Beating Obesity With Bariatric Surgery

According to the Centers for Disease Control and Prevention, roughly 30 percent of American adults are considered obese. That is up from 23 percent just 10 years ago. Obesity in children is also on the rise.

Obese or overweight?
Being obese and being overweight are not the same thing. Overweight refers to an excessive amount of body weight that includes muscle, bone, fat, and water. An obese person has a large amount of extra body fat. People who are obese are very overweight and at risk for serious health problems.

A growing number of health experts view obesity as a complex and serious disease rather than the sole result of bad eating habits. But as scientists learn more about obesity, they still don’t know why some people are obese and others aren’t.

“We think chemicals play a major role because they control large parts of the sensations of hunger and appetite and the body’s ability to metabolize food,” says Rajan Nair, M.D., bariatric surgeon at Salem Hospital. The good news for people battling obesity is that it can be treated. Whether they’re trying to lose weight for the first time or have failed every weight-loss program imaginable, help is available.

“Miracle diets and quick fixes don’t work,” says Dr. Nair. “Ongoing treatment is vital because obesity significantly increases the risk for heart disease, Type 2 diabetes, hypertension, sleep apnea, high cholesterol, and a number of other life-threatening conditions.”

Weight-loss surgery
Sometimes obese patients fail to lose weight or maintain their weight loss even with the help of a comprehensive program. For these patients, the only effective option may be surgery.

“Surgery is an option to be considered only when other efforts to lose weight have failed,” says Dr. Nair. “But surgery—along with lifestyle changes and lifelong follow-up— can bring dramatic results.”

The most common bariatric procedure performed in the United Sates is the Roux-en-Y gastric bypass. Using traditional open surgery or minimally invasive techniques, doctors create a small pouch out of the existing stomach. Next, they connect a portion of the small intestine directly to the pouch.

“The Roux-en-Y gastric bypass procedure helps patients lose weight by creating a very small pouch, thereby limiting the number of calories that can be comfortably eaten at any given meal,” says Dr. Nair. “After surgery, patients can experience unpleasant symptoms when they eat sugary foods, so they tend to eat less of these high-calorie foods. Surgery also seems to suppress appetite so patients don’t feel the urge to eat as much.”

Another option is a procedure called laparoscopic adjustable gastric banding, or Lap-Band^®. A hollow Lap-Band is placed around the upper portion of the stomach to create a small stomach pouch that holds about one to two ounces of food. A tube attached to the band has a port through the abdomen wall that allows the doctor to later add small amounts of saline to increase restriction to the stomach. As in other gastric procedures, this also creates a longer lasting feeling of fullness.

Biliopancreatic Diversion with Duodenal Switch is another weight-loss surgery procedure. It involves surgically removing approximately two-thirds of the stomach to decrease the amount of food that can be comfortably eaten at one time, while also rerouting food to bypass much of the small intestine. This surgery is primarily a “malabsorptive” operation, but also has a mildly “restrictive” component.

Only open Roux-en-Y gastric bypass surgery is currently being done at Salem Hospital.

Weight-loss surgery is not without risk. As with any surgery there can be complications. The most serious complications related to weight-loss surgeries include leaks, infections, bleeding, blood clots and intestinal blockage. Gallstones and nutritional deficiencies are possible, but can easily be controlled with medication and nutritional supplements.

Maintaining a healthy weight
“Regardless of how obese patients lose weight, maintaining their weight loss is a lifelong process,” says Catherine Quinn, M.A., R.D., bariatric dietitian at Salem Hospital. “The surgery is only one part of the process, which also includes dietary and lifestyle modifications, including regular physical activities.”

Patients will often see significant improvements in their obesity-related medical conditions, and some conditions may go away completely.