Program Overview

Program Overview

Obesity is a serious, chronic disease that affects over 25% of American adults and 14% of American children. Every day, more than 1,000 people in the United States will die from obesity and its related health conditions. People who are obese also run a greatly increased risk of developing diabetes, heart disease and respiratory illnesses.

Morbid Obesity

Morbid Obesity is more than just being overweight. Simply put, morbid obesity means being anywhere from 80-100+ pounds overweight and unhealthy as a result of it. Health problems related or attributed to obesity include: respiratory dysfunction, sleep apnea, hypertension, elevated cholesterol, cardiac dysfunction, diabetes, arthritis, urinary stress incontinence and an increase in risk of cancer: colon, prostate, ovarian, and breast cancer.

Is surgery for you?

For patients who remain severely obese after non-surgical approaches to weight loss have failed, or for patients who have an obesity–related disease, surgery may be the best next step. But for other patients, greater efforts toward weight control, such as changes in eating habits, behavior modification, and increasing physical activity, may be more appropriate. Answers to the following questions may help in your decision to undergo surgery for weight loss.

Are you:

• unlikely to lose weight successfully with (further) non-surgical measures?
• well informed about the surgical procedure and the effects of treatment?
• determined to lose weight and improve your health?
• aware of how your life may change after the operation (adjustment to the side effects of the surgery, including need to chew well and inability to eat large meals)?
• aware of the potential for serious complications, the associated dietary restrictions, and the occasional failures?
• committed to lifelong medical follow up?

Do you:

• have a BMI of 40 or more? BMI stands for Body Mass Index. It is a number that shows body weight adjusted for height. Click here for more information on the Body Mass Index (BMI). Insert link to CDC Web site: http://www.cdc.gov/nccdphp/dnpa/bmi/
• have an obesity–related physical problem (such as body size that interferes with employment, walking, or family function)?
• have high–risk obesity–related health problems (such as severe sleep apnea or obesity–related heart disease)?
  

Remember: There are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with your fullest cooperation and commitment to behavioral change and medical follow–up—and this cooperation and commitment should be carried out for the rest of your life.

The decision for surgery

The decision to have a weight loss operation should be made carefully. It should be made only with:

• a full understanding of the risks and benefits of the procedure
• the knowledge and willingness to accept the dietary changes imposed by the procedure
• the understanding that regular exercise is essential for any weight loss program,
• a willingness to commit to life-long follow-up appointment with your surgeon.
  

It is strongly recommended that you speak with others who have had a similar operation and that you research the issues on your own prior to your initial appointment.

Eligibility criteria

Patients must meet specific criteria before they will be considered for an evaluation with our surgeon. Selection is based on guidelines established by the National Institutes of Health, which defined morbid obesity as one or more of the following criteria:

• Be a minimum of 100 pounds overweight.
• Have a body mass index (BMI) of greater than 40, or a BMI of 35 accompanied by other issues related to health (co-morbidities).
• Have documented failure in several medically supervised weight reduction program within the last two years
• Age between 18 and 65 years (with some exceptions)
• A long history of obesity
• No current issues with drug or alcohol abuse
• No serious psychiatric illness that would impair someone’s ability to follow our program

Bariatric Surgery General Information

Gastric bypass surgery

Gastric bypass surgery is an appropriate alternative for patients who have tried all conservative measures to control their weight and have failed. We know that we can treat patients successfully, reduce the risk and severity of their problems and improve their quality of life. The prospect of having an operation to solve this weight problem is a big step, but it takes a big step to solve a big problem. It is only after all other reasonable measures at weight reduction have failed that weight loss surgery is a reasonable consideration.

The gastric bypass operation is designed to limit the amount of food you eat. This is done by dividing and stapling the stomach. The “new stomach,” also called the pouch, is only about 5–10% the size of the “old stomach” and holds less food. The pouch is about the size of a golf ball as opposed to a normal stomach, which is about the size of a football. The pouch is designed to be permanent, although it is reversible.

When food enters the pouch, it must have a way to leave. An opening is made from the pouch to the small intestine. This opening is called a stoma and is about the size of a dime. The opening is made small so that food empties slowly and the sensation of being full or satisfied lasts longer. Because the opening leaving the pouch is small, you must cut your food into small pieces and chew it well for food to be able to pass easily. It is possible to damage the pouch and stoma by overeating. This could result in stretching the pouch and dilating the stoma. If this occurs, your weight loss and long term results will not be as good.

A type of intestinal connection is created, called a Roux–en–Y. The part of the small intestine that is attached to the pouch does not metabolize refined sugars well. Approximately 50% of people who undergo this operation may have difficulty with foods or liquids high in refined sugar (table sugar). If you are one of these people, after the operation if you consume a large amount of refined sugar (chocolate bar/cheesecake/syrup), you may not feel well for 5–20 minutes. When large amounts of sugar enter the pouch attached to the intestine, a signal goes to the pancreas to secrete insulin. Insulin lowers your blood sugar and this can give patients what is called “dumping syndrome.” Symptoms may include a cold sweat, an ill stomach, and/or possible diarrhea. In general, this is unpleasant and people would not intentionally experience it again. This mechanism assists in keeping patients from consuming large amounts of calorie rich sugar and helps in weight reduction. The normal amount of sugar in what is not considered desserts or snack food will generally not cause these symptoms.

The bottom part of the stomach is not removed and continues to function. The bottom part of the stomach will secrete the gastric juices as before and they empty into the small intestine to mix with the food and assist in digestion.

The three mechanisms by which patients lose weight after the gastric bypass surgery are:

1. The pouch is very small and holds only a tiny portion of food. You feel full quickly.
2. The size of the opening, called the stoma, allows food to empty only slowly from the pouch. You stay full for a long period of time after consuming small amounts of food.
3. A large number of patients have the inability to tolerate large amounts of refined sugar.

Lap Band™ Surgery

A less invasive alternative to the gastric bypass surgery is also available: the adjustable gastric banding – also known as the Lap-Band™. The band is placed around the upper part of the stomach through tiny incisions in the abdomen. When inflated, it can reduce stomach size, thus prolonging the period of fullness and limiting food intake.

Although less invasive and less drastic as the gastric bypass surgery, it can also be less effective. It takes longer to lose weight and patients must have more self-control since there is no “built in” resistance to sweet or fatty foods.

Your doctor can discuss your options with you, and help you decide which is the best course of action for your health condition.