Although most people can lose weight the old-fashioned way through disciplined eating and regular exercise, bariatric (the treatment of obesity) surgery is an option for very overweight people who have tried everything else.
"You don't just jump into this," says Dr. Frederick Buckley Jr., F.A.C.S., who practices general, vascular and bariatric surgery in Salem. "We're the last stop, and this solution is intended to be forever."
Weight-loss surgery is not for the slightly overweight, nor is it a quick fix for people who haven't tried other methods first. To be eligible, patients must be at least 100 pounds overweight, undergo psychological and cardiac screening and commit to a new eating pattern for the rest of their lives. Insurance companies may also require them to undergo six months of physician-monitored weight loss (usually by a primary-care provider) during the year prior to surgery or their own six-month phone-monitored system, which Buckley believes is less effective than proceeding directly to what he considers "life-saving" surgery.
Most of Buckley's patients have tried other programs without success. "Our patients have lost and regained hundreds of pounds," he said. "It is not a pure willpower thing and it's not for lack of trying that they come here."
He pointed out that only one to two percent of people who are 100 pounds or more overweight can lose significant amounts of weight and keep it off for 10 years. For most of these patients, he said surgery is often the only way weight loss can be achieved and maintained.
The advantages of surgery can be dramatic - diabetics can immediately benefit from gastric bypass, and conditions such as high blood pressure and sleep apnea can be largely eliminated through the resulting weight loss.
Gastric bypass surgery creates a small pouch in the stomach via stapling and "short circuits" four feet of the small intestine, which reduces the amount of calories consumed and absorbed into the body. "These procedures limit the amount you can eat, which gives you the tool to reduce your intake," Buckley said.
Banding, or the "lap band," works by inserting an artificial plastic and silicone device around the top of the stomach. This ring is filled with fluid, which compresses the stomach and creates a small pouch. The fluid can be adjusted by the doctor through an access port under the skin; more fluid tightens the band and shrinks the pouch and vice versa. Adjustments are made after the surgery to tighten the band until an optimal rate of weight loss is achieved.
"You don't just jump into this," says Dr. Frederick Buckley Jr., F.A.C.S., who practices general, vascular and bariatric surgery in Salem. "We're the last stop, and this solution is intended to be forever."
Weight-loss surgery is not for the slightly overweight, nor is it a quick fix for people who haven't tried other methods first. To be eligible, patients must be at least 100 pounds overweight, undergo psychological and cardiac screening and commit to a new eating pattern for the rest of their lives. Insurance companies may also require them to undergo six months of physician-monitored weight loss (usually by a primary-care provider) during the year prior to surgery or their own six-month phone-monitored system, which Buckley believes is less effective than proceeding directly to what he considers "life-saving" surgery.
Most of Buckley's patients have tried other programs without success. "Our patients have lost and regained hundreds of pounds," he said. "It is not a pure willpower thing and it's not for lack of trying that they come here."
He pointed out that only one to two percent of people who are 100 pounds or more overweight can lose significant amounts of weight and keep it off for 10 years. For most of these patients, he said surgery is often the only way weight loss can be achieved and maintained.
The advantages of surgery can be dramatic - diabetics can immediately benefit from gastric bypass, and conditions such as high blood pressure and sleep apnea can be largely eliminated through the resulting weight loss.
Gastric bypass surgery creates a small pouch in the stomach via stapling and "short circuits" four feet of the small intestine, which reduces the amount of calories consumed and absorbed into the body. "These procedures limit the amount you can eat, which gives you the tool to reduce your intake," Buckley said.
Banding, or the "lap band," works by inserting an artificial plastic and silicone device around the top of the stomach. This ring is filled with fluid, which compresses the stomach and creates a small pouch. The fluid can be adjusted by the doctor through an access port under the skin; more fluid tightens the band and shrinks the pouch and vice versa. Adjustments are made after the surgery to tighten the band until an optimal rate of weight loss is achieved.
"You usually need two to four fills before most patients get into the 'green zone,' where they are losing one to two pounds per week, but are not throwing up or ravenously hungry," Buckley said.
Banding is considered less invasive than gastric bypass, he said, but it does not work for everyone, and some patients don't lose weight. The band can be relaxed if a patient becomes pregnant and needs to consume more calories, but not because ideal weight is achieved. "This is permanent, even if optimal weight loss occurs," Buckley said. "Most patients will regain the weight if the band is removed."
Gastric bypass surgery made headlines in its early years after some patients died, but Buckley said the mortality rate has decreased dramatically, and the complications from this surgery are now minimal.
In the 1990s, the Betsy Lehman Center for Patient Safety convened a group of medial professionals in Massachusetts to ensure surgeons had proper training to perform these procedures and that hospitals had the necessary equipment. Every medical center in Massachusetts that is certified as a "Center of Excellence," including Salem Hospital, has passed a rigorous national screening evaluation and site visit to confirm that the hospital and surgeons have all the appropriate facilities, training and support to evaluate, operate on and care for these patients.
Buckley is trained to perform both operations laproscopically, which affords patients a faster recovery. Serious risks are few, he said, but may include leakage from the staple lines, which could require more surgery; some bleeding, the development of hernias and, very infrequently, death (occurring in less than one in 1,000 cases in Massachusetts).
After surgery, patients will be able to eat and drink only very small amounts or they will become ill. For example, patients are encouraged to eat with toddler spoons and forks so they reduce portion size and do not overeat. Likewise, excessively sugary and greasy foods are not easily digested after surgery, and patients may experience severe diarrhea and fatigue after eating these foods. "If you cheat, the payback is almost immediate," Buckley said.
Patients will also need to take vitamins after surgery, and bypass recipients will need calcium supplements for the rest of their lives and iron pills if they are still menstruating.
It is possible to stretch the surgical pouch by overindulging, so patients must adhere to these new eating guidelines at all times or they won't benefit from the surgery.
"It's a huge alteration in lifestyle. They will become the slowpoke at the family table," Buckley said.
To ensure weight loss, post-operative patients should slowly eat three small (two- to three-ounce) meals per day and three protein-rich snacks. And since overall consumption is greatly diminished, it becomes very important to use the calories allowed judiciously to allow for proper nutrition.
To smooth the transition to these new eating habits, all of North Shore Medical Center's patients must enroll in a 12-week post-operative course to help them adjust to their new lifestyle. Patients receive coaching on nutrition, stress management and exercise, among other topics.
"We help change people's lifestyles so they don't get into bad habits again," Buckley said. "We try very hard to reprogram them."
For more information, talk with your primary-care provider first as well as check out the Web sites for the Centers for Disease Control (www.cdc.gov) or the National Institute of Health (www.nih.gov), which contain details on bariatric surgery.
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This article is part of a regular health education series provided by the Gloucester Health Department and Addison Gilbert Hospital.
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