Wednesday, December 13, 2017

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Is weight loss surgery for you? It’s not a cure-all, but it can be a dramatic help.

Written by  Rick Piester

This is the time of year when many of us are trying to make good on our New Year’s weight-loss resolutions. We’re furiously dieting and steadfastly working out, trying to get our bodies down to that elusive “ideal weight” goal.

But for some of us, the goal isn’t merely elusive: It’s completely out of reach. No amount of dieting or exercise is going to lead to significant and lasting weight loss for us.  

We are — in medical terms — obese. And the more obese we are, the less likely we are to lose weight and keep it off through diet and exercise.

Some of those who have made repeated serious-but-failed attempts at traditional weight loss programs are now turning to weight loss surgery, called “bariatric” surgery. This alters the digestive system to help people lose weight by limiting how much they can eat. Bariatric surgeries have become so popular that about 200,000 of them are performed each year in the U.S. alone, a tenfold increase since the early 1990s. Although they were considered to be rather exotic, high-risk procedures not long ago, they have become a safe and relatively standard surgical approach to a lifestyle problem.

In fact, they have become so effective that many healthcare insurers in Virginia and at least 47 other states as well as Medicare and Medicaid cover them, as long as the somewhat stringent eligibility and patient education requirements are met.

In Richmond, Eliseo Bautista, MD, is part of the Bon Secours St. Mary’s Hospital bariatric surgery department, recognized since 2005 as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery.

Dr. Bautista says that St. Mary’s criteria for people seeking bariatric surgery is fairly straightforward and is determined in large part by healthcare insurers. “It’s important that people understand that surgery is a tool to help meet weight-loss goals,” he notes. “People still have to be mindful of what they eat — that the operation doesn’t force you to eat the right foods and the right portion sizes.”

For that reason, candidates for surgery complete an evaluation by hospital dietitians, pre-surgery educational programs run by dietitians and nurses from the bariatric surgery department, a mental evaluation, an assessment of any related health problems such as diabetes or heart disease, and a psychological assessment. Preparation for surgery typically takes from two to three months, Dr. Bautista says, and post-surgical care consists of frequent contact with surgeons, dietitians and nurses from the department.

A key criteria for surgery is having a body mass index (BMI) of 40 and above, if there are no accompanying medical problems. If a person has diabetes, blood pressure issues, or any other weight-related ailments, the BMI requirement drops to 35.

Body mass index

BMI is a measurement of body fat based on each person’s weight and height. It’s a numerical score that applies to both women and men, used to indicate whether a person is underweight, of normal weight, overweight, obese, or severely obese. If you score a BMI between 18.5 and 25, you are considered to be a normal weight for your height. If your BMI is between 25 and 30, you are considered to be overweight, and medical professionals consider you to be obese if your BMI is 30 or higher. A BMI of 40 or higher indicates severe obesity.

About two out of every three American adults are overweight, and one out of three can be said to be obese. In 1990, hardly any states had obesity rates of more than 15 percent; today, all 50 states have obesity rates of at least 20 percent. A 2012 study in the Journal of Health Economics estimated the medical care costs of obesity in the U.S. in 2005 to have been as high as a 190 billion dollars, a figure that is steadily increasing.

Weight gain also gives rise to looming health risks. The physical ailments associated with obesity include higher rates of heart disease and stroke, diabetes, sleep difficulties, joint problems, and an increased risk of certain types of cancers. Obesity, in fact, has become second only to tobacco as a major killer in the United States. This is part of the reason that healthcare insurers cover bariatric surgery. The surgery helps reduce the costs of serious weight-related diseases.

Bariatric surgeries do not remove fat tissue. Instead, surgeons rework the stomach and intestines so that a person feels full more quickly, ingests fewer calories, or both.

Types of surgery

At Bon Secours St. Mary’s, surgeons perform three types of bariatric operations, all of them laparoscopic surgeries in which small “keyhole” incisions rather than larger, open incisions allow surgeons to introduce a video camera and surgical instruments rather.

Dr. Bautista calls gastric bypass surgery the “old faithful” of the operations he performs. It’s been in use for the longest time and offers the best and longest-lasting results, in his opinion. In this surgery, the stomach is made smaller by creating a small pouch at the top using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.

In a sleeve gastrectomy, the stomach is surgically narrowed to resemble a sleeve. The smaller stomach pouch, about 15 percent the size of the “original,” has a capacity that is reduced from about 1½ quarts to between 4 and 6 ounces.

The third approach, gastric banding, is falling out of favor with surgeons and patients alike because of the intensive level of follow-up needed, Dr. Bautista says. In this surgery, a device is wrapped around the upper part of the stomach to form a ring. A thin tube is attached to the ring, and an access port in the body allows surgeons to tighten or loosen the band by injecting saline solution.

Recovery time with all three approaches is relatively rapid, with most patients going home a day or two after surgery and getting back to work between a week and a month after surgery, depending on the kind of work they do.

However, Dr. Bautista cautions that bariatric surgery does not signal an end to a person’s fight against weight gain. Surgery can create new and different nutritional, medical and physical challenges along with changes in a person’s emotions and behavior.

Still, Dr. Bautista relishes the chance to form long-term relationships with his patients and says that he never tires of the impact that he and his team can have on the health of others. “It can be fascinating,” he says, “to watch a patient’s sometimes long list of medications become pared down to just a few items — such as vitamins — and to help them live healthier lives.”

Is your weight normal, or is it under or over what it should be? For a quick look at your Body Mass Index (BMI), go to http://www.bmi-calculator.net.