Clinically Speaking: Bariatric Surgery Takes a Team Approach to Better Health
By: Mark A. Colquitt, MD, FACS
East Tennessee continues rank among the highest in percentage of the population suffering from obesity and diabetes, with a current fifth-place national ranking for obesity. To address these issues, bariatric surgery options have become more common choices to provide better health and a longer life span for many obese patients.
Bariatric surgery is a viable option when physician-supervised programs of diet and exercise fail, which is true for nearly 90 percent of morbidly obese patients. With that in mind, if a patient is more than 100 pounds over their ideal body weight; has a Body Mass Index (BMI) of more than 35; is experiencing negative health effects related to obesity; and/or cannot achieve a healthy body weight, bariatric surgery can offer a lasting solution.
Weight loss success is a team effort involving primary care physicians, bariatric surgeons, and nutrition and lifestyle counselors along with the commitment of the patient. With the latest technologies and procedures available, the success rate of bariatric surgery is extremely high.
The measure of success is much more than reduced body weight. It is also measured by the reduction, elimination or prevention of comorbidities, which leads to better cardiovascular health and an overall improvement in the quality of life. Outcomes of bariatric surgery are increased life expectancy and improvement or, in many cases, resolution of obesity-related comorbidities such as adult-onset diabetes, hypertension, sleep apnea, gastroesophageal reflux disease (GERD) and certain cancers.
By eliminating excess weight, 90 to 95 percent of patients no longer need medication for diabetes. Hypertension and high cholesterol are often improved, and many patients previously suffering from sleep apnea can eliminate the use of the nightly continuous positive airway pressure (CPAP) machine. Patients also experience a significant alleviation of joint pain, which can mean no more medications or the avoidance of joint replacement surgery. Additionally, weight loss contributes to an overall sense of well-being and reduced depression.
As the demographics and causes of obesity are varied, so are the treatment options. The foundation for all treatment is a multi-faceted approach including behavior and nutrition counseling; overall mental and physical health assessment; and consensus with the patient on the most effective surgical option. Various bariatric surgical procedures are available and address the situation through modalities that are restrictive, restricting the amount of food the patient can eat; malabsorptive, limiting the caloric absorption through the intestines; or both.
The Realize Adjustable Gastric Band and the LAP-BAND system are restrictive procedures that use a saline-based device to constrict the stomach to make it feel full faster and longer, limiting food intake. Adjustable and reversible, these are the simplest and safest weight loss surgery options available.
The Roux-en-Y Gastric Bypass combines this restrictive approach with a malabsorptive component by stapling to create a small pouch stomach that empties directly into the lower portion of the small intestine, thus bypassing calorie absorption. This is currently the gold standard and most commonly used procedure for weight loss surgery.
Laparoscopic sleeve gastrectomy is a restrictive procedure involving the removal of 85 percent or more of the stomach. This is the newest procedure and is becoming very popular, offering significant weight loss like gastric bypass and the safety of the band procedures Unlike band procedures, no adjustments are necessary.
The ROSE (Restorative Obesity Surgery, Endolumenal) procedure is used if a patient who was initially successful after gastric bypass surgery begins to regain weight. Through this incision-free procedure, the stomach is returned to the original post-surgery size to help patients get back on track.
Most bariatric surgery procedures are covered by major insurance carriers and Medicare. The laparoscopic sleeve gastrectomy procedure is now covered by United Healthcare.
Treatment for obesity is definitely not one-size-fits-all. Each patient is different and requires specific treatments and procedures. Keeping the entire health care team involved is essential.
But the risk-benefit ratio of bariatric surgery may strongly favor bariatric surgery for producing lasting improvement in overall health. The risk associated with bariatric surgery is comparable to that of hip replacement surgery and has been shown to have the advantage of keeping the weight off long-term. For this reason, the use of bariatric surgery has achieved overall acceptance by the medical community over the past ten years.
Obesity affects every organ in the body. Bariatric surgery is a vital tool in the fight against weight-related medical conditions and a significant step on the road to better health.
Mark A. Colquitt, MD, FACS, is medical director and a bariatric surgeon for Foothills Weight Loss Specialists, a division of Premier Surgical Associates and a Bariatric Surgery Center of Excellence. Colquitt is board certified by the American Board of Surgery. He is a fellow of the American College of Surgeons and a member of the American Society of Metabolic and Bariatric Surgery and the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit http://www.foothillsweightloss.com.
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