Surgical Weight Loss Mission Bariatrics
Obesity is a major health problem in the United States, with more than one in every three people suffering from this chronic condition. Obese adults are at an increased risk of developing illnesses, and morbidly obese patients have been shown to have a significant reduction in life expectancy. Bariatric surgery, which promotes weight loss by restricting food intake, is one method of overcoming obesity. Obesity is measured in terms of a person s Body Mass Index (BMI). A normal-weight person has a BMI between 20 and 25. Morbid obesity is defined as a BMI of more than 40, and usually means a person s actual body weight exceeds the ideal body weight by 100 pounds or more for men and about 80 pounds for women. Surgery is an option, in some cases, for people with a BMI between 35 and 40 who also have life-threatening complications related to their obesity, such as severe sleep apnea, diabetes or heart disease. The success of surgical weight loss, as with other treatments for obesity, depends largely on a person s motivation and behavior. Note: To calculate your BMI please refer to the chart on page 9. How Surgery Promotes Weight Loss To understand how bariatric surgery results in weight loss, you first need to understand the normal digestive process. Normally, after food is swallowed it enters the stomach, which holds the food and allows small amounts to pass further into the digestive tract. The stomach can usually hold up to about 48 ounces of food. As food continues through the digestive process, digestive juices and enzymes help absorb calories and nutrients. Most iron and calcium is absorbed as it moves from the stomach into the first section of the small intestine. The rest of the digestive process occurs in the remaining two sections about 20 feet of the small intestine. Food that cannot be digested in the small intestine is stored in the large intestine until it is eliminated. Bariatric surgery promotes weight loss in two ways: By restricting the amount of food that can be stored. Gastric banding and gastric bypass limit the amount of food the stomach can hold by closing off or removing parts of the stomach. These operations also delay emptying of the stomach. By reducing the amount of food absorbed. Gastric bypass surgically connects a lower segment of the small intestine to the stomach. The use of bariatric surgery to control severe obesity was developed after physicians observed weight loss among patients who had large portions of the stomach or small intestine removed as treatment for cancer or severe ulcers. 2 3
What are the Surgical Options? Gastric Banding Mission Hospitals now offers the LAP-BAND procedure. The LAP-BAND procedure uses laparoscopic surgery to place a silicone band around the upper portion of the stomach. This creates a smaller gastric pouch and reduces the size of the stomach without compromising the absorption of nutrients or changing the natural digestive process. Patients without complications will generally be home within 24 hours of the surgery. Due to a decreased appetite because of the smaller gastric pouch, long-term weight loss is usually between 50 to 60 percent of excess weight. Mission Hospitals gastric banding candidates BMI will be evaluated on an individual basis. Considering the following questions may help you determine if gastric banding is right for you. Are you: a morbidly obese patient at least 100 lbs. overweight who weighs 400 pounds or less? a patient for whom other weight loss techniques, including special diets, did not work? an obese woman of child-bearing age who may wish to have children? a morbidly obese patient who prefers a less invasive bariatric procedure? 4 Weighing the Risks of LAP-BAND Surgery Gastric banding surgery carries the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight. In a U.S. clinical study, 1% of patients developed a gastric perforation (a tear in the stomach wall) during or after the procedure that lead to the need for another surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it. Results show that the LAP-BAND system surgery may have fewer risks than other surgical treatments for obesity. Patients can experience complications after surgery. Some may require hospitalization and/or re-operation. One or more of the following adverse events, ranging from mild, moderate to severe can occur: Nausea and vomiting Gastroesophageal reflux Band slippage/pouch dilatation Stomach-band outlet blockage Poor esophageal function Constipation Diarrhea Difficulty swallowing Leaking or twisted access port Band erosion There can also be adverse events that are considered to be non-serious. Be sure to ask your surgeon about these possible complications. 5
Roux-en-Y Gastric Bypass Another of the surgical weight loss methods used at Mission Hospitals is the Roux-en-Y gastric bypass procedure, which is the most common surgical method used to control obesity today. Through this procedure, a small stomach pouch is created to restrict food intake. The capacity of the stomach is reduced to only one ounce. This pouch is created by stapling across the stomach with a special metal device. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower portion of the stomach and the first segment of the small intestine. This reduces calorie and nutrient absorption. Patients typically lose 75 percent of their excess weight within the first 18 to 24 months after surgery. Weighing the Risks of Gastric Bypass Surgery Surgery to produce weight loss is a serious undertaking. Each patient should have a thorough understanding of what is involved and the benefits and risks associated with this procedure. The risks associated with weight loss surgery are similar to any abdominal surgery. However, obese people are at a greater risk than people of normal body weight during an operation due to diseases and conditions related to obesity, such as hypertension and diabetes. Reducing your BMI with weight loss prior to surgery will reduce the chances of complications during surgery. Mission offers the OPTIFAST Program to help bariatric surgery patients reduce their BMI prior to surgery. According to the Weight Control Information Network, ten to twenty percent of weight loss surgery patients require follow-up surgery to correct complications. Abdominal hernias are the most common complication. Esophagus Small Pouch Stomach Duodenum Staples More than a third of weight loss surgery patients develop gallstones and may require a second operation for gallbladder removal. Some risks also exist for pouch stretching, leakage of stomach contents into the abdomen and breakdown of the staple line. Because food is skipping the first section of the small intestine where most iron and calcium is absorbed, there is a risk for nutritional deficiencies. Maintaining the necessary vitamin intake can be achieved by taking vitamin and mineral supplements your physician will recommend for the rest of your life. Protein deficiencies also can occur but can be prevented by consuming protein during the first half of each meal. 6 7
Nausea and vomiting may occur if the patient gets full during a meal and continues to eat. Limiting food intake will address this issue. Some patients also experience some food intolerances. Red meats are harder to digest than other proteins and may cause vomiting. Sugar draws fluid into the intestine and may cause a condition known as dumping syndrome. Symptoms of dumping syndrome include nausea, weakness, sweating, faintness and occasionally diarrhea. Most patients manage or avoid this condition by not consuming sweets on an empty stomach. If an intolerance to milk products occurs, lactose-free products can be substituted. Stool softeners may also be needed after surgery due to the reduced quantities of roughage being consumed. Hair and muscle loss also can occur when the body is experiencing a drastic reduction of calories and substantial weight loss. Hair loss is temporary and usually corrected when nutrition and weight stabilize. Loss of muscle mass can be prevented by exercising vigorously as soon after surgery as your physician allows. disease also can be considerably relieved with weight loss, and the risk of heart disease is reduced. Is Weight Loss Surgery Right for You? Severely obese patients who have not had success with nonsurgical approaches to weight loss or who have an obesity-related disease, may be good candidates for bariatric surgery. However, increased efforts at behavioral modification and increased physical activity may be more appropriate for others. Mission Hospitals gastric bypass candidates must have a BMI of 35 to 45. Gastric banding patients BMI will be evaluated on an individual basis. Some previous abdominal surgeries may exclude you as a candidate. Nutritional and psychological consults, which may not be covered by insurance, are required, and payment is expected at the time of service. The Benefits of Weight Loss Surgery Immediately following surgery, patients experience rapid weight loss. Although most patients will regain some of the weight they lose, few regain it all. The surgery and reduced weight also improve most obesity-related conditions, such as diabetes, high blood pressure and high cholesterol. Many experience fewer and less severe incidents of asthma, gastro esophageal reflux disease, sleep apnea and stress urinary incontinence. Lower back pain, degenerative disk disease and degenerative joint Body Mass Index Table (For full BMI table, log on to www.nhlbisupport.com/bmi) overweight obese BMI 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Hgt. (in) Body Weight (lbs.) 58 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 59 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 60 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 61 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 62 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 63 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 64 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 65 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 66 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 67 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 68 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 69 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 70 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 71 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 72 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 73 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 74 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 75 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 76 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 8 9
Considering the following questions may help you determine if gastric bypass is right for you. Are you: age 18 to 55? determined to lose weight and improve your quality of life? aware of lifestyle changes that will need to be made after bariatric surgery to prevent side effects and ensure optimal results? aware of the potential for serious complications, periodic failures and related dietary restrictions? committed to continuous medical follow up? at a high risk for obesity-related health problems? Do you: have a BMI between 35 and 45 and weigh 400 pounds or less? have an obesity-related health problem or problems? have a strong network of friends and family members to provide emotional support? Have you: tried and been unsuccessful with numerous nonsurgical weight loss methods? If you answered yes to a number of these questions, and are interested in the possibility of weight loss surgery, please call (828) 213-2222, and press 2 to schedule yourself for a free Mission Bariatrics gastric banding and/or gastric bypass information session. 10 Additional Sources on Weight Loss Surgery American Society of Bariatric Physicians: www.asbp.org American Society for Bariatric Surgery: www.asbs.org American Obesity Association: www.obesity.org International Federation for the Surgery of Obesity: www.obesity-online.com/ifso Association for Morbid Obesity Support: http://www.obesityhelp.com/morbidobesity/home.p html Gastrointestinal Surgery for Severe Obesity, Consensus Statement, NIH Consensus Development Conference, March 25-27, 1991; Public Health Service, National Institutes of Health. Office of Medical Applications Research, Building 1, Room 260, Bethesda, MD 20892. This publication, written for health professionals, summarizes the findings of a conference discussing treatments for severe obesity: www.niddk.nih.gov/ health/nutrit/pubs/gastric/gastricsurgery.htm Understanding Adult Obesity, NIH Publication No. 94-3680. This fact sheet describes what obesity is, its causes, how it is measured and related health risks: www.niddk.nih.gov/ health/nutrit/pubs/unders.htm Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, Department of Health and Human Resources, National Institutes of Health; 1998, NIH Publication No. 98-4083: www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm 11
To learn more about Mission Hospitals Bariatric Surgery Program, or to schedule a free information session with our team, please call us at (828) 213-2222. Listen to the recorded message for hours of operation, and then press 2. Mission Bariatrics 445 Biltmore Center Asheville, NC 28801 Rev. 4/2005 www.missionhospitals.org