgery, including the risks, is an important part of preparing for the operation.

All surgeries carry some risk of infection or blood clots. And obese people are at higher risk for complications, particularly if they have early signs of diabetes or heart disease. A 2004 government report estimates that 0.19% of people die from weight loss surgery. The death rate is higher in older patients, and in people with high blood pressure. Yet weight loss surgery may cut in half the risk of heart disease in extremely obese people. And studies show that formerly obese people who had weight loss surgery live longer than obese people who don't have bariatric surgery. So, while the surgery has its risks, it saves lives.

For maximum protection, doctors recommend patients have a thorough pre-operative workup that can identify potential problems before surgery. Using an experienced and qualified surgeon is also critical.

Often patients find the required psychological evaluation helps prepare them mentally for the surgery and the risks. It helps some people become more conscious of what they are thinking and feeling, and prepares them to think of food in a different way.

Expectations After Weight Loss Surgery

Weight loss surgery -- like any surgical procedure, may require an extensive recovery period. Recovery time varies with the person, but usually takes at least one full week, and often up to three or four weeks.

New techniques have helped lessen recovery time. Today, the weight loss surgery can be performed minimally invasively via small incisions. In a few centers around the country, weight loss surgery is even done on an outpatient basis.

Most obese people lose about a pound a day for the first month or so after weight loss surgery. Then they may lose between 50% and 75% of their excess body weight within a full year after surgery. But even then, the process is not over. People who have weight loss surgery are at risk for medical problems due to nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. They need to follow a careful healthy diet, exercise, and have regular checkups with doctors who can monitor their nutritional health.

Quick Questions to Ask Yourself About Weight Loss Surgery

Ask yourself these questions, from the National Institute of Diabetes and Digestive and Kidney Diseases, if you are considering weight loss surgery. If you answer yes to many or all of them, start by calling your primary care doctor and insurance company.

Are you:

Unlikely to lose weight or keep weight off long term with nonsurgical measures?

  • Well informed about the surgical procedure and the effects of treatment?
  • Determined to lose weight and improve your health?
  • Aware of how your life may change after the operation (adjustments to the side effects of the operation include the need to chew food well and inability to eat large meals)?
  • Aware of the potential for serious complications, dietary restrictions, and occasional failures?
  • Committed to lifelong medical follow-up and vitamin/mineral supplementation?
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