Bariatric Surgery
What is Clinically Severe Obesity?
The body mass index [weight (kg)/ height (m2)] or BMI is used to determine level of obesity. To be eligible for surgery you must have a BMI over 40, which is typically at least 80-100 lbs overweight. You may also be eligible if your BMI is over 35 and you have certain medical problems caused by obesity. Your BMI can be calculated online or give us a call.
Why is Excess Weight a Concern?
People with severe obesity are at increased risk for developing multiple medical problems, as well as, premature death. The following is a partial list of the medical problems associated with obesity:
- Asthma
- Depression
- Diabetes
- Heart burn
- Heart disease
- High blood pressure
- High cholesterol
- Infertility
- Joint pain
- Leakage of urine
- Leg ulcers and swelling
- Obstructive sleep apnea
All of the above medical problems have been shown to improve or resolve after surgery.
What are the Options for Losing Weight?
Diet & Exercise
There are almost as many diet and exercise programs as there are people overweight. Many of these can work for those looking to lose 10 or 15 lbs. Unfortunately, none of these programs has ever been shown to result in significant sustained weight loss in people with clinically severe obesity. However, diet and exercise are critical to maintaining weight loss after surgery, and to leading a healthier life. The surgery allows you to maintain your diet, and gives you the energy to exercise.
Weight Loss Drugs
There are only three prescription drugs approved by the FDA for weight loss. None of these has been shown to produce significant sustained weight loss in the severely obese. The myriad of nonprescription diet pills are even less effective, and some are potentially dangerous. Because of the epidemic of obesity and the potential for huge profits, there is a great deal of money being spent on drug development. It is possible an effective weight loss medication will become available in the future, but there is currently little on the horizon.
Surgery
Roux-en-Y gastric bypass 
Many operations have been developed to create weight loss. The most popular and most tested is the Roux-en-Y gastric bypass. This involves making a thumb size pouch out of the stomach and connecting the intestines to it. The intestines are reconnected down-stream so that less nutrient absorption occurs. This operation has been around for over 30 years and reliably produces major weight loss that can be sustained for decades.
Adjustable Gastric Band 
A newer approach is the adjustable gastric band. This is a plastic ring placed around the top of the stomach to limit the amount and rate of food consumption. Adjusting the tightness of the band is a simple office procedure, typically done 4-5 times in the first year. In general, there is less weight loss with this approach, but it is less invasive and possibly safer.
Both of these procedures are done laparoscopicaly through several small incisions and typically only require one night in the hospital.
Life After Surgery
Because of the laparoscopic approach, the recovery is quite rapid. Most patients are back at work within2 weeks. The biggest adjustment is the new diet. Patients have very little appetite and often struggle to get adequate protein in the first several months. They are required to take multivitamins every day for the rest of their life, to prevent any deficiencies. Exercise is critical to improving health and maintaining the weight loss long term. Fortunately, this becomes easier as the pounds come off and energy levels typically improve.
Risks
In deciding to have surgery one must weigh the risks of the procedure against the risk of not losing weight. Several large scientific studies have found people undergoing the surgery are more likely to be alive in 5 years then similar obese people who have not. The following are a few of the potential complications:
- Narrowing of the pouch outlet requiring endoscopy (5%)
- Bowel obstruction from hernias or adhesions (less than 5%)
- Ulcers and bleeding (less than 3%)
- Internal infection resulting from leakage of digestive juices (1%)
- Blood clots — may lead to more serious condition called pulmonary embolism (0.5%)
- Death, approximately 1 in 200 gastric bypasses and 1 in 2000 gastric bands (This can be higher with inexperienced surgeons working outside of specialized centers.)
Taking the First Step
If you are interested in learning more about weight-loss surgery, please call us for the date of our next free information seminar at (805) 898-3472. The weight-loss surgery department has an experienced staff to guide you through this life-changing process. We have helped many individuals improve their health and we look forward to meeting you and helping you achieve your goals.