WLS article!!!

Bariatric Surgery: Losing Weight Surgically by Debra Wood, RN A growing number of obese people are opting for a surgical solution to weight loss and discovering improved health and quality of life. "Everything about my life has changed, from tying my shoes to playing with my kids to being treated like a normal person," said Diana Garcia of Apopka, Florida. She has dropped 111 pounds in a year, down to 130. "I'd do it again in a heartbeat." Randy Brown of Topeka, Kansas concurs. He has lost close to 150 pounds in the year since his surgery. He said, "Instead of being a coach potato, I'm doing stuff all the time. My energy level is 10 times what it was. I'm healthy, active, and ready to go." Like many obesity surgery candidates, Brown, 48, and Garcia, 30, struggled throughout their lives to control their weight. Both tried multiple diet plans, sometimes losing weight only to gain it back. Hitting the scales at 425, Brown suffered from diabetes mellitus, high blood pressure, gout, and high cholesterol and triglycerides. Now his blood pressure, sugar, and lipid levels fall within normal ranges, without medications. Trend Toward Surgery As people learn more about the many health risks of being obese, greater numbers seek what may seem like a drastic solution: surgery. The American Society for Bariatric Surgery (ASBS) estimates its members will perform 62,000 procedures this year, compared to 23,000 five years ago. "There's an incredible need for a solution to the obesity crisis," said Douglas M. Krahn, MD, who practices at U.S. Bariatric Inc. in Fort Lauderdale and Orlando, Florida. Surgical options include laparoscopic procedures, in which surgery is performed through small abdominal openings. Such minimal-access surgery offers a faster, less painful recovery. Dr. Krahn thinks this approach removes a barrier for some patients. But not everyone qualifies for less-invasive surgery. It depends on medical history, surgical difficulty, and body shape. Candidates Bariatric surgery may be considered for severely obese, motivated patients who have failed at other attempts to lose weight. That means having a body mass index (BMI) above 40. Typically to reach that level, one must weigh 80 to 100 pounds above normal. Patients who are not quite that heavy but who have serious medical conditions may also be candidates. Because the long-term success of bariatric surgery depends on the patient making significant lifestyle changes, surgeons often require that candidates have a psychologic evaluation before proceeding. Patients must understand the need for long-term medical follow-up and evaluate risks and benefits. Numbers vary based on the type of surgery and each patient's underlying risk; however, about 10% of patients may experience complications shortly after surgery. For example, leaking of gastric contents or a blockage may require additional, immediate surgery. Patients may also need future surgery to repair a hernia. The Procedures Doctors have improved results by combining two techniques--restriction and malabsorption. Patients receiving the combined procedure, on average lose about 50-74% of their excess weight, and keep it off for five or more years. To cause restriction, the surgeon creates a thumb-size stomach. It only holds a small amount of food and does not empty as fast as normal, thereby making a person feel full rather quickly. The most popular restriction procedure has been the vertical banded gastroplasty, or stomach stapling. But with restriction-only procedures, many patients gain weight back or lose an inadequate amount. So now, most bariatric surgeons combine restriction with a gastric bypass. A gastric bypass connects the new, smaller stomach to a lower segment of the small intestine. This causes malabsorption--fewer nutrients, including vitamins and minerals as well as calories, are absorbed. By altering the flow of food, a gastric bypass also produces a local endocrine effect that increases insulin sensitivity and decreases hunger. Two major drawbacks are that anemia and nutritional deficiencies can develop. Therefore, patients must take vitamin and mineral supplements. Another concern is that patients must avoid sweets. Eating sweets can lead to "dumping syndrome," which is the rapid movement of large volumes of food into the small intestine. Symptoms include nausea, vomiting, cramps, diarrhea, sweating, and weakness. "It creates a deterrent to high-calorie sugars, chocolate, and cookies," said Dr. Krahn. "Gastric bypass also leads to a resolution of [type 2] diabetes very quickly, much faster than would be possible or explainable by diet modification or weight loss." A Comprehensive Approach Avoiding sugar is only one change patients must make. They must totally change how they eat and approach food. To avoid pain, they slowly consume small, nutritious meals, as advised by their doctors. Overfilling the tiny pouch results in pain or vomiting. Diets progress from liquids to pureed to well-chewed soft foods. And the amount of food tolerated will usually increase to a couple of ounces. In addition to changing eating habits, regular exercise is encouraged. Aerobic exercise, even walking, helps shed excess pounds and keep them off. "Surgery is a starting point. You have to buy into the therapy," said ASBS President Kenneth B. Jones, MD of Shreveport, Louisiana. "It is a life-long commitment, not an operation to guarantee weight loss. If patients cooperate, the post-op results are remarkable." Some practices, like Dr. Krahn's, offer on-site nutrition guidance, exercise training, counseling, and support groups. Brown and Garcia attribute much of their success to receiving the total package. They both drive hours to go to a practice offering extensive long-term services. "I go to the support group every month," Garcia said. "It keeps me on track." Garcia feels better about herself and her life. Like 85% of morbidly obese patients, she was depressed before surgery. But that cloud lifted as the weight came off. Some patients need counseling to help them get beyond issues that initially contributed to their overeating. Surgery combined with a life-long diet plan offers seriously overweight people hope for improved health and well-being. Some doctors say they have not found anything as successful. "It's a serious commitment," Brown concluded. "People need to be prepared that life changes for the better, but it's not always easy." RESOURCES: American Society for Bariatric Surgery http://www.asbs.org National Institute of Diabetes & Digestive & Kidney Diseases http://www.niddk.nih.gov -------------------------------------------------------------------------------- Last reviewed August 2004 by Kimberly Rask, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Copyright © 2005 HealthGate Data Corp. All rights reserved. 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