weight loss surgery is a tool

Weight Loss Surgery Is A Tool, Not A Cure: A Bariatric Surgeon’s Perspective

August 4, 2017

Obesity is a chronic problem in America. Today, more than 127 million Americans, 64 percent of the population, are overweight. Of these, 65 million are obese, and 10 million are morbidly obese.

Obesity is also more than just carrying around extra weight. It’s a complex, far-reaching disease that is typically accompanied by life-affecting co-morbidities from diabetes and cancer to reproductive dysfunctions and chronic pain or joint diseases. The complications of being obese go beyond medical problems and include orthopedic issues, physical limitations, psychological illnesses, social stigmas and economic costs.

The goal of a bariatric surgeon is to help a patient live a longer, healthier life. But surgery isn’t a cure by itself.

The weight loss journey is a partnership that begins with a thorough review of the different types of surgeries, as it’s important to evaluate the pros and cons, benefits and risks, of each based on a number of factors, including safety and efficacy of treating and/or resolving co-morbidity factors.

Understanding The Co-Morbidities From Obesity

A co-morbidity is the presence of two chronic diseases in a patient. In this case, obesity, plus one of 20 obesity-related diseases. A startling truth is that the top five leading causes of death are directly related to obesity.

Heart disease

The number one cause of death among men and women, resulting in 1-in-4 deaths, the key risk factors for heart disease are directly attributed to high blood pressure and high cholesterol and linked to medical conditions and lifestyle choices, including obesity, diabetes, and physical inactivity.

Cancer

Cancer is the second most common cause of death among adults in the U.S. Excess body fat produces hormones that have been proven to raise the risk of several diseases, including cancer. As a case in point, fat cells produce estrogen, which is a significant risk factor in the development of breast cancer.

Stroke

As the third leading cause of death, stroke, like heart disease, is directly attributed to weight. In fact, obesity is the primary risk factor for stroke among men and women of all ages and races. Excess fatty tissue causes inflammation, which can lead to difficulty in blood flow and an increased risk of blockage.

Diabetes

Being overweight or obese is the best predictor of type 2 diabetes. In fact, 90 percent of people living with type 2 diabetes are overweight or have obesity. Why? Because excess weight challenges peoples’ bodies to use insulin to control blood sugar levels. The exponential increase of diabetes cases among Americans directly correlates to the growing prevalence of obesity.

Pneumonia

Obesity is a cause of several respiratory diseases, including pneumonia, which is the fifth leading cause of death. Specifically, aspiration pneumonia is caused by the shorter and more narrowed airways, where stomach contents can move into the lungs and cause infection.

To Combat Obesity, Weight Loss Surgery Is A Tool

Surgery is a serious weight-loss option to consider when various attempts of diet and exercise have not helped a patient shed excess weight or resolve co-morbidities.

It’s important to note that when it comes to the weight loss surgery procedures, one size does not fit all!

A board-certified bariatric surgeon will guide a patient toward the best medical option that will not only help them achieve their weight loss goals but also positively impact co-morbidities. While all procedures should reduce weight, different co-morbid conditions are uniquely affected by the different methods.

The five most common weight loss procedures are Adjustable Gastric Banding, Roux-en-Y (RNY) Gastric Bypass, Vertical Sleeve Gastrectomy, Biliopancreatic Diversion with Duodenal Switch and ORBERA® Weight Loss Balloon. Each one comes with its own benefits and complications, especially when it comes to tackling medical challenges of co-morbidities.

Adjustable Gastric Banding
How it Works
  • Band added to top of stomach with needle-induced adjustments made to meet individual weight loss needs
Average weight loss
  • 30% excess body weight loss at 2 years’ post-surgery
Ensuring success
  • Staged diet
  • Exercise
  • Physician follow-up
  • Periodic lab evaluations
  • Classes
  • Support groups
Potential specific complications
  • Gastric perforation
  • Slippage
  • Gastric prolapse
  • Infection
  • Device failure
  • Esophageal dilatation
  • Heartburn
Healing
Co-morbidities
  • Success of healing co-morbidities is relatively low and commiserate with amount of weight lost
  • Potential to improve/resolve asthma, high blood pressure, diabetes, sleep apnea and GERD

 

Roux-en-Y (RNY) Gastric Bypass
How it Works
  • Most common bariatric surgery and is considered ‘gold standard’
  • Restricts stomach size and creates a change in the absorption of nutrients
Average weight loss
  • 75% excess body weight loss at 1-year post-surgery
Ensuring success
  • Staged diet
  • Exercise
  • Medication reduction
  • Physician follow-up
  • Periodic lab evaluations
  • Vitamins/supplements
  • Classes
  • Support groups
Potential specific complications
  • Leaks
  • Anastomotic stricture
  • Ulcers
  • Malnutrition
  • Anemia
  • Diarrhea/flatulence
  • Vitamin deficiency
  • Dumping syndrome
Healing
Co-morbidities
  • Typically, the best option for diabetic patients and those with heartburn as both conditions tend to disappear almost immediately following surgery.

 

Vertical Sleeve Gastrectomy
How it Works
  • Changes size and shape of the stomach to long, narrow tube
  • Restricts stomach to 20 percent of its former capacity
  • Does not rearrange intestines
  • Less hormone production; less hunger
Average weight loss
  • 60% excess body weight loss at 1-year post-surgery
Ensuring success
  • Staged diet
  • Exercise
  • Medication reduction
  • Physician follow-up
  • Periodic lab evaluations
  • Vitamins/supplements
  • Classes
  • Support groups
Potential specific complications
  • Leaking or bleeding along suture line
  • Stricture
  • Permanent; cannot be reversed
Healing
Co-morbidities
  • Will tackle most co-morbidities, but heartburn will become worse due to structure of post-surgery anatomy

 

Biliopancreatic Diversion with Duodenal Switch
How it Works
  • Greatest amount of weight loss and better resolution of co-morbidities
  • Series of two operations (Sleeve procedure first to get weight more manageable, gastric bypass to continue weight loss and more effectively deal with co-morbidities
  • Most effective for patients with an extremely high BMI (<50)
  • May not be the best option for those with GERD or inflammatory bowel disease
Average weight loss
  • 80 percent excess weight loss at one-year post-surgery
Ensuring success
  • Staged diet
  • Exercise
  • Medication reduction
  • Physician follow-up
  • Periodic lab evaluations
  • Vitamins/supplements
  • Classes
  • Support groups
Potential specific complications
  • Severe malnutrition
  • Vitamin deficiencies
  • Leaks
  • Diarrhea/flatulence
  • Anastomotic stricture
  • GERD (reflux)
  • Excessive weight loss
Healing
Co-morbidities
  • Since it’s a combination of two procedures, it will ultimately heal most co-morbidities following the Roux-en-Y procedure
  • Proven effective in improving type 2 diabetes, high cholesterol, sleep apnea, hyperlipidemia, and hypertriglyceridemia. Improving these conditions can improve hypertension and other conditions

 

ORBERA® Weight Loss Balloon
How it Works
  • One of the newest options available, the ORBERA balloon is a temporary, non-surgical weight loss solution.
  • A small balloon made of soft silicone is placed inside the stomach via endoscopy, which is then inflated with saline typically to the size of a grapefruit.
  • Part of a 12-month weight loss program, the initial procedure takes only 20-30 mins.
  • Balloon slows digestion and improves portion control teaching patients to eat less and feel full faster.
  • Balloon is removed after six months, but patients continue following diet and exercise plan
  • Most effective for patients with a BMI of 30-40
Average weight loss
  • Average patient loses three times more weight with ORBERA compared to just diet and exercise.
Ensuring success
  • Exercise
  • Medication reduction
  • Physician follow-up
  • Periodic lab evaluations
  • Classes
  • Support groups
Potential specific complications
  • Balloon migration
  • Bowel obstruction (if balloon stays in stomach past six months)
  • Endoscopic procedure tears
  • Partial or complete blockage of the bowel by the balloon
  • Stomach discomfort
  • Nausea and vomiting
  • Abdominal or back pain
  • Acid reflux
  • Blockage of food
  • Bacterial growth in fluid filling balloon causing infection or injury to the lining of the digestive tract, stomach or esophagus
  • Balloon deflation
Healing
Co-morbidities
  • Success of healing co-morbidities is relatively low and commiserate with amount of weight lost
  • Potential to improve/resolve asthma, high blood pressure, diabetes, sleep apnea and GERD

Using Surgery As A Tool And Working Toward A Goal Together

Moving forward with bariatric surgery can be an exciting time in a potential patient’s life. With the goal of living longer and being happier, every bariatric procedure has the potential to allow a patient to succeed initially. However, maintaining success, especially over the long-term is a team effort.

Undergoing surgery or a medical procedure is not only a commitment to altering your body’s function, but also a commitment to a long-term bariatric lifestyle education and support program.

The first five years are critical to lifelong success as it gives physicians a chance to help patients to monitor progress; closely monitor the status of co-morbid diseases; establish lasting healthy habits; tackle post-surgical issues, such as handling newfound self-esteem; and more.

As potential patients begin to explore the right board-certified practices and potential surgeries, it’s vital to consider the team of professionals who will guide them every step of the way, both celebrating successes and overcome the challenges.

robert-schuster

ABOUT THE AUTHOR

Dr. Robert Schuster is a board-certified bariatric surgeon practicing at Bridges Center for Surgical Weight Management at St. Luke’s Medical Center in Phoenix, and Mountain Vista Medical Center in Mesa, Arizona. Bridges Center for Surgical Weight Management provides a comprehensive program to help individuals achieve healthy, long-term weight loss.

Read more articles from Robert!