Bariatric Surgery: Hearsay, Hype and Hope

You’ve seen the ads, you’ve heard the testimonials.  Surgical weight loss solutions are trendier than ever.  Online videos featuring prominent surgeons detailing the benefits and explaining the mechanics of the procedures are just a click away.  Happy, overweight-no-more clients run along sandy beaches with their pretty families and dance at their college reunions, voice-overs sharing their new joie de vivre and sense of accomplishment following the surgery.

Cynics see the procedures as extreme, exploitative,  permission for doctors to print money and the lazy to take an easy way out.  Advocates remind us they help dangerously obese patients, patients who tried every other way to lose weight and failed, and save lives.  The whole thing sounds way too good to be true on one hand, and really, really scary on the other.

Americans, in ever-increasing numbers, are fat – too fat.  We know this.  We also know the very serious health consequences of being fat – diabetes, heart disease, hypertension and stroke, and metabolic and endocrine disorders are just the start.  Sensible eating, some honest self-discipline and regular exercise work just fine for many of us, in fact, most of us – but not all.  Some severely obese adults cannot lose weight any other way, or have very dangerous health problems related to their obesity that must be addressed.  These individuals may be candidates for bariatric surgery.

Bariatrics is the branch of medicine that deals with the causes, control and treatment of obesity and related diseases.  Bariatric surgery is an operation on the stomach and/or intestines of a severely obese patient that helps that patient to lose weight by restricting food intake.

The US Department of Health and Human Services, in their Weight-control Information Network (WIN) publication, reports that clinically severe obesity is a body mass index (BMI) equal to, or greater than, 40, or a BMI equal to, or greater than, 35 with a serious health problem linked to that obesity.  The body mass index is a measure of height in relation to weight and is used to define levels of obesity.  The FDA has approved the use of an adjustable gastric band (AGB) for patients with a BMI equal to, or greater than, 30 who also have at least one condition related to obesity, such as diabetes or heart disease.

To qualify for bariatric surgery, patients typically will have maintained a minimum BMI of 40 for at least five years or more, or a minimum BMI of 35 with a serious medical complication related to obesity.  He or she must be between the ages of 18 and 65, though younger and older patients are considered on a case-by-case basis.  And he or she must also document evidence of previous sincere efforts to lose weight through a medically supervised program.  In fact, this documentation is required by many insurance providers, something most clinicians find lacking much logic.

Patients who are not candidates for any type of weight loss surgery include those with severe mental illness, such as psychosis;  patients with a chronic intestinal disease, such as Crohn’s;  individuals unable to undergo general anesthesia; and patients recently diagnosed with cancer or other serious medical conditions that might make the surgery too risky.

Surgery is a big step.  The potential adult candidate for one of the procedures might think about some of the following questions.  Am I:

  • Unlikely to lose weight, or keep off that weight over the long term, using other methods?
  • Well informed about the surgery and treatment effects?
  • Ready to lose weight and improve my health?
  • Completely aware of the benefits and risks of surgery?
  • Aware of the limits on food choices and occasional failures I may face?
  • Aware of how life may change after the surgery?  I may need to adjust to side effects (such as the need to chew food thoroughly and slowly, and the loss of the ability to eat larger meals).
  • Truly committed to lifelong healthy eating and physical activity, scrupulous medical follow-ups, and the need to take extra vitamins and minerals?

Tomorrow, we will explore the different types of bariatric surgery, their side effects, the costs, how health insurance companies deal with it and more.  Again, this is emphatically not the way to go for most of us struggling with our waistlines.  But there are those among us – our sisters, our dads, our teachers, our friends – who aren’t lazy or bad people, who aren’t self-indulgent or undisciplined people.  They are, instead, our loved ones – good people, who, despite their very best efforts, are losing the struggle with severe obesity, a very serious, life-threatening chronic disease.  The more we know and understand, then, the better. 



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