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Syndicated Press Features
Surgical Weight Loss Exploding in Popularity
Doctors, patients caution those who expect an “easy fix”
by Pascale Aceiveda
The weight-loss industry is a billion-dollar business, driven by Americans' ever-expanding waistlines. Diets, exercise plans, and drugs are all advertised as viable ways to lose weight. And with obesity on the rise in children as well as adults, it's clear to everyone—not just health experts—that something must be done.
That something may turn out to be weight-loss surgery. While officials caution that proper diet and regular exercise are still the answer for most people trying to maintain a healthy weight, a growing number of the obese are turning to bariatric surgery as a last resort. The results are often close to miraculous.
Take Kelly, for instance (all patients' names in this article have been changed to protect their privacy). Years of depression led her to binge eat, then turn to fad diets to lose weight. She yo-yo'd up and down, from a low of 140 in high school, to 175 at the time of her first marriage. Divorce and a second marriage meant more stress, more eating, and more unsuccessful dieting. By the time her daughter was born, when Kelly was 36, she was over 200 pounds. As a stay-at-home mom, she had more time to eat, but little time to exercise. It was when her daughter turned 4, she says, that she realized she needed help. "I weighed almost 280 pounds, and I couldn't follow Michelle up the stairs," she says. Nothing else had ever worked for me, so I made an appointment with a bariatric surgeon."
Experts concur with Kelly's feeling that "nothing else worked." Once patients' weight climbs over 250 pounds, says gastric surgeon Donald Raimes, dietary changes and exercise along may not do enough to help them.
"250 is sort of a tipping point," Raimes explains from his clinic in New York. "Below that weight, there's a chance for diet and exercise to control the problem. Over 250, the complicating factors just pile up too quickly. People have skeletal or circulatory problems from carrying all that extra weight, and they can't exercise much. Their hearts are under terrific strain. Restricted mobility and emotional factors make it very difficult for some of them to stick to a stick diet. They need some additional help, or they will never get any traction on the weight-loss process."
Help can sometimes mean gastric bypass surgery. The classical "stomach bypass," technically called Roux-en-Y, has been in use for years, and usually results in substantial weight loss. However, the extremely invasive procedure—involving staples in the stomach and intestinal re-sectioning—also carries the risk of severe complications. How risky is it? Patient mortality rates are difficult to determine accurately, says Raimes. "Ideally, patients who have severe complicating factors such as heart trouble, diabetes, breathing problems—they are not good candidates for surgery. But you have to balance the risk of surgery with the very real risks of death from obesity. Many people make the decision to accept the surgical risk in order to reduce their overall, long-term risks from obesity."
And now the risks of surgery may be dropping further. Laparoscopic Adjustable Gastric Banding, or LAGB, is a new method of weight-loss surgery quickly gaining popularity in America. In this method, the surgeon works through skin incisions to place a band around part of the stomach. As with "classical" gastric bypass surgery, the net effect is to "shrink" the usable portion of the stomach, so the patient feels full sooner.
Proponents say the procedure is easier to recover from, cheaper, and less likely to cause complications than the older method. Health officials agree that the procedure is relatively safe, having been approved for use in the U.S. in 2001. But even reduced surgical risks do not make the procedure a quick fix, they caution.
"All patients considering gastric bypass surgery for weight loss need to seriously think about the impact it will have on them—both immediately after the procedure and then for the rest of their lives," says Raimes. "Becoming a non-obese person means many changes in lifestyle, and it affects not only the patient, but their family, friends, and co-workers."
Kelly agrees. Her LAGB surgery helped her lose weight, but it didn't magically transform her life. Weight loss, she found, brought its own set of problems. “It was a really tough decision, and it’s not easy after you decide to go through with it, either,” she says. After reaching 300 pounds at age 42, she underwent the surgery hoping to turn her life around. “I lost weight immediately, but I rebounded after I got down to 200,” she said. “I was back up to 238 until I began group counseling.” A combination of group therapy, regular attendance at Weight Watchers, and regular exercise eventually allowed Kelly to reach her goal of 170 pounds, but she still must struggle daily to maintain her weight. The weight loss has taken a toll on her personal life as well. Perhaps because of her new-found independence, she and her husband grew apart, she says, leading them to divorce. She has since re-entered the workplace. “The surgery saved my life, absolutely,” she says. "But being overweight was my way of avoiding a lot of problems, and now I’m having to deal with them.”
Raimes cautions those interested in weight-loss surgery to find a reputable surgeon who provides post-operative support services. "There are plenty of people out there who will plop you on the operating table, do the procedure, file for your insurance payment, and have you back out on the street a week after you first saw them," he says. "They're doing surgery, but they aren't, in my opinion, practicing medicine. They aren't asking the patient enough questions about lifestyle and expectations for the surgery. They aren't educating patients about how to eat for the rest of their lives. They aren't warning them about the emotional upheaval that may follow surgery, and how to cope with it. All those pieces of the treatment plan must be assembled collaboratively by the patient and doctor, if you want to have the best chance at a successful outcome."
But even critics admit that surgical treatments for obesity have come a long way, and offer real hope for patients. “Taking into account the risks, the costs, and the benefits, it is clear that surgical therapies for weight loss are often a good long-term treatment option,” says Kirk Border of the American Health Foundation. Given the economic costs of obesity to our nation and our healthcare system, and the personal and emotional costs suffered by the severely overweight, weight-loss surgery is often an appropriate, if drastic, treatment option.
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