Articles on WLS in Yesterday's WSJ - Long----

I thought these articles might be of interest to you - they were to me. Gastric Bypass May Have Edge Over Other Weight-Loss Surgery By Jennifer Corbett Dooren The Wall Street Journal Extremely obese patients undergoing weight-loss surgery may do better with a procedure that bypasses part of the intestine rather than undergoing a banding procedure that creates a small pouch in the stomach, according to a new study. Researchers at the State University of New York, Health Science Center of Brooklyn and Lutheran Medical Center, also in Brooklyn, N.Y., looked at two commonly performed types of bariatric surgery in 106 patients who underwent the procedures between February 2001 and June 2004. The study appears in the July edition of the Archives of Surgery. Sixty patients received a so-called Lap-Band device through a laparoscopic procedure that allows surgeons -- through a small incision near the stomach -- to place a silicone band around the stomach, dividing it into two smaller compartments. The device, which was made by Inamed Corp., is designed to restrict food intake and make patients feel full sooner. Inamed was acquired earlier this year by Allergan Inc., of Irvine, Calif. Crystal Cienfuegos, an Allergan spokeswoman, said, "the majority of published data contradicts this study's findings, and the world-wide experience of nearly 250,000 procedures underscores the overall safety and effectiveness of the Lap-Band system." The system was approved for use in the U.S. by the Food and Drug Administration in 2001. Forty-three patients underwent another type of procedure known as the laparoscopic Roux-en-Y gastric bypass, which involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions, reducing the amount of calories absorbed by the body from food. Overall, researchers found patients undergoing the laparoscopic bypass surgery had fewer long-term complications; lost more weight and had larger improvements in other co-morbidities, such as high blood pressure and diabetes, than patients who underwent the lap-band procedure. Dr. George Ferzli, a bariatric surgeon who was one of the researchers, said that the better outcomes of patients undergoing the bypass procedure are likely the result of better compliance among those patients rather than a particular problem with the lap-band. He said the lap-band can allow patients to cheat and consume more calories through liquids because they can still pass fairly easily through the small stomach. "For the band to be successful it requires significant will power, discipline and compliance," Dr. Ferzli said. Patients in the study were considered "super" morbidly obese and had body mass indexes of 50 or greater. On average, patients in the study weighed roughly 340 pounds before surgery. BMI is a body-fat measure that uses height and weight. "Overweight" is defined as having a BMI ranging from 25 to 29.9 while people with a BMI of 30 and greater are considered obese. Patients undergoing the lap-band procedure were hospitalized for less time, with an average of 1.8 days compared with 3.5 days for patients undergoing the bypass procedure. Short-term complications were statistically similar between the two groups. However, long-term complications, or those that occurred after 30 days or longer, were more common in the lap-band group, with 78% of patients experiencing complications, compared to 28% in the bypass group. The most common long-term complication was vomiting and dehydration. The study also showed that 15 patients with the lap-band needed follow up surgery compared to three in the bypass group. The lap-band can be adjusted after initial surgery to be made larger or smaller. Patients in the study were followed for an average of 16.2 months. The patients who underwent the bypass had an average BMI decrease of 26.5 compared with 9.8 in the lap-band group; however researchers said both procedures produced "satisfactory" amounts of weight loss. All patients reported fewer co morbidities after surgery, but the decrease was more pronounced in gastric bypass patients. For example, rates of diabetes dropped to zero from 17.4% before surgery in the bypass group. Rates of diabetes in the lap-band group fell to 11% from 18.3% before surgery. The typical gastric surgery patient has a pre-surgery BMI of 40. Some patients with BMIs of 35 or more are also considered good surgery candidates if they have another problem linked to being overweight like diabetes. Although the study focused on patients with BMIs of 50 or greater, Dr. Ferzli said he generally finds his patients do better with a bypass rather than a lap-band. -------------------------------------------------------------------------------------------------- The New Science of Addiction --- Alcoholism in People Who Had Weight-Loss Surgery Offers Clues to Roots of Dependency By Jane Spencer The Wall Street Journal ON THE HEELS of a five-year boom in weight-loss surgeries, researchers are observing an unusual phenomenon: Some patients stop overeating -- but wind up acquiring new compulsive disorders such as alcoholism, gambling addiction or compulsive shopping. Awareness of the issue is just beginning to surface. Some bariatric-surgery centers say they are starting to counsel patients about the issue. Substance-abuse centers, including the Betty Ford Center in Rancho Mirage, Calif., say they are seeing more bariatric-surgery patients checking in for help with new addictions. And alcohol use has become a topic of discussion on bariatric-surgery-support sites, such as Weight Loss Surgery Center, wlscenter.com. Some psychologists describe it as a type of "addiction transfer," an outcome of substance-abuse treatment whereby patients swap one compulsive behavior for another. At the Betty Ford Center, about 25% of alcoholics *****lapse switch to a new drug, such as opiates. The behavior has long been explained as a psychological phenomenon as patients seek new strategies for filling an inner void. But as substance-abuse experts learn to decode the brain's addiction pathways, some researchers are coming to believe that swapping behaviors may have a neurological basis. A new wave of research suggests that the biochemical causes of compulsive eating are extremely similar to those underlying other self-destructive addictions, such as alcohol or cocaine addiction. Alcohol use in particular is a concern for bariatric patients because some versions of the surgery can change the way patients metabolize alcohol, making it far more powerful. Exploring the overlaps between compulsive eating and other addictions is a growing focus at the National Institute on Drug Abuse, which spent $1.4 million on obesity research last year. Researchers at NIDA hope to piggyback on the drug industry's extensive research on obesity in an effort to find new compounds that might treat multiple types of impulse-control disorders at once. "The potential is extraordinary," says Nora Volkow, NIDA director. "A drug that could condition craving behavior -- whether it's for chocolate or cocaine -- would be a gigantic market." Dozens of clinical trials on addiction treatments are under way at the National Institutes of Health. Topiramate, an epilepsy drug marketed by Ortho-McNeil Neurologics under the name Topamax, is currently being studied for binge eating, alcohol dependence, cocaine addiction and compulsive gambling. Bupropian, marketed by GlaxoSmithKline as the antidepressant Wellbutrin and the smoking-cessation drug Zyban, is currently being studied as a treatment for gambling, obesity, nicotine dependence and alcoholism. And Rimonabant, made by Sanofi-Aventis is being reviewed by the Food and Drug Administration as a treatment for obesity and associated health problems, but it is also being studied as a treatment for alcoholism. Estimates on the prevalence of new addictions after weight-loss surgery vary widely. Philip Schauer, director of bariatric surgery at the Cleveland Clinic and current president of the American Society for Bariatric Surgery, estimates that only about 5% of bariatric-surgery patients develop a new compulsive behavior after surgery, such as alcoholism, compulsive shopping or smoking. He adds there is no evidence that the new addictions have any direct link to the surgery. At U.S. Bariatric, a weight-loss surgery center with offices in Orlando and Fort Lauderdale, Fla., therapists estimate that roughly 20% of patients acquire new addictive behaviors. Melodie Moorehead, a psychologist who spoke at a session during the American Society for Bariatric Surgery Association annual meeting last month, cited preliminary data suggesting that roughly 30% of bariatric-surgery patients struggle with new addictions after surgery. But she says the issue requires further study. One possible reason for the disparity in estimates is that alcohol problems can surface several years after the surgery, when surgeons are no longer tracking patients as closely. And some patients may not see a link between their drinking and the surgery, or report their problem to a surgeon. Roughly 140,000 bariatric surgeries are performed in this country each year. Some bariatric doctors dismiss the issue as pure coincidence. "People don't become alcoholics as a side effect of the surgery," says Neil Hutcher, past president of the American Society for Bariatric Surgery. "They become alcoholics for the same reasons anyone becomes an alcoholic. The surgery is not a cure-all for everything transpiring in the patient's life." For a variety of reasons -- including the fact that alcohol is high in calories -- bariatric-surgery patients are often advised not to drink alcohol for the first six months to a year after surgery. In addition, most bariatric centers screen patients for heavy alcohol use, and exclude patients who exhibit signs of alcohol dependence. "The surgery creates profound changes in people, both physical and mental," says Dr. Schauer. "Even though they're good changes, they could ignite problems in people with active substance-abuse problems." Gastric bypass surgery, which accounts for 75% of all bariatric surgeries in the U.S., involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine. As a result, alcohol passes rapidly into the intestine where it is quickly absorbed into the bloodstream. "You shorten the time to the brain so much that if you liked alcohol before, you'll love it now," says Mark Gold, professor of psychiatry and neuroscience at the University of Florida College of Medicine. (Lap-band procedures, which account for 20% of U.S. weight-loss surgeries, don't have the same impact. The procedure involves restricting part of the stomach with a silicon band, but doesn't change the absorption process.) The issue is a sensitive one for the bariatric-surgery community following a series of major studies raising questions about the long-term health benefits of the procedure. A large study of 60,000 gastric-bypass patients published in the Journal of the American Medical Association last October, found that 40.4% of patients who had the surgery were readmitted to a hospital at least once during the three years after surgery, double the 20.2% rate of hospitalizations in the three years prior to surgery. Some in the field hope the concerns about substance abuse will add to the growing interest in psychological counseling of patients. Some research suggests that obesity might offer some protection against other types of addictions, including alcohol. A study of 9,125 adults published earlier this month in the Archives of General Psychiatry found that obese people had a 25% decrease in likeliness for substance abuse. And in 2004, researchers at the University of Florida, Gainesville, published a study of 298 women showing that obese women have lower rates of alcohol use than the general population. The researchers theorize that food and alcohol trigger the same reward sites in the brain. Some people may feed their addictive cravings with food; others with alcohol. Neuroimaging studies suggest that obese people and substance abusers have abnormal levels of dopamine in the brain, contributing to cravings. "They always feel something is lacking, and in order for them to feel OK, they need to use something that boosts the dopamine in brain," says Gene-Jack Wang, chairman of the Medical Department Brookhaven National Laboratory. Bankole Johnson, chairman of the department of psychiatric medicine at the University of Virginia, says gastric-bypass surgery provides a mechanical solution that leaves the underlying neurobiological problem untreated. "It's like a thirst," says Dr. Johnson. If you're thirsty -- and there's no water -- you'll drink lemonade." ------------------------------------------------------------------------------------------------- 'I Drank the Way I Ate' By Jane Spencer The Wall Street Journal FOR MUCH of her life, Patty Worrells was wracked by uncontrollable food cravings. She binged on half-gallon tubs of cookies 'n cream ice cream at 3 a.m. She devoured eight cinnamon rolls at breakfast. Often, she ate in secret. By the time she was in her mid-40s, her weight had soared to 265 pounds on her 5-foot, 4-inch frame, and she was struggling with type II diabetes and arthritis. Then, four years ago, Ms. Worrells joined the rush of Americans signing up for gastric-bypass surgery and had her stomach reduced to a tiny pouch. She dropped 134 pounds in a year. For the first time in decades, she could fit comfortably in a restaurant booth and board an airplane without glares from other passengers. Ms. Worrells was elated -- until a new craving took over. Never a heavy drinker before surgery, she found herself going out for drinks more often with friends. Eighteen months after her surgery, she was downing 15 to 20 shots of tequila almost every night. She often woke up in the morning with bruises and scratches from drunken falls she couldn't remember. "I drank the way I ate," Ms. Worrells says. "There was no such thing as enough." Before her surgery, alcohol never gave Ms. Worrells much of a buzz. But food was a reliable source of solace. Growing up in Akron, Ohio, a blue-collar rubber-manufacturing town, Ms. Worrells was always a little on the heavy side. (She remembers wincing when her dad, a truck driver, introduced her to friends by saying, "That's my daughter Patty -- she likes her supper.") When she reached her early 20s, her weight began to spiral out of control. Her high-school boyfriend, recently returned from military service overseas, was intent on marrying her, but she had fallen in love with her best friend, a woman she went to high school with. In the end, she ditched both. Ms. Worrells sank into a deep depression. "I decided I'd be alone forever," she says. "Food became my comfort." Feeling isolated and untethered, she joined a conservative church. For more than a decade, she threw herself into church activities, leading bible studies and joining the chorus. But the loneliness endured. At night, she consoled herself with heaping portions of pasta casseroles, French bread smothered in peanut butter, and pineapple cream pie. The cravings were intense. She gained 130 pounds, doubling her body weight. "I had this emptiness inside of me that needed filling," she says. That began to change in her mid-30s, when she went back to school, eventually earning an undergraduate degree in psychology, which she followed up with a master's degree in clinical counseling. But her weight was taking a toll on her health. In 2002, she made a snap decision to get gastric-bypass surgery. As her body weight melted away, her diabetes and arthritis all but vanished. The day her weight dropped below 200 pounds, she cried and took a photograph of the scale. Like many bariatric patients who have long been isolated by their weight, she became more social, joining a support group for bariatric patients and developing a clique of close friends. Most members of the group were in their 30s and 40s, but they began partying like wild teenagers, hosting karaoke parties, going camping, and getting into romantic entanglements. "We felt like we had a lot of fun to make up for," says Mary-Jo Banish, a member of Ms. Worrells's circle. "When we were huge, we were never the life of the party." Ms. Worrells still remembers the massive rush she got from her first sip of liquor after her surgery. "It was like putting alcohol directly into a vein," she says. "Boom!" Her reaction isn't uncommon, as bypass surgery enables food and drink, including alcohol, to pass more rapidly into the patient's system. Ms. Worrells, who is gentle and soft spoken when sober, developed a reputation as an out-of-control partier with a taste for tequila. At parties, she often crashed into furniture and got into screaming matches with her partner for the past six years, Debbie Anello. Friend Ginny Altomari recalls hosting a Halloween party where she unsuccessfully tried to put an inebriated Ms. Worrells to bed. Ms. Worrells wasn't the only member of the group drinking too much. At a recent meeting of her bariatric-patient support group at a Denny's restaurant in Parma, Ohio, several other women in the group recounted their own stories. "My children were devastated," recalled Jeannine Narowitz, a mother of seven who had bariatric surgery in 2003 and began drinking heavily the following year. Once, she woke up with a black eye from a drunken fall she couldn't remember. She finally forced herself to quit after she discovered that her 15-year-old son had poured all of her liquor out and refilled the bottles with water. Ms. Worrells had plenty of experience with addiction long before her own problem started. Her father was an alcoholic who died at age 54. Her younger sister Peggy also struggled with serious addiction problems for her entire life. Ms. Worrells struggled desperately to hide her alcohol problem from her family, and avoid disappointing her mother and sister. She never drank at family gatherings, and avoided phone calls when she was drunk. She worked as clinical director of a substance-abuse clinic, and sometimes led group-therapy sessions for drug addicts. She says she never drank at work, but began quietly leaving the clinic at lunch to buy tequila, just to make sure she would have it when she got home at night. She frequented five different liquor stores in the area so the clerks wouldn't realize how often she was buying it. Within eight months of her first drink after surgery, her food cravings had vanished. But she was drinking every night at home until she passed out. She stopped taking calls from her mother and sister in the evenings so she could focus on drinking, lining up shots on the stove and downing 15 to 20 shots in the course of the evening. "The progression was unstoppable," says Ms. Worrells. "I've never seen a person change so fast," recalls Ms. Anello, who often drank with her in the evenings and was developing her own issues with alcohol. "She became a monster." It was a single phone call to her mother that got Ms. Worrells to seek help. One evening while Ms. Worrells was cursing and shouting in the midst of a drunken rage, Ms. Anello picked up the phone in desperation and dialed Ms. Worrells's mother. "Listen to your daughter," she said, and held up the receiver. Ms. Worrells instantly froze -- mortified that her mother had heard her cursing. Even at age 50, she couldn't bear to let her mother down. The next day, 10 months after her drinking began; Ms. Worrells went to her first 12-step-program meeting. Three weeks later Ms. Worrells got an evening call from her mother. Her sister Peggy had died of what was later determined to be an overdose of Xanax. Ms. Worrells remembers feeling grateful that she was sober that night, as she drove to her mother's house to take care of her. Recovery didn't come easy. For the first eight months, she relapsed regularly, going three or four days without drinking before succumbing again. She finally had her last drink after becoming frightened by an episode when she drove drunk -- something she had vowed she would never do. Ms. Worrells still sometimes feels the same gnawing emptiness that drove her to overeat, and later to drink. Instead of drinking in the evenings, she and Ms. Anello visit the great blue herons that nest in Cuyahoga Valley near their home, or visit a wildlife preserve. She still attends four 12-step-program meetings a week, but she says she has no regrets about the surgery: "I'd do it again in a heartbeat." ------------------------------------------------------------------------------------------------- Food for Thought--- Hugs, Nannette

thanks for the post Dr. Ferzli quoted in the article was my surgeon and he is the best. The information in all the articles is very useful.

Hey Nannette, Very Insightful. Thanks for sharing this information. It can only help us be more aware of the pitfalls so that we may avoid them. You are a wonderful mentor to us all. Thank You! Joe

Nannette~ THANKS so much for taking the time to post those articles, especially the first one about the differences between lap band and RNY surgery. I met a friend for a pedicure this morning and she is looking into lap band surgery. She has been wanting to get the surgery for a while, and has just decided to get serious and attend the seminar at Hackensack this coming week I am so happy for her! I don't think that lap band is the right surgery "for her", I know her very well..... and I am so glad I could send this article to her. She can read it and hopefully it will give her some insight into her choices and decision. I am trying to get her to join us at the support group tonight......keeping my fingers crossed! See you tonight and thanks so much for posting those articles. Michelle Brennan

hi nanette those were great articles, kinda scary though, because i think i have an addictive personality. that worries me. it was great meeting you last night. will email you dr. noyans infor over the weekend. thanks, jacki