More than one out of every four people in the United States is obese. Many states in Europe are similar or not far behind. How many of them may be candidates for weight loss surgery?
Many overweight people today are at risk of diabetes, cardiovascular disease, hypertension, and even cancer. Very few will return to a healthy body weight.
Americans by the millions of pop diet pills. Obesity is an epidemic puzzle in our world, and the place of weight loss surgery needs to be identified.
Simply stated, obesity is identified by an excessive amount of body fat. According to your body mass index (BMI), a score greater than 30 is considered obese. Scores ranging from 25-30 are deemed overweight.
BMI calculates your weight (in kilograms) divided by your height (in meters squared). Those who reach 40 kg per m2 are considered morbidly obese. Weight loss surgery must be considered for such as are at high risk for chronic diseases related to obesity.
What do we know about obesity and weight loss surgery? Weight loss surgery can lead to weight loss, particularly in the morbidly obese. Some are better researched than others.
Weight loss surgery can result in a more than 20 percent loss in body weight. That loss can be consistent for 10 years.
Medication for Weight Loss
Drugs are also available to combat obesity. Some commonly prescribed medications for weight loss include orlistat, phentermine, rimonabant, and sibutramine. They are shown to promote weight loss from 2 to 16 pounds among obese adults.
Like all medications and surgeries, such drugs also have risks and side effects. These must be discussed with your doctor. Medications also need to be used in correlation with lifestyle change.
Orlistatis meant to block fat from being absorbed into your system. It's used for weight loss as well as a tool to prevent re-gaining weight in adults who have already shed pounds.
It is used simultaneously with diet and exercise in adults only. Orlistat has been associated with gastrointestinal side effects.
It is sold under the brand name of Alli.
Rimonabant is another appetite suppressant that alters appetite-related cell membranes in the body. Though it is approved worldwide, it has been associated with risk of certain psychiatric disorders.
Sibutramine is an appetite suppressant not available in a lot of countries. This may be because of Sibutramine's association with potential cardiac arrest. It has also been connected to strokes.
Causes of Obesity
Simply stated, obesity is the result of your energy intake overwhelming your spent energy. It is a big picture that involves individual health, appetite, diet, lifestyle, genetics, and psychological wellness.
Typically, though, such factors get back to the basic recipe of excessive eating and minimal to no exercise.
Obesity Health Risks
Obesity can lead to type 2 diabetes, heart disease, sleep apnea, hypertension, dyslipidemia, and certain cancers.
Diabetes shows itself when your blood glucose levels are too high. With type 2 diabetes the body resists insulin and does not use it properly.
Heart disease involves a condition in which your blood vessels narrow and increase the chance of heart attack and stroke. Heart disease can also affect your heartbeat, cardiovascular muscles, or valves.
Sleep apnea is a sleep that affects a person's breathing while sleeping. If not treated, people can stop breathing during their sleep, keeping the brain from receiving enough oxygen.
Hypertension is characterized by high blood pressure and stress.
Dyslipidemia results in a high level of lipids in the blood. High cholesterol is the most common issue, as well as high triglycerides.
Certain cancers can be linked to diabetes because high levels of insulin have been associated with the development of colon, kidney, prostate, and endometrial cancers.
Other cancer factors in obese people include ongoing inflammation that can damage DNA. Fat tissue can result in too much estrogen which has been linked to risks of breast and ovarian cancers.
Obese adults have high hospitalization rates, high prescription drug use, and a lower quality of life.
Obesity in Children
Because obesity is measured using BMI scores, it is difficult to pinpoint in children. A child's BMI varies as the child ages and is different between boys and girls. BMI rates must be compared against reference groups.
Internationally there is no unified, objective measurement of childhood obesity. By hesitating to label a child as obese or morbidly obese, more consideration is given to intervention.
If we look at children with a BMI above the 95th percentile, the number of obese children is steadily growing.
The two primary factors involving childhood obesity are diet and activity. Children today may spend a lot of time in front of computers, video games, or the television. They may do so while snacking on unhealthy foods.
Other factors involve genetics, parent education, and psychological issues. Children who reach the 95th BMI percentile usually become obese adults. Overweight children are often at risk for diabetes, high blood pressure, hypertension, cardiovascular disease, sleep apnea, and other diseases.
Physicians and parents
Physicians and parents, together, should promote and facilitate healthy diet and exercise in the lives of overweight children.
Weight Loss Surgery
Obesity has serious ramifications for patients. Ultimately, it may be a life-and-death issue. Obesity can affect every organ in the human body, including the heart, kidneys, and liver.
Intervention is very important for adults with a BMI of 30 or higher, which may or may not lead to the need for weight loss surgery. However, weight loss surgery statistically results in greater weight loss than other interventions.
Your family physician can counsel you and provide more information about surgical treatment of for weight loss.
Talking to Your Physician
Your doctor is an important voice as you consider a life-changing option for obesity. Weight loss surgery may deliver a patient from the risk of life-threatening diseases, but there risks and variables that must be considered.
Your doctor has the advantage of already knowing your medical history and unique medical needs. Consider discussing some of these questions with your doctor:
How does weight loss surgery work?
- What are the primary advantages of weight loss surgery?
- Am I a candidate given my current health?
- If not, what would I need to do to become a candidate?
- What sorts of surgeries are available? Am I a better candidate for one than another?
- What are the dangers of weight loss surgery?
- What are my next steps?
How Does Weight Loss Surgery Work?
Weight loss surgery, also called bariatric surgery, is a serious weight loss option for obese and morbidly obese patients. There are two primary categories of bariatric surgery:
1. Restriction surgeries limit the amount of food that reach or can be stored in the stomach, naturally limiting your caloric intake.
2. Malabsorption surgery shortens the time food particles are in the small intestine, limiting the amount of time that calories are being absorbed by the body.
Types of Weight Loss Surgeries
Weight loss surgery is usually done laparoscopically, meaning a small incision is made in the abdomen and performed with the use of a camera. This is minimally invasive and more popular than open procedures.
There are four very basic surgical operations for weight loss.
Adjustable Gastric Banding
This laparoscopic uses a flexible band to cinch the upper stomach thereby reducing the stomach's capacity to hold food. It also makes the patient feel full.
The band is adjusted by a balloon that can be inflated with saline. Saline is added through a port under the skin of the abdomen. The balloon can also be deflated as needed.
The demand for gastric banding has waned with other surgical options that present less risk and potentially greater weight loss.
A sleeve gastrectomy is a laparoscopic surgical procedure that removes much of the patient's stomach. The remaining stomach is formed into a tubal structure. After surgery, the stomach is smaller and produces fewer appetite hormones.
Biliopancreatic diversion (with duodenal switch)
Biliopancreatic diversion also begins by removing a part of the stomach. The first part is the small intestine, called the duodenal, remains, as well as the valve that regulates food between the stomach and intestine.
The last part of the intestine is placed directly onto the duodenal. The unused middle portion of the intestine is then used to transport bile and other juices.
Thus, the patient's stomach is smaller, and food bypasses the entire middle section of the intestine
Roux-en-Y Gastric Bypass
A Roux-en-Y gastric bypass procedure divides the upper and lower stomach to create a small pouch at the top of the stomach.
The pouch will be the only part of the stomach that receives food. The patient eats less food and feels fuller more quickly
The small intestine is attached directly to the bottom of the pouch. The remaining section of the stomach below the pouch continues to function and create digestive juices.
As your doctor describes these procedures in more detail, think about your own preference, the potential surgeon's experience with each option, and the specific risks associated with each.
After surgery, a post-op management plan will be put in place including patient monitoring to detect any possible complications. A dietician will monitor the patient's diet and likely assign journaling of all meals.
Some typical post-op effects can include hair loss, extreme fatigue, and severe colds. Medications must be strictly monitored by your doctor after surgery.
Weight loss is a primary goal of bariatric surgery, but rapid weight loss can bring other risks, such as nutrient deficiency. Routine assessments of your nutrition will be required for at least a year after surgery.
Who Should Consider Surgery?
Before surgery, patients are evaluated for their candidacy. Variables such as
- Cancer screenings
- A complete physical and medical history evaluation
- A full blood work evaluation
- A complete assessment of patient's nutrition
- Pregnancy test for females
- Psychological evaluation
- Smoking/tobacco evaluation. You may have to kick the habit to be a candidate.
- Stress test
- Gastrointestinal assessment
Patients approved for bariatric surgery will be those who are dedicated to carefully following all post-op procedures, including diet, journaling, follow-up visits, etc.). Qualified patients will also:
- Have a BMI of 40 or higher with no co-existing medical conditions.
- Have a BMI of 35 or higher with multiple obesity-related medical conditions.
- Have a BMI between 30 and 35 with certain medical conditions.
Patients will often be disqualified due to:
- Heart disease or cardiovascular risk
- Drug or alcohol use
- Endocrine conditions
- Psychiatric conditions
Knowing the Risks
It is a hard truth that out of every 2,500 bariatric surgeries, 7 individual will die. In certain high-risk populations, the percentages can be even higher.
On the other hand, many lives are likely saved by bariatric surgeries. You must decide for yourself if the benefits outweigh the risks.
Obesity can lead to life-threatening conditions, including diabetes, heart disease, and stroke. Even for those who live a long life, the quality of life can be severely damaged. Some are barely mobile, and others are depressed.
For many, bariatric surgery is worth the risks. In recent decades the number of weight loss surgeries has increased nearly 20 times. The familiarity may also make people more likely to opt for surgery.
Control What You Can
Risks and side effects following weight loss surgery can be proportional to a patient's willingness to adjust his lifestyle. Patients willing to be persistent with diet and exercise will often suffer fewer side effects than those who do not.
Consistent post-op visits can also detect and prevent difficulties for those who are consistent in attending their appointments. Some patients will spend the rest of their lives on special diets and supplement regimens, and their willingness to follow these programs will bear directly on their quality of life.
Can Children Have Weight Loss Surgery?
Family physicians and pediatricians are aware of the childhood obesity crisis in our country. Every day doctors treat obesity-related conditions in our children including diabetes, heart disease, depression, and diabetes.
Children and families try different methods for losing weight, and each method fails. Is weight loss surgery an option for children or adolescents? There are pediatric surgeons who specialize in weight-loss surgical procedures for children and teenagers.
Like every candidate for weight loss surgery, children have unique needs. While most programs center on adults, there are centers that focus entirely on pediatric weight loss surgery, such as the Children's National Health System.
Parents of potential pediatric patients need to ensure their children are in a safe arena with proven success in pediatric bariatrics.
How different are the candidate qualifications for children than adults? Typically, pediatric candidates have suffered from obesity for at least three years while having no success with other weight loss methods.
A BMI score of at least 35 with obesity-related conditions—or a BMI of 40 without conditions—are basic screeners. Like adults, it is even more important that parents and children understand the dedication needed for a lifetime of healthy living.
Like adult candidates who undergo psychological evaluations, they are also necessary for child and teen candidates. They can be more important in the pediatric area because it needs to be established that the child or teen is mature enough to comply with the many requirements that he or she is facing.
For at least three years, pediatric patients will need to be faithful in follow-up visits.
There is no official age limit for pediatric candidacy, but a child should be old enough that he has exhausted all other weight loss efforts with no success. A child of any age will face certain advantages and dangers with weight loss surgery, and they must be looked at on an individual basis.
Age limit for pediatric candidates
The severity of a child's comorbid conditions will also be a factor in the advisability of weight loss surgery. In other words, bariatric surgery for children and preteens should be a last resort.
Just like in adults, weight loss surgery is not a magic wand. Children and their families must be committed to the other burdensome requirements and lifestyle necessities. It may be harder for a child to alter his or her bad eating habits than an adult.
A dedicated support system is a must for successful childhood weight loss surgery. Parents and family physicians must be committed to helping the child be successful.
Where a child lacks the mental and psychological maturity to understand the scope and impact of his or her decisions, parent and guardians are taking a great responsibility to make decisions for the child and to groom him or her to make their own health decisions in the future.
The overall cost of bariatric surgery depends on your location as well as the medical facility. Of course, the type of surgery you choose is a variable, as well as the surgeon's bill.
A ballpark figure the cost of bariatric surgery will range from $14,000 to $25,000.
Is Weight Loss Surgery Covered by Insurance?
A less dangerous but serious practical risk it that of cost. More than one American has gone bankrupt over unpaid medical bills. The good news is that a lot of insurance do cover bariatric surgery, but it depends on individual policies.
Differences in insurance plans and your required surgery will affect your coverage, so be sure to do your research properly. If possible, get something in writing from your insurance company stating that obesity is covered.
The International Statistical Classification of Diseases and Related Health Problems (ICD) for common bariatric surgeries include ICD10 -E66.01 for morbid obesity and Ecc.0 for obesity.
Think You're Ready?
Weight loss surgery is not a daylong or week-long undertaking. The surgery will have implications for the rest of your life.
Weight loss surgery is not an easy way out. It is not an option for people who are too weak-willed to diet and exercise. Rather, bariatric surgery is a serious step in a life change that includes diet and exercise.
Not every friend and acquaintance will support you after your surgery. This is because they will not understand or be interested in your lifestyle changes. If you are prepared to deal with these obstacles, your quality of life may greatly improve. If not, your new life may be a disappointment.
Ask yourself if you are ready for a few things.
- Do you know the hard work is just beginning after the surgery? Diet, exercise, schedule, and outlook will be crucial. A healthy lifestyle is not a goal; it is a way of being.
- New hobbies and social activities will be needed. Fast food habits, cooking routines, and many antics with the guys (or gals) are no longer acceptable. Certain situations that revolve around the wrong foods may require you to decline the invitation.
- Such tough decisions may alienate old friends. Family and real friends will need to accept your new lifestyle if they are to be a help to you and not a hindrance.
- New friends and support circles with similar priorities may begin to replace your old circles.
- In a best-case scenario, your incredible weight loss may result in loose skin. Skin surgery is not cheap and may prove harder to find insurance coverage. Extremely loose skin can be as embarrassing as morbid obesity for some people.
How to Choose the Best Type of Procedure
Each bariatric option has pros and cons, but there are certain non-negotiables, to begin with. You must have a competent surgeon, a strong professional and personal support system, and a desire to be successful.
Regardless of what procedure you choose, you must be committed to your lifestyle changes. Any surgery you choose is only one tool in your lifestyle tool-belt. However, projects always turn out better when you use the best tool for the job.
- On average, patients lose a slightly higher percentage of excess weight with gastric bypass surgery than with sleeve or banding procedure.
- Sleeve and banding patients more consistently lose their target weight loss number.
- Banding procedures offer the widest range of adults. Some patients lose nearly all of their excess weight, and others lose none.
- Banding patients who lose weight have a higher success rate of keeping it off than bypass or sleeve patients
- Bypass and Sleeve patients may continue to lose weight over the course of a year or more following the surgery. Banding patients may lose less weight each week, but they can continue losing weight for multiple years.
- Sleeve procedures are newer than other options and have fewer bodies of research on long-term effects.
- The success of banding procedures is dependent upon balloon adjustments. You must be seen frequently following the surgery to have proper adjustments made
- Bypass patients often become totally unable to eat sugars following the procedure. This can be a perk if it helps keep sugary foods out of your diet.
- Regardless of what operation you choose, at least 10 percent of patients will face complications. Most are not life-threatening.
- While loose skin can be a frustration to patients who lose a lot of weight, there is no difference in loose skin between any of the procedures.
- If your insurance is not covering the entire operation, you may note that on the average, banding procedures are less expensive than bypass and sleeve procedures.
There is no cookie-cutter for best patients or best procedures. You have to be convinced of the procedure you want. You know yourself better than anybody else, so be sure you are happy with your decision.
For each procedure, be sure to evaluate its strategy, advantage, disadvantages, and dangers.
Adjustable Gastric Banding
This is a restrictive surgery. The inflatable band squeezes your stomach so that your stomach holds less food. Patients feel full after eating as little as a half cup of soft food.
Sleeve procedures are restrictive weight loss surgeries. The majority of the stomach is removed, and the new, smaller stomach is connected directly to the intestines.
Roux-en-Y Gastric Bypass
This procedure involves restrictive and malabsorptive approaches. Your stomach is folded into a pouch. The pouch is connected to the small intestine creating a bypass for the food to travel. The stomach pouch holds less food and the bypass allows fewer calories to be absorbed into the body.
Biliopancreatic Diversion (with duodenal switch)
Biliopancreatic diversion with a duodenal switch is less drastic and removes less of the stomach. In this procedure, a smaller part of the stomach is removed.
The duodenal, or first part is the small intestine, remains with the valve that regulates food between the stomach and intestine.
The middle section of the intestine is removed from the rest of the intestine and repurposed to transport bile. Your stomach is smaller, and calories bypass the entire middle section of the intestine.
The Surgical Process
While the process of your surgical journey will vary based on your doctor, surgeon, and hospital, there are some common practices to be aware of.
- You will likely be expected to attend educational seminars. While it is ultimately your job to be informed, it is the medical community's job to be sure you are taking your job seriously.
- You will need to consult with a surgeon. We have talked about the importance of receiving counsel from your family physician. Family doctors are typically not surgeons, let alone bariatric surgeons. This is an important conversation to have.
- You may need to take nutrition classes. If you convince the doctors that you are serious about your nutritional future, they will want you to be armed with the necessary knowledge.
- This will lead to consultations with dietitians. Your relationship with the dietitian will be important as you discuss your food journals and next steps.
- You will likely need to undergo consultation with mental health professionals. Your psychological well being is important in your candidacy for surgery as well as your lifestyle thereafter.
- Be ready to run the gauntlet of screenings and tests. A complete physical examination is key to be sure your body is able to undergo weight loss surgery.
- Complete preliminary tests and screenings and obtain any necessary clearances.
- You will become one member of your multidisciplinary team. This team of members will represent different disciplines such as psychiatric, social, wellness, etc., each facilitating specific services. The team will work together on an overall set of goals specific to you!
- Money talks. Be ready to work with the hospital to ensure your insurance will cover the bill.
- Yes, it will finally be time for surgery.
- Follow-up visits. And more follow-ups. And more.
You can expect up to half a year from serious consultation until your actual surgery. Followups and lifestyle changes will be a lifelong undertaking.
The Recovery Process
What should you expect after your weight loss surgery? You hope to lose a lot of weight. You want to see improvement in your obesity-related health concerns. You want in improved quality of life.
At the same time, you are also recovering from major surgery. There is a good chance that you had a laparoscopic procedure with small cuts. If so, that will help lessen your recovery time.
You can expect to stay in the hospital two or three days after the surgery. It will take roughly one month before you are back to routine activities.
If you underwent open surgery, your incisions would be larger and deeper, and all aspects of healing will take longer.
Ten percent of bariatric surgery patients will have minor complications; about 4 percent will have more serious obstacles.
Some post-op side effects will include:
- Infrequent bowel movements. Talk to your doctor about your options, and avoid fibrous items such as Metamucil or psyllium.
- You know about dumping. High sugar pop and juice can be particularly troublesome in this regards.
- Over half of bariatric patients will experience gallstones after surgery. Though they are not a serious threat, they can cause stomach pain and vomiting. Some bariatric patients will need a follow-up surgery to remove the gallstones.
- For three weeks after surgery, you must be cognizant of potential infection. Watch for redness or pus near the surgical wound.
More serious post-op side effects are possible, such as blood clots.
- While blood clots are rare for bariatric patients, they are very dangerous when present. Blood clots in the lungs can be fatal. Doctors will likely treat them with blood thinners.
- Experience bloody stool is another serious potential side effect. Your doctor should be notified immediately, and if you can't reach him right away, you should go to the emergency room.
- Malnutrition is another concern after surgery. Iron, B-12, calcium,and vitamin D are no longer absorbed by your body as the used to be. Talk to your doctor about supplements.
Don't eat large meals during your weight loss surgery recovery. Aside from dumping, your newly fashioned stomach cannot hold as much as it used to. Obese folks likely have a history of binge eating, so it is important to learn how to eat smaller, more frequent meals.
Never lose your dietitian's phone number. Smaller, more frequent meals still have to contain the proper components.
Be sure your trainer's phone number is on the fridge as well. Kudos to you if you have the energy to exercise and make it to the gym. Be sure you're getting the most bang for your buck by working with professional guidance.
The Future Is Yours
You now have the beginning of knowledge to consider weight loss surgery. These surgeries are not isolated events in your life; rather they are the beginning of a new life and lifestyle.
The decision to have weight loss surgery must be made with eyes wide open. There is always a risk when succumbing to surgery, and there are unique risks involved with weight loss surgery.
In light of the dangers, there are also consequences. Lives have been lost, but lives have also been saved. Only you know if the risk is worth the reward for you.