This is a drastic surgery for the morbidly obese, defined as those who are at least 100 pounds heavier than the ideal for their age, height and weight. Obesity is considered the second-leading cause of preventable death in the United States. This serious surgery requires a lifetime commitment to nutrition and following proper protocols to make sure your body is getting enough vitamins.
It is rising in popularity as the American obesity rate skyrockets. Some 18 million people in the United States are categorized as obese, according to statistics compiled by the National Institutes of Health. As the number climbed, so, too, did the number of bariatric surgeries, rising from 16,000 in the early 1990s to an estimated 180,000 in 2005, according to the American Society for Bariatric Surgery.
Whether you are clinically overweight is determined by something called the Body Mass Index, or BMI. It’s a calculation based on weight and height, using age. Generally, a person with a Body Mass Index of 25 to 29.9 is considered overweight. Those greater than 30 are obese. Those whose BMI is higher than 40 are considered to be severely obese and are good candidates for bariatric surgery.
With more than two in three adults considered overweight or obese, clearly it’s a health crisis that requires non-conventional intervention. Obese people are at high risk of Type 2 diabetes, high blood pressure, heart disease, fatty liver disease, arthritis, stroke and some types of cancer.
Thus, bariatric surgery has stepped into the breach.
What is the procedure?
If you undergo bariatric surgery, the procedure will be done under general anesthesia. Your surgeon first will make the stomach smaller by using staples to divide it into two sections, a small upper pouch and larger bottom. The top is for food and is about the size of a walnut, holding about one ounce of food. The bypass part is trickier. The surgeon will connect a part of the small intestine to a small hole in the pouch. This will now take the food you eat into the small intestine from this opening. The downside is you will get fewer calories and nutrients from food, requiring you to take vitamin supplements.
The surgery can be performed using a large surgical cut or can be used with a tiny camera known as a laparoscope. This will require up to six cuts in your belly and will use thin surgical instruments in combination with the small camera to perform the procedure. The results will be the same whether you go for the full cut or the laparoscopy, but the smaller cut will enable you to recover faster, have a smaller scar, get out of the hospital faster and endure less pain.
Because any surgery is risky, these procedures are considered a last resort when the patient cannot lose weight via diet, exercise or changing behaviors. Risks include developing an allergic reaction to medicine, a blood clot, blood loss, serious infections, breathing issues, unforeseen blockages, and a stroke or heart attack during the surgery, which can last four hours or more. There is also a small chance of death on the operating table, estimated historically at 0.1 percent to 2 percent, with recent data pegging it at 1 percent.
Keep in mind that bariatric surgery is not a cure. You will be required to diet and exercise for the rest of your life, and the stomach can stretch over time, in effect undoing the benefits of the surgery and allowing you to ingest more food.
Dramatic Results
Patients who undergo surgery can lose up to 20 pounds a month in the first year after having the surgery, and there are reports that patients could lose up to half their weight in the first two years. There are hormonal changes as well. Weight loss eventually will slow or plateau, but with diet and exercise, patients should be able to reach their goal weight. Obviously, the health benefits are enormous, lessening the risks of high blood pressure and diabetes, asthma and sleep apnea, and decreasing the risk of developing gastroesophageal reflux, or GERD, as it’s known.
Unfortunately, not every bariatric surgery patient has a final success story. Because lifestyle and habits play a role in weight gain, some patients resume their problematic behaviors, stretching the stomach and subsequently gaining weight. That can set off a cascade of guilt and depression and require a procedure to re-shrink the stomach to regain the benefits of the prior bariatric surgery. New sutures are put in place that again will make the stomach smaller, although the psychological problems that caused the prior failure will need to be dealt with in individual or group therapy.
Insurance generally will cover bariatric surgery but not in every case. There are often psychological evaluations required before surgery is approved, both to discover environmental causes of the behavior and to assess the likelihood of success.
However, it’s clear that obese patients lose more weight with bariatric surgery than with any other medical weight loss treatment currently available. Even though there are risks, and the patient must continue to be monitored, more and more insurance companies realize that the cost of surgery is often less than treating the illnesses that may result from being severely overweight. That is a factor that cannot be underestimated when deciding whether the surgery is right for you.