NCMA Healthy Insights

Bariatric Surgery: Weighing the Options

by Robert O. Woodbury, MD
Morbid obesity is the second leading cause of preventable death in the United States, with a loss of 300,000 lives every year. People who are morbidly obese often experience profound social, economical, psychological and physical consequences. This complex chronic disease results in limited activity, shorter life expectancy and a greater risk of health problems. The National Institutes of Health recommend that morbidly obese patients consider weight loss surgery when repeated attempts at dieting have failed.

The risks associated with long-term morbid obesity outweigh the risks associated with weight loss surgery. Surgical options have increased dramatically as more and more research has resulted in new and more advanced techniques. It’s no longer a one-size-fits-all procedure. Patient comfort, safety, successful recovery and adaptation to the loss of weight are important considerations as new surgical techniques and technologies are incorporated into medical practice.

Taking the First Step:

The first step is truly committing to a healthy and active life, getting educated on bariatric surgery, having a supportive primary physician, and then enrolling in a comprehensive program.Morbid obesity is a multifactorial disease that requires a multidisciplinary team for a successful treatment outcome. Healthy Steps Weight Loss Center brings together surgeons from NCMA, Drs. Robert Woodbury and Allen Cortez, along with other specialists in nutritional and exercise education, psychological and emotional preparation, social support, and lifestyle support. Candidates start their journey at an education seminar and also may begin attending a support group. Neither of these have enrollment fees or reservation sign ups, and information can be found at www.healthystepsinfo.com. They will learn about the comprehensive program and surgical options, and meet people who have experienced weight loss surgery and are maintaining a healthier lifestyle.

If a person decides to proceed, then he or she will begin a series of steps starting with a consultation with one of the NCMA surgeons, followed by a series of lifestyle and education sessions with the other professionals in the Healthy Steps program. The program usually lasts three months or longer. The patient will then undergo surgery, usually spend one to three days in the hospital, and be fully recovered in two to six weeks depending on which surgery is performed. Aftercare involves continued lifestyle sessions at Healthy Steps, surgical follow up, and continued follow up with one’s primary physician. This may include monitoring labs and bone density, and adjustment of medications for things such as diabetes and hypertension as these conditions improve after surgery.

How Does It Work?

At Healthy Steps, surgeons offer three minimally invasive surgical procedures, each designed to optimize resolution of obesity related medical conditions, and achieve weight loss based on a patient’s individual needs. The most popular surgical weight loss procedure in the U.S. and the world, is the Roux-en-Y gastric bypass. It involves creation of a new, smaller stomach “pouch,” and bypasses the remaining stomach (which still functions by producing digestive juices) and a portion of the upper small intestine. The next most powerful procedure is the vertical sleeve gastrectomy. In this procedure, most of the storage portion of the stomach is removed. This also results in a decreased level of certain hormones so the patient is less hungry. The only fully reversible procedure is the adjustable gastric banding. The NCMA surgeons use either the Lap Band (™) or the Realize Band (™) systems. An inflatable band is installed around the stomach, effectively creating a new, smaller stomach pouch. The system requires adjustments in the office for a customized pouch size.

There are several mechanisms involved in bariatric surgery. Each procedure is different in how many of these mechanisms are involved. The predominant one is by “restriction.” The pouches created by the gastric bypass or band system, or the sleeve created by the vertical gastrectomy, reduces the stomach’s volume, thereby restricting food consumption and caloric intake. There is a hormonal mechanism caused by the gastric bypass and vertical sleeve gastrectomy that decreases hunger at a physiologic level. Finally, in patients with a bypass there is malabsorption of calories and nutrients. This malabsorption mechanism also is very powerful in treating diabetes. All of the procedures are performed laparoscopically through tiny incisions with a video camera and special instrumentation. More details are located at www. healthystepsinfo.com.

As with any life-threatening disease, the doctor-patient relationship in the treatment of morbid obesity is a critical partnership. Patients and physicians should consult closely when considering surgery as an option. It is the surgeon’s obligation to thoroughly explain – and the patient’s responsibility to fully understand – the risks associated with each procedure and what the patient should expect in terms of weight loss and disease improvement, which varies from procedure to procedure. Above all, the patient should proceed only when they are physically and psychologically prepared to proactively manage and maintain their new, post-surgery lifestyle.

Read Dr. Woodbury’s article in NCMA Healthy Insights Magazine