This Band Could Save Your Life

... and other weight loss surgery secrets

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Thursday, June 03, 2010

It's no secret that obesity is one of the leading medical conditions facing America today. According to a 2010 report by the U.S. Centers for Disease Control and Prevention, "Nearly 34 percent of adults are obese, more than double the percentage 30 years ago."

While these statistics are certainly scary, perhaps the greater threat is to the young, where the same study showed that the number of obese children in America has tripled to nearly 17 percent.

Efforts to combat the health risks caused by obesity now permeate popular culture. Diet programs like Weight Watchers and Jenny Craig frequently use celebrity spokesmen to tout their effectiveness. Television shows like NBC's The Biggest Loser and VH1's Celebrity Fit Club combine popular reality programming with exercise promotion and nutritional advice.

Even the National Football League has hopped on the bandwagon with its "Play 60" campaign, which encourages healthy lifestyle decisions by young people in order to create a more active generation.

However, yet another trend has emerged in weight loss management. Though it's intended only for the severest of cases, bariatric surgery has become an increasingly popular alternative for those most severely affected by obesity. The field of bariatrics deals exclusively with the management of patients who are listed as dangerously overweight or obese, and treatment often includes a combination of dieting advice, instruction in exercise regimens and behavioral therapy approaches that employ weight loss drugs and surgery.

Several forms of weight loss surgery have become quite well known through their exposure in entertainment media, perhaps the most notable being gastric bypass surgery, which has been used by celebrities like Sharon Osbourne and Star Jones. Consequently, other forms of surgery are beginning to see a rise in numbers as more patients seek the safest way to get the results they want. One current favorite is gastric banding.

Laparoscopic adjustable gastric band surgery, popularly known as lap-band, is a medical procedure involving the placement of an inflatable silicone device around the top portion of the stomach. This device helps curb the body's feeling of hunger by separating the stomach into two parts. While the smaller upper part fills quickly with food, the band slows the passage of nutrients to the lower portion and creates the illusion that the whole stomach is full. The hope is to induce a patient to eat smaller portions and gradually lose weight over time.

However, many medical professionals warn that such an undertaking still holds all the same risks as serious surgery, and that patients should not go into the process without undergoing the proper counseling.

At Baystate Medical Center in Springfield, Dr. Jay Kuhn and his colleague Dr. John Romanelli deal with a variety of patients looking to lose weight. On the Baystate Health website, they also try to make the public aware of the challenges involved in all forms of weight loss surgery by answering some frequently asked questions. For example, as Kuhn points out on the site, "Nutritional counseling is one of the most important components of the pre-certification process. We've discovered in our practice that our patients who continue to work with our dietitians long after surgery are the ones who seem to have the greatest benefits with regard to healthy living and long-term high-volume weight loss."

Nutritional counseling is not the only form of therapy offered to those interested in weight loss surgery. Before being accepted for surgery, many bariatric patients are asked to undergo a psychological evaluation to assess their emotional readiness for the procedure and their ability to make the diet and lifestyle changes that will be needed afterward.

Safety and understanding of the gastric banding process are the primary concern for weight loss surgeons as well as their patients. Writing in Weight Loss Success Lifestyles magazine in 2006, Romanelli outlined several risk factors facing bariatric patients, including possible death.

"Many patients are beginning to opt for gastric banding as it has been shown to have a lower morbidity rate than gastric bypass surgery," he wrote. "Yet there are several aspects of gastric banding surgery that patients do not completely understand."

Kuhn elaborated on the mortality risk involved with bariatric surgery by citing a study involving 16,000 gastric bypass patients that appeared in the Journal of the American Medical Association in October, 2005. The study, he explained, "found that the mortality rate within 30 days of the procedure was actually 2 percent. It is important to note, however, that these patients all were Medicare patients, which means that they were either over age 65 or had a medical condition leading to permanent disability. Nonetheless, it is important to discuss all of the risks of gastric bypass surgery, including mortality, with your surgeon."

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Medical professionals urge those considering weight loss surgery to thoroughly investigate all possible avenues with their doctor before going under the knife. The work can often be worth it. For example, former bariatric patient Tricia L., who lost 115 pounds after her surgery, agrees that such investigation is key to ensuring a positive outcome. On the Baystate Health website she wrote, "When undertaking such a huge commitment to your health, it is imperative to find a doctor with whom you feel comfortable. Finding the right surgeon for me made my surgery a great success."

Still, it's after the surgery that the real work begins, when those same feelings of dedication and commitment must be tested over the long haul. Some of the biggest challenges facing patients post-surgery involve what they can and cannot do and what they can and cannot eat. For example, many doctors recommend that they emphasize protein in their diets while minimizing fat and alcohol. If a patient breaks these rules and begins eating improperly, the consequences can be very unpleasant.

One of the problems that may result from poor dieting is something called "dumping syndrome." Romanelli defined "dumping syndrome" as "a constellation of symptoms such as abdominal pain, nausea, vomiting, flushing, chest pain, palpitations, and rapid heartbeat." This combination of symptoms can create a very unpleasant feeling for affected patients, but may also act as a reminder of sorts to watch what they eat. Unfortunately, the syndrome may go away in time and weight gain may resume. Sufferers would do well to heed the initial warnings and follow all dietary restrictions.

In addition to eating differently, some patients may be forced to make significant lifestyle changes in order to avoid the threat of complications after surgery. One example is patients who are smokers. Smoking can cause respiratory difficulties, which increase the risks involved in using the general anesthesia the operation requires, and can retard healing by inhibiting blood flow to the affected tissues. Romanelli's website warns, "While there has never been literature to suggest that smokers do poorly after gastric banding, any good bariatric surgery program should include smoking cessation as a component to better health."

Yet, amid all the risks and variables, there is no doubt about the effectiveness of many bariatric surgery programs. If patients diligently follow up with their surgeons and heed all dieting and nutritional advice, the outcomes can be life-altering.

For former patient William H., the results even went beyond personal satisfaction. On Baystate Health's website he wrote, "[As a result of losing weight] I stopped taking my meds, sleep all night, do not have problems taking the stairs and can run without getting out of breath. I feel my wife and I have gotten closer, and the sex life does get better." Perhaps most important, he added, "I will be around for my children and grandchildren." Now who can argue with results like that?

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