Castle Medical Center Hospital

at Castle Medical Center

Offering Hope

Obesity is a complex, chronic disease that affects nearly one out of every three American adults, or about 60 million people, according to the American Obesity Association, an education and advocacy group. Nine million Americans are severely (morbidly) obese.

Factor in weight-related illnesses like diabetes, hypertension, sleep apnea, liver disease, and arthritis, and obesity becomes an even more alarming national health issue, accounting for some 300,000 preventable deaths each year.

Locally, statistics from the Hawai‘i Department of Health indicate that in Windward O‘ahu alone, more than 10,000 adults are obese or morbidly obese—a disproportionately large number compared with other parts of the state. And this number is growing by about two percent, or 200 people, annually.

Better Health Through Weight Loss

Bariatric (or weight-loss) surgery has proven to be the best solution for morbidly obese patients aiming for sustained weight loss. Even a ten-percent reduction in body weight, if maintained, can reduce many obesity-related health risks.

Though Castle Medical Center has a long-standing, individualized weight management program, the new Surgical Weight Loss Institute was established to help patients who are morbidly obese manage the health risks of obesity through a comprehensive, multidisciplinary approach.

“Our focus is to help patients regain their health through surgical weight loss,” explains Joanne Reid, administrative director. “Physiological, psychological, genetic, and social factors all contribute to the disease, so Castle has assembled a team of obesity and weight-loss experts who can address all of these areas.”

The team includes bariatric surgeons, a psychologist, a physical therapist, a registered dietitian, a fitness specialist, and a nurse coordinator, all of whom are involved in assessing each patient’s health issues and developing an individual weight management plan.

If a patient of size is struggling with life-threatening health risks and unable to lose weight through dieting, medication, behavior therapy, exercise, and other medical treatments, bariatric surgery may be recommended.

Bariatric Basics

Bariatric surgery, which modifies the stomach or intestines to restrict the amount of food one eats or the amount of calories and nutrients the body absorbs, has been around since the 1950s. It is only in the last ten years, though, that the number of surgeries has surged, due in large part to the development of safer, less invasive procedures. Nonetheless, the procedures are not without risk, and Castle’s bariatric team carefully evaluates the risks and benefits for each patient, as well as the individual’s readiness to make the lifestyle changes that are part of the program.

Generally, the program evaluates candidates for weight-loss surgery if they are between the ages of 18 and 65.

Steven Fowler, M.D., is a bariatric surgeon and medical director for Castle’s Surgical Weight Loss Institute. Board-certified in surgery with a focus in laparoscopic surgery, Dr. Fowler is a graduate of Boston University School of Medicine and completed his residency at Cedars-Sinai Medical Center in Los Angeles.

“We offer two types of bariatric procedures at Castle, both of which are performed laparoscopically through small incisions using a camera and instruments,” Dr. Fowler says.

These minimally invasive procedures are less painful, result in quicker recovery and fewer complications, and don’t leave large incision scars.

The laparoscopic restrictive band, or LAP-BAND, is placed around the top part of the stomach to create a small pouch where the food stays, making a person feel full, sooner. The band can be tightened or loosened as needed by adding or subtracting fluid through a small port placed under the skin.

Laparoscopic gastric bypass surgery, or Roux-en-Y, is the most commonly used weight-loss procedure, and is described by Dr. Fowler as the “gold standard” of bariatric surgery. It induces weight loss through a combination of restricted food intake and a process called malabsorption. The procedure cuts the stomach to make it smaller, then bypasses a section of the small intestine so that calories and nutrients from food have less time to be absorbed into the body.

Risks and Rewards

According to Dr. Fowler, patients who have the LAP-BAND procedure can lose about 40 percent of their excess weight in the first year following surgery. Although this is less than the 60 percent of excess weight loss experienced with the bypass procedure, the LAP-BAND procedure has the advantage of fewer complications.

“There are greater risks associated with cutting the intestines, including the risk of infection, strictures, and internal hernias,” he says. “And because patients with bypass surgery absorb fewer nutrients and minerals, they require lifetime nutritional support.”

While excess weight loss from bypass surgery usually plateaus after the first year, LAP-BAND patients tend to continue losing weight for several years, resulting in about the same amount of weight loss at the end of five years. The patient and surgeon decide together which method is best for the individual.

Dr. Fowler emphasizes, however, that neither procedure is a guarantee for weight loss.

“Patients can still ‘cheat’ by continuing to eat,” he says. “To keep the weight off, patients must be willing to make lifestyle changes. That’s why any bariatric surgery program worth its salt is a comprehensive program with physical therapy, psychological, and nutritional components.”

Regardless of which procedure is used, patients can see a dramatic improvement in obesity-related health risks within the first month, including a reduction in medicines for hypertension and diabetes and less sleep apnea. Within a year, 80 to 90 percent of these associated diseases are significantly reduced, if not gone completely, Dr. Fowler says.

On the Road to Better Health

Weight-loss surgery brings radical changes to an individual—both physically and psychologically—and it’s important that patients are equipped with the tools they need to sustain their weight loss and successfully reintegrate into their communities.

Following surgery, patients in the program receive twelve months of follow-up care that includes group and individual counseling sessions, nutrition counseling and cooking demonstrations, fitness classes designed specifically for program patients, and peer support groups that help address emotional, behavioral, and other issues. Patients can always get additional support beyond the twelve months.

“It’s very exciting. No one else in Hawai‘i has a program quite like ours,” Reid says. “With Castle’s established Wellness Center, we are uniquely equipped to offer a comprehensive treatment package.”

For more information, please call Castle’s Surgical Weight Loss Institute at (808) 263?5176.