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Resource Description: 
Visit the site for an information-rich section entitled, "Working with Your Doctor to Overcome Overweight and Obesity".
This site is one of the web's most comprehensive sources of information on obesity and overweight.
American Society for Metabloic and Bariatric Surgery (ASMBS) is an association of bariatric surgeons. The site includes a section for patients that includes a BMI calculator, a find-a-surgeon area, and detailed descriptions of the various types of bariatric surgery.
This site offers information and resources on obesity and bariatric surgery. It contains a library of answers that patients have posted to commonly asked questions about the emotional and health aspects of the surgery process.
Weight-control Information Network (WIN) is an information service from the National Institute of Diabetes & Digestive & Kidney Diseases and the National Institutes of Health. This page aims to provide science-based information, with links to fact sheets on current hot topics, research, and statistics. The Gastrointestinal Surgery for Severe Obesity page covers the basics of gastric bypass surgery, including its risks and benefits.
Episode number: 
306

One of the most intractable health problems in the U.S. is obesity.  Statistics from the National Center for Health show that 30 percent of U.S. adults age 20 and older are obese.  That translates to over 60 million people – and the number is growing.  Medical professionals predict that by the year 2010, 40 percent of Americans will be obese.

There's no consensus on the causes of obesity, but the costs are clear – increased chronic health problems and painful loss of self-esteem.

The solution seems simple.  People should eat less and exercise more.  But if you ask the millions of people who have tried and failed they'll tell you that diets work for a little while; then they regain the weight plus more.  This pattern – called yo-yo dieting or weight cycling – is a dangerous sequence that can actually change the body's fat-to-muscle ratio, one of the more important factors in health.

So, while it's always best to lose weight through a healthy diet and regular physical activity, weight loss (bariatric) surgery may be the only real long term solution for those who have been struggling with chronic obesity for years.  In fact, thousands of people are doing just that with as many as 175,000 to 200,000 procedures predicted for this year by the American Society for Bariatric Surgery.

 

Quick Facts

  • You need to burn 3,500 calories to lose a pound of body weight.

  • You know your height and weight. You also should know your blood pressure, cholesterol level, and Body Mass Index (BMI).

  • Obesity has been directly linked to heart disease, high blood pressure, stroke, and type II diabetes and may set the stage for a host of other illnesses. In fact, American Cancer Society researchers recently announced that obesity accounts for about 90,000 cancer deaths a year in this country.

  • Today 127 million Americans, more than one-third of the adult population, are overweight, and 60 million are obese. An estimated 9 million of those are considered morbidly obese.

  • According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk.

  • Obesity surgery may be recommended as a treatment option for people who:
    • Weigh more than 50 percent of their ideal body weight
    • Have a BMI of
      • 40 or over; or 
      • 35 to 39.9 with serious medical conditions, such as heart problems, diabetes, sleep apnea or other risk factors

  • According to the American Society for Bariatric Surgery, surgeons will perform 175,000 to 200,000 bariatric procedures this year (up from 47,000 in 2001).

  • Surgery is a well-established method for long-term weight control for persons with severe obesity.

  • Patients should be motivated and committed to making a lifestyle change after surgery.

  • A medical team, including behavioral and nutritional professionals, should be part of a life-long follow-up plan.

Ask Your Doctor

This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.

Questions to ask your physician:

  • What is my BMI? What should it be?

  • What is my ideal weight?

  • Do you think surgery is the answer for me? Why?

  • What risks of having surgery versus the risks of not having surgery?

  • What surgeons do you recommend?  Why?

Questions to ask your surgeon:

  • Did you receive formal training in bariatrics?

  • How long was your training?

  • Are you board-certified?

  • Is the anesthesiologist your work with board certified?

  • Do you work with the same surgical team each time you do this procedure?

  • What types of weight loss surgery procedures have you performed?

  • Which weight loss procedure is best for me? Why?

  • What are the risks and how likely are they to occur?  

  • How frequently do you perform the procedure recommended for me?

  • How many times have you performed the procedure recommended for me?

  • Can the procedure be performed using minimally invasive techniques?

  • What is your safety record?

  • What can I expect following surgery?

  • How much pain should I expect?
    • How will it be controlled?
    • How long is it likely to last?

  • How long am I likely to be in the hospital?

  • Will I need assistance at home?

  • What are the best case and worst case scenarios?

  • Can you give me the name of one of your patients who has had the procedure so I can talk to him/her?

  • What do you expect from me if I decide to choose a surgical solution?

  • What will my after-surgery regimen be like?

  • What type of long-term, after-care services do you provide?

  • What type of plastic surgery do you think I will need after my weight loss?  What surgeon(s) do your recommend?

  • What are all the costs involved in this surgery and follow-up care?

  • Will you work with me to gain insurance approval?

  • If I am denied insurance coverage, do you offer payment options?

Key Point 1

Obesity is a major problem in the United States.  Not everyone can make diet and exercise work and diet pills are not the answer.  Obese people are left with the medical and social consequences of being fat. 

In the past decade, the percentage of obese U.S. adults has nearly doubled.  But it's not just a problem in the U.S.  According to the World Health Organization (WHO) it's a global issue with more than 1 billion of the world's adults being overweight and at least 300 million of them obese. 

WHO points to profound changes in society and in behavioral patterns of communities over recent decades as the reason.  Our diet has changed to one with a higher proportion of fats, saturated fats and sugars.  And we've become sedentary with less physically demanding work, more technology at home and more passive leisure pursuits.  More people than ever have become couch potatoes and mouse potatoes. The stress of our modern-day life may also contribute to obesity.  Some people find eating to be soothing and an effective stress-reducer.  Also, scientists have proposed that stress may influence hormones in the body that promote storage of body fat.   

Most doctors agree that every other weight loss option should be exhausted before considering something as drastic as surgery.  However, both experience and medical studies have shown that traditional weight-loss methods just don't work for the severely obese.  In this group, the failure rate of dieting approaches 100 percent.  For these people shedding pounds and keeping it off is a monumental struggle.  Many have tried every diet and every weight loss pill in the book. Some even reach their weight loss goal, only to gain the weight back.

It's important to treat obesity for many reasons, not the least of which is that studies have shown that obese people have shorter life spans if untreated.  Perhaps as importantly, these people also tend to lead less satisfying lives.

Obesity puts a tremendous burden on the body. When it's severe, it's disabling in and of itself.  Plus, obesity opens the door for a whole host of serious health problems including diabetes, high blood pressure, stroke, heart disease, osteoarthritis, sudden death sleep apnea and an increased risk of death from some cancers.

Obesity carries other implications as well.  There's a stigma to being overweight. People who are not overweight judge those who are harshly.  They look at obese people as being lazy, weak-willed, less competent, less intelligent and out of control, even when the facts don't support that view.  The obese are likely to be discriminated against in school and on the job. The obese may even be stereotyped by their physicians.  Bias is never more obvious than when it comes to romance.  Just as "location, location, location" is the mantra for real estate, "appearance, appearance, appearance" is often fundamental for attracting and keeping a mate.  In many cases body image dissatisfaction prevents the obese individual from attempting intimacy. The obese tend to be at high risk for depression and anxiety, social isolation and alienation.

In the end, people who have fought with the scales for years have two choices:

  • Go on another behavior modification program
  • Consider a surgical alternative

Conspicuously absent from the above list is the alternative of taking diet pills.  A "magic bullet" diet pill may be invented in the not-too-distant future, but today there isn't one that will help you to lose significant amounts of weight safely and permanently.
 
When does it make sense to consider surgery?  The answer for many is when the consequences of staying at their current weight put them at higher risk than the risk of surgery.

    

Key Point 2

Bariatric surgery requires you to make lifestyle changes that include your eating habits and complying with an exercise program. 

Today's bariatric surgery is more effective than ever.  Consider these facts:

  • Bariatric surgery succeeds in 75 percent of cases
  • Dramatic weight loss begins immediately after the procedure and levels off in 18 to 24 months
  • The average patient loses between 50 percent and 75 percent of his/her excess weight and keeps it off

Yes, 75 percent of bariatric surgery patients succeed.  But on the flip side, that means that 25% of them fail. Why?  Because bariatric surgery isn't a "be-all, end-all" solution.  The surgery is only part of the solution.  It simply makes it physically easier to adjust eating habits because a feeling of fullness is achieved with small quantities of food.  Long term success requires that patients make a commitment to lifelong changes in diet and exercise.  Patients who fail either never reach their target weight or they regain weight by continuing a sedentary lifestyle, eating high-calorie foods, eating too frequently and, over time, increasing the quantity they eat and stretching the stomach pouch far beyond its post-surgery size.

One major indicator for long term success with post surgical weight loss is a person's willingness to modify their dietary and exercise habits prior to surgery.  That's why many surgeons require patients who are not at an acutely dangerous stage of morbid obesity to undertake a pre-surgery program of behavior modification.  These programs usually include both medical and emotional counseling. Doctors view a patient's compliance during this period as a strong statement that he or she is really committed to a healthier lifestyle.

The long term regimen after surgery generally includes:

  • Five to six small meals a day totaling up to a 1200- to 1500-calorie low-fat, low-sugar diet.
  • Avoidance of certain foods.  Some people will not be able to eat red meats, non-toasted bread, fruits with peels on them, or some raw vegetables after bariatric surgery. Many patients won't ever be able to tolerate sweets again because they get Dumping Syndrome.   
  • Daily vitamin and mineral supplements. Bypass patients don't just eat less – they absorb less of what they eat. As a result most patients require daily vitamins for the rest of their lives.
  • Daily exercise.
  • Frequent follow up medical visits.  Patients will need to stay in touch with their family physicians and a dietician in order to check periodically for vitamin and mineral deficiencies, weight regain, and inadequate nutrition.
    

Key Point 3

Bariatric surgery is an effective weight loss procedure but there are consequences and risks that you need to be aware of.  You need to have good communication with your doctor so that you are not surprised with any results.  

Bariatric surgery is a complex weight loss surgery.  It's generally reserved only for the severely obese meaning they:

  • Weigh more than 50 percent of their ideal body weight
  • Have a BMI of
    • 40 or over; or 
    • 35 to 39.9 with serious medical conditions, such as heart problems, diabetes, sleep apnea or other risk factors

Bariatric surgery is a significant step with all of the complications normally associated with surgery plus several that are specifically related to rapid weight loss and change in physiology.  It should not be considered until you:

  • Are completely satisfied that non-surgical methods will not work for you
  • Undergo extensive medical screening
  • Discuss with your doctor the various surgical options available and which is best for you 
  • Work with your doctor to set realistic goals
  • Make a commitment to lifelong dietary and lifestyle changes
  • Understand the risks and side effects of the surgery, including the fact that problems may arise after surgery requiring additional operations
  • Understand that excess skin, called "skin redundancy" may mean you will want or need plastic surgery to remove it
  • Make sure you are psychologically ready

Different gastric procedures yield different results.  Gastric bypass is the most commonly performed bariatric surgery in the U.S., but it may not be right for everyone.  The <<American Society of Bariatric Surgery>> [www.asbs.org] web site features detailed descriptions of the various types of bariatric surgery. 

Surgery-Specific Risks
No surgery is risk free.  Bariatric surgery requires general anesthesia, with time in the hospital and for recovery depending on whether the procedure is performed with a laparoscopic or open method.  The death rate from the surgery is, on average, less than 1 percent.  Complications include, bleeding, deep vein thrombosis (blood clots), infections, leaks, marginal ulcers and pulmonary problems.  

Rapid Weight Loss and Change-in-Physiology Side Effects
Considerable stress can come with considerable body change.  Patients have to re-learn what to eat, how much to eat and when to eat.  They are terrified of regaining the weight. Their friends and families have to learn new ways to relate to them.  They either have to accept "skin redundancy" or go through – and pay for – plastic surgery to correct it.  And they may have to deal with (mostly temporary) side effects like:

  • Body aches
  • Fatigue
  • Feeling cold
  • Dry skin
  • Hair thinning and hair loss
  • Mood changes
  • Disappointment when weight loss doesn't fix all life's problems

There are lots to consider.  But, despite all the challenges, most people report that after the surgery and subsequent weight loss they feel better, are more active, and take fewer medications to treat the complications of obesity.   And they say they'd do it all again – in a heartbeat.  When the pros and cons are tallied, the pros win.

Medline Plus

Medline Description: 

Conduct an off-site search for Bariatric Surgery information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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