The Benefits of Surgical Weight Loss: Is it Right for You?
According to the Centers for Disease Control and Prevention (CDC), nearly 37 percent of Americans over the age of 20 are considered obese. However, due to the stigma attached to the condition, very few of these people seek the medical help they need to lose the extra pounds, often putting them at risk for a myriad of disorders directly associated with being overweight, including diabetes, high cholesterol and heart disease.
“This is a non-cosmetic disease that people don’t recognize,” said Fernando B. Bonanni, Jr., MD, director of the Institute for Metabolic and Bariatric Surgery and vice chair of the Department of Surgery at Abington—Jefferson Health. “Being 100 pounds overweight takes up to 22 years off of your life.”
But this doesn’t have to be permanent. For some patients, surgical weight loss is an option to get back on the road to good health.
Set Points and Obesity
“Some people are genetically predisposed to obesity,” said Dr. Bonanni. “You can’t just ‘eat less’ when the problem is how your body stores energy.” In fact, eating less may be aggravating the problem.
Dr. Bonanni says there is a “dark side” for all of us, where weight can’t be lost through traditional measures due to the body’s metabolic set point.
When the human body’s systems first developed, it was normal to only gather enough food for a few meals per week. During this time, the body developed what is called a set point—a defense mechanism that stores fat from food to save energy for lean times.
Today, with refined nutrients and food widely available, our bodies still have those fat stores, even if we no longer need them.
What is Surgical Weight Loss?
Surgical weight loss encompasses several operations designed to reset the body’s set point by circumventing environmental and genetic factors. Some procedures are more invasive than others, and require more prep time and nutritional education.
“What the surgery does,” said Dr. Bonanni, “is get under that set point and reset your body. Diets aren’t going to do that.”
The most common types of bariatric surgery are:
• Gastric sleeve surgery is the most common weight loss surgery. It is a popular choice for those patients looking for a relatively low-maintenance procedure with consistent results. With the gastric sleeve, the stomach is surgically reduced to around 15 percent of its size, causing patients to feel full more quickly and reducing the amount of food ingested. Following surgery, 55 percent of patients lose their excess body weight and nearly 70 percent of patients who have had diabetes for five years or less experience a resolution of their symptoms.
• Gastric bypass surgery was the most popular weight loss surgery for many years, but has been edged out by the gastric sleeve. During the operation, your doctor will separate the stomach into two distinct “pockets,” where the smaller top pocket will receive food and connect directly to the small intestine while the bottom pocket continues producing digestive fluids. This way, less food is eaten, and fewer calories and nutrients are absorbed into the system. Gastric bypass has the largest impact on patients with diabetes, with 84 percent of those who have the procedure within 10 years of diagnosis have symptom resolution. Sixty-five percent of patients lose their excess body weight.
• Duodenal switch is a complex surgery designed for those more than 150 pounds overweight or suffering from severe diabetes to reduce the absorption of food by removing 60 to 70 percent of the stomach and bypassing a portion of the intestine. The procedure also maintains the highest success rate of the weight loss procedures. In fact, 75 to 85 percent of patients lose their excess body weight, and 95 to 98 percent of diabetes symptoms will be resolved for 20 years or more.
Following these procedures, patients can expect to take fewer medications. They often see a resolution of their diabetes symptoms, decreased joint pain, lowered cholesterol and improved cardiac health.
Who Is a Candidate?
For some patients, bariatric surgery is the only option. In fact, if you’re 100-plus pounds overweight, the likelihood of losing weight through traditional means is less than five percent.
“Yet, only one percent of people who need surgery do it,” said Dr. Bonanni, who also says this disparity is linked to the stigma of excess weight and limited access to care.
However, before speaking to your doctor, it’s important to know that bariatric surgery is a long road; it involves painstaking preparation and ample support.
“This is a multifactorial disease with a multidisciplinary approach,” said Dr. Bonanni. Most surgeons and health systems will require that patients meet with a handful of providers before confirming a care plan—this preparation period that can last anywhere from three to six months.
A bariatric surgery care team should include:
• A psychiatrist who will screen for underlying issues or undiagnosed behavioral disorders that may contribute to a person’s obesity, including eating disorders or food reliance.
• A physical therapist who will observe the patient’s ability to maintain regular physical activity and exercise regularly.
• A nutritionist who will ensure that patients understand basic nutrition, as well as the specified diet plans associated with their procedure.
In all, the patient will need to satisfy the requirements of their care team and have an endoscopy before receiving approval for surgery. Many patients will also have to first exhibit weight loss to qualify for bariatric surgery.
“It’s not a walk in the park,” said Dr. Bonanni. “It takes education, a program committed to the disease of obesity and a patient committed to life-long change.”
Attend an information session to learn more about bariatric surgery.