Fighting Obesity Obesity—A Treatment Overview (Continued from page 17)
first have attempted other means of weight loss. Candidates for the surgery undergo a psychological exam to assure that they can adjust to the lifestyle changes that accompany bariatric surgery. Insurance companies each have their own specific criteria for coverage. Surgery is the Most Effective Treatment for Morbid Obesity
It is a misconception that obesity is simply the result of a lack of willpower or laziness and that surgery is an easy way out. Weight loss surgery is a tool that must be used correctly on a daily basis for the rest of a patient’s life. Getting and keeping weight off is still difficult but bariatric surgery provides a tool that significantly assists the individual in achieving long-term success. On the average, patients lose 45 to 80 percent of their excess weight, depending on the procedure they choose, and their commitment to a healthy lifestyle. (Brethauer, Chand, and Schauer, Risks and Benefits of Bariatric Surgery: Current Evidence, Cleveland Clinic Journal of Medicine, vol 73, 2006).
A well known study published in Annals of Surgery, 1995, vol. 222, No. 3, pp. 339352 showed that 89 percent of weight loss was maintained after 14 years. (Pories, WJ, Swanson, MS, MacDonald KG, et al. Who would have thought it? -An Operation Proves to be the Most Effective Therapy for Adult-Onset Diabetes Mellitus.) A meta-analysis (Buchwald, et al, 2004) of more than 22,000 bariatric surgery patients showed that many of the life-threatening conditions that accompany obesity are completely resolved or improved after the surgery. Diabetes was resolved in 76.8 percent of patients, and resolved or improved in 86 percent of patients. High blood pressure was resolved in 61.7 percent of patients, and resolved or improved in 78.5 percent. Sleep apnea was resolved in 85 percent of patients and more than 70 percent of patients improved or corrected their high cholesterol. Types of Surgery
Weight loss surgery works on two basic mechanisms: restriction and malabsorption. The most common surgical procedures utilize one or both
of these mechanisms. All procedures discussed are most commonly done laparoscopically. Average hospital stays tend to be just over two days with the majority of patients going home the day following surgery. Adjustable gastric banding restricts the amount of food that can be consumed at one time by placing an adjustable silastic band around the top of stomach. The band has an inner tube or balloon that can be injected with fluid so that the restriction can be increased or decreased. The small stomach pouch proximal to the band holds about ¾ cup to one cup of food. Because the pouch empties slowly, the small volume of food will control a patient’s appetite for about three to five hours. Patients lose weight slowly — about one to two pounds per week. They can expect to lose their excess weight over approximately 18-24 months. There are currently two bands in use in the U.S. today, the LapBand by Allergan and the Realize Band made by Ethicon. A sleeve gastrectomy is another restrictive procedure which reshapes the stomach into a long narrow tube. About 75 percent of the stomach is removed. This procedure has been
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November/December 2010
MetroDoctors
The Journal of the Twin Cities Medical Society