Tuesday, September 30, 2008

Could gastric bypass surgery cure diabetes?

Raleigh, NC
Gastric bypass and other surgeries have become a popular way for the obese to lose weight. The procedure has also proven effective at curing diabetes.

Mary Stanford weighed 300 pounds four years ago and was a Type 2 diabetic. Gastric bypass surgery helped her lose 140 pounds, and her diabetes disappeared almost immediately.

“(It was) definitely a relief. Your sugars are normal, you don't have to worry about testing every day (and) you don't have to worry about remembering to take your medication,” she said.

Some doctors are considering gastric bypass for a larger number of diabetics.

“We now have sufficient evidence that gastric bypass can improve diabetes dramatically,” said Dr. Francesco Rubino with the Weill Cornell Medical Center in New York.

There is an obesity threshold. Someone who is 5 feet 8 inches tall has to be at least 230 pounds to get the surgery. Rubino said he planned to begin a new study, performing the surgery on patients about 30 pounds lighter.

“We're going to compare surgery [with] conventional medical treatment to understand whether surgery might be preferable in this subset of patients,” he said.

Researchers say it's not just the weight loss that rids the body of diabetes. The surgery might also spark hormonal changes in the body.

“A large number of people with diabetes will see their diabetes drop off within days to a few weeks after the bypass, long before they've lost much weight,” said Dr. David Crumpler, an endocrinologist.

Experts say they believe it's possible that the surgery could even help diabetics who are just overweight and not obese.

“We have to be very cautious and do more studies before we offer surgery to everybody,” Rubino said.

Labels: , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Sunday, September 28, 2008

Robot may reduce risk of gastric bypass

Houston, TX
U.S. surgeons say using a robot may lower the risk of a rare but serious complication of weight-loss surgery.

The five-year study, published in the Journal of Robotic Surgery, compared 605 patients undergoing laparoscopic gastric bypass without and with robotic assistance. Six in the first group experienced a gastrointestinal leak while none in the robot group did.

"While robotic surgery may take slightly longer and be more costly to use than traditional laparoscopy, we believe that the improved outcome and decreased leak rates may offset the cost to some extent," study senior author Dr. Erik Wilson of the University of Texas Medical School at Houston said in a statement.

Symptoms of a gastrointestinal leak which may occur when the small intestine is reconnected to a small pouch created in the stomach can include pain, shortness of breath, fever, nausea, vomiting and -- rarely -- death. In this study, there were no deaths in either group, and the rate for all complications was slightly lower than those previously reported in journals.

Lead author Dr. Brad Snyder says the robot allows for more precise suturing.

"The angles encountered during a laparoscopic gastric bypass are sometimes awkward and can make the surgical technique challenging," he says. "With the robot, this additional challenge is minimized."

Labels: ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Gastrc byass surgery last resort after pills, diets

Lumberton, NC
Bernice Wilson sits in a hospital bed, listing the names of the diets and pills she’s tried in attempts to lose weight over the years.

The words trip off her tongue as though she’s naming her children: Slimfast; Weight Watchers; Atkins; South Beach; D-12; Adipex; Phen-Phen; Xenacal.

She’s sure there are more, but she can’t remember them all.

Now she’s trying something else — the laparoscopic adjustable gastric banding procedure, or lap-band — in which a band is wrapped around the upper part of her stomach to control the amount of food she can eat.

Wilson, who is 54, was the first person to undergo the procedure at Southeastern Regional Medical Center on Aug. 15.

Dr. Barry Williamson, who performed the laparoscopic surgery, said 30 patients are already lined up to receive it. He expects to do about three surgeries a week, or more than 150 a year.

The surgery is not cheap. At Southeastern Regional, lap-band costs between $15,000 and $20,000, depending on the length of hospital stay and other factors. It also doesn’t include the surgeon’s fees, said Faith Ferguson, bariatric program coordinator at the hospital.

Weight-loss surgeries, such as gastric bypass and gastropexy, can cost $30,000 or more in the United States. In some cases, insurance will pay for a portion. Medicare will pay when a hospital has been approved as a Bariatric Center of Excellence, Ferguson said.

Being obese can be even more costly.

Williamson estimated that it costs about $18,000 a year, per person, in doctor and hospital visits, diet plans and dining out, as well as the side effects from diabetes such as long-term dialysis resulting from kidney failure.

Fresh start

For Wilson, health concerns were only part of the reason she decided to have the procedure.

Mostly, she just wants a fresh start — a chance to try for a better life.

Wilson has been overweight for more than 30 years, since she had her twins. As she’s gotten older, it has been harder to lose weight, she said.

“When you hit your 40s and 50s, man, this stuff is like glue,” she said.

The excess weight has caused health problems such as high blood pressure. Wilson said she worries about developing diabetes like her grandmother, who eventually went blind after her kidneys failed.

“I want to get off the blood pressure pills,” Wilson said. “Stuff really hides in this fat — diseases, illnesses.”

But she also wants to lose weight and experience the little things about life that she quit enjoying years ago.

“I want to walk up steps and not be out of breath,” she said. “I just hope I keep losing forever and ever. As long as I’m maintaining that healthy weight, I’ll be satisfied.”
Staff writer Jennifer Calhoun can be reached at calhounj@fayobserver.com or 486-3595.

Labels: , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Thursday, September 25, 2008

Weight loss more difficult for diabetics after gastric byass surgery, new study shows

Winter Park, FL
Diabetics and people with larger stomachs may have more difficulty losing weight after gastric bypass surgery, according to a new study.

The surgery involves doctors creating a smaller stomach pouch that restricts food intake and bypasses large sections of the digestive system. Although it’s an effective way for thousands of obese people to lose weight, approximately five to 15 percent of patients do not lose weight successfully.

In the study, 12 percent of patients did not lose the expected amount of weight a year after the surgery. Diabetes and having a larger size stomach pouch after surgery were independently associated with poor weight loss, researchers said.

The study’s authors said diabetics might take insulin or other drugs that stimulate the production of fat and cholesterol. They concluded that changes in the use of diabetes medications may reduce the risk of poor weight loss after gastric bypass surgery.

During gastric bypass, surgeons estimate the stomach pouch size using anatomical landmarks rather than using a sizing balloon.

“As the use of gastric bypass continues to grow, we believe it is critical to stress the importance of and to teach the creation of the small gastric pouch and to better standardize the technique used for pouch creation,” the authors wrote.

Labels: , , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Lap-Band touted as effective alternative to gastric bypass surgery

Lakeland, FL
Obesity is a nationwide epidemic in the United States.
LAP-BAND surgery, with a device like this, is much less risky and not as invasive as gastric bypass.

Additional heath problems associated with obesity compound the problem. Usually, an improved diet along with regular exercise can reverse this trend. When diet and exercise are not enough to lose weight, however, surgery might be an answer.

Gastric bypass surgery has been the most common type of weight-loss surgery.

The purpose is to give the patient a satiated feeling more quickly. To do this, a portion of the small intestine is bypassed, so fewer calories are digested and absorbed. This allows the patient to lose weight, but it is major surgery and carries certain associated risks.

Possible setbacks could come from infection of the incisions or a leak from the stomach into the abdomen, which can result in peritonitis. There is also a potential for gallstones problems to develop. Recovery can take as long as six weeks.

Another procedure that offers similar results is much less invasive and dramatically reduces patient recovery time.

Laparoscopic Louxen-Y - or Lap-Band - surgery is much less risky and not as invasive as gastric bypass, said Dr. Ravindra Mailapur, a bariactric surgeon practicing in Huntsville, Ala.

The Lap-Band is made of silastic - a brand of flexible silicone - and is implanted around the upper part of the stomach. This creates about a 1-ounce pocket, dividing the stomach into two parts. This restricts the amount of food allowed to pass into the stomach, creating a sense of fullness and reducing the caloric intake, thereby allowing the patient to lose weight, Mailapur said.

"The Lap-Band comes in a variety of sizes and can be adjusted by way of a port that is implanted below the skin," he said.

Mailapur said to qualify for Lap-Band, you must have a body mass index, or BMI, of at least 40 or a BMI of 35 if you have two or more health problems related to your weight.

The advantages of the Lap-Band surgery over gastric-bypass are many.

Lap-Band is a restrictive-type surgery and can be done by laparoscopy, a procedure that uses smaller incisions and is conducted usually on an outpatient basis. The results are less tissue damage, shorter operating times and quicker recovery periods. It is adjustable, so can be manipulated laparoscopically to make the stomach larger or smaller as the patient loses weight.

There is, however, a down side - the risks.

"Any time you perform surgery, there are risks involved, and Lap-Band surgery is no different," Mailapur said. "After all, you are introducing a foreign body into the patient."

Potential problems can include infection, the kinking of the Lap-Band and the band moving out of place, he said, in which case the band must be removed. To reduce such risks, it's important to select a surgeon who regularly performs this type of surgery and who works out of a facility with multiple specialties.

The gastric band was developed and patented in Sweden in 1985. The Lap-Band procedure came about in Europe in 1993. It has been readily available throughout Europe and since 2001, has had approval from the Food and Drug Administration for use in the United States.

Labels: ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Wednesday, September 10, 2008

Gastric bypass alternative Stomaphyx involves no Incisions, no stitching

Denver, CO
Imagine surgery without incisions. No cutting, no stitching -- all the work is done through the patient's mouth. A doctor at one local hospital says it can mean a quicker recovery with fewer complications.

CBS4's Kathy Walsh went to Presbyterian/St. Luke's Medical Center to follow a woman who had a gastric bypass in 1999. It seemed like any other operation. Doctors and staff worked in a sterile environment on a patient who was closely monitored.

"She lost a fair amount of weight but then started to gain some weight back," Dr. Matthew Metz said.

Her stomach had stretched and she came in for a gastric bypass revision; a procedure called Stomaphyx, making the stomach smaller. But in this surgery there was no cutting, no incisions at all; it was all done through her mouth.

"We actually have a sewing machine that we mount on the end of a scope that goes down the mouth and we're able to re-sew the stomach and the connection to the small intestine without making any incisions in the abdomen," Metz said.

Metz says he is the first in the region to offer the operation.

"Doing this through the mouth enables you to do the procedure much faster," Metz said. "The recovery time is much shorter."

Metz said the potential for bleeding and infection with a traditional revision surgery can be as high as 60 percent. Through the mouth it's just 3 percent. With another incision, a patient can spend 5 days or longer in the hospital, according to Metz.

The woman went home the same day, ready to get back on track managing her weight.

The Stomaphyx device was approved by the Food and Drop Administration in 2007.

Labels: ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Monday, September 8, 2008

Student will be first adolescent to have gastric bypass as part of UM Health System program

Ann Arbor, MI
She wants to shop for a prom dress, buy clothing at a regular mall store and walk easily across the stage on graduation day.

"I don't want to wheeze when I grab my diploma," said Sarah White, 16, of Vandercook Lake. "I don't want to graduate in a really large gown."

With more than 410 pounds on her 5-foot, 4-inch frame, the Vandercook Lake High School junior is desperate to lose the weight that for years has restricted her activities, drawn sneers from some classmates and compromised her health.
About gastric bypass surgery

The surgery changes the anatomy of a patient's digestive system to limit the amount of food that can be eaten and digested. It redirects food to bypass most of the stomach and flow directly into the middle of the small intestine, which limits calorie absorption. The surgeon uses staples to create a walnut-sized pouch at the top of the stomach that holds about an ounce of food and sews part of the small intestine directly onto the pouch. Risks include death, blood clots in the legs, leaking at the staple lines in the stomach and dumping syndrome, caused by stomach contents moving too quickly through the small intestine. The syndrome causes diarrhea, abdominal cramps, vomiting, sweating and dizziness.

— Source: Mayo Foundation for Medical Education and Research

She is scheduled to undergo gastric bypass surgery Tuesday at C.S. Mott Children's Hospital at the University of Michigan in Ann Arbor. White will be the first adolescent to have the weight-loss surgery as part of the UM Health System's new Pediatric Comprehensive Weight Management Center program.

"Her health is so significantly affected that surgery is warranted," said Dr. Susan Woolford, a university pediatrician and the center's medical director.

The university set up the family-focused program a year ago to combat the growing problem of childhood obesity. White entered in February 2007 when she was at her peak weight of 423 pounds, said her mother, Patricia White.

Sarah White revamped her diet and started exercising more, but did not lose much weight due to underlying health conditions, including a thyroid problem, Woolford said.

The surgery, which restructures the digestive tract and shrinks the stomach to limit the intake of food, is becoming increasingly common among teens as more struggle with obesity. But it still is not performed often, doctors said.

Some children's hospitals do not offer the surgery, and Woolford said she doesn't know of gastric bypass ever having been performed on an adolescent at UM.

According to medical literature, there are concerns about the long-term effects and the ability of pediatric patients to give informed consent to an invasive procedure that involves a lifetime of follow-up care and dietary restrictions.

"I had no other option," said White, who with support from her mother made the decision to go ahead with the procedure despite some early reservations.

"I was scared about all my intestines looking like a modern-day Picasso," she said Friday at the high school. She plays clarinet in the band, belongs to Students Against Destructive Decisions and said she has a 3.79 grade point average.

She had some qualms about the permanency of the surgery, "But it's either face up to eternity or die at 20," she said.

Fighting the weight

For years, White's weight-loss attempts have failed.

"I remember in elementary school, she bought salads and white milk or water when she bought lunch every day; that didn't work. She walked three miles a day and that didn't work," said her friend, Kelsey Weathers, 16, a diminutive girl who has been friends with White since kindergarten.

White once joined Weight Watchers with her grandmother, but said it seemed weird to be with a group of older women. She didn't lose weight, became frustrated and quit.

She weighed 6 pounds, 13 ounces at birth but quickly gained weight, developing faster than average children, her mother said.

Sometimes it is just easier and cheaper to eat at McDonald's than buy healthier foods, said Sarah White, who listed her weaknesses as Mexican food and pizza. At times, she struggled with emotional eating, but wasn't the type who raided the refrigerator at night, her mother said.

"Her body just doesn't metabolize the food," Patricia White said of her daughter, who was diagnosed at an early age with a type of hypothyroidism, meaning her thyroid gland doesn't produce enough of certain hormones, which impact metabolism.
By Dave Weatherwax | Jackson Citizen PatriotSarah White collapses her head on her mother's shoulder, Patricia White, after finishing her workout Friday afternoon at Planet Fitness of Jackson.

Both sides of her family have overweight members, said Patricia White, whose brother had gastric bypass surgery about two years ago. "She is genetically screwed."

Her daughter was obese by age 8, said White, a single, working mother who is both fiercely protective and proud of her daughter.

The two are clearly close and tease each other continually.

Friday, Patricia White razzed her daughter about her weight-induced spinal curvature, calling her Quasimodo.

"Well, he got the girl in the end, so there is hope for me," Sarah White countered, smiling.

Struggling with pain

The surgery is expected fix some of her problems, such as the curvature and the weight-related pain she feels in her back and knees.

At 8, Sarah White was diagnosed with type 2 diabetes and metabolic syndrome, a cluster of conditions that occur together and increase risk of heart disease, stroke and diabetes.

The excess weight has affected her self-esteem, her friends said. She regularly endures strangers' stares. It also makes school occasionally difficult.

Though White is witty, reads regularly and impresses friends with her vocabulary, her classmates haven't always been accepting, she said. "Especially in middle school, when everyone is discovering the opposite sex."

She cried often then.

Before she got involved with the program at UM Health System, which taught her to change some of the behaviors that contributed to her weight issues, she said she felt like a panda.

"All I did was sit around and eat and look cute," said White, who likes pandas and has many stuffed versions of them in her oriental-themed bedroom.

By the time she got to high school, things got better as the focus turned to academics.
More info

For more information about the University of Michigan's Pediatric Comprehensive Weight Management Center, visit www.med.umich.edu/MPOWER

"I've always been the smart fat kid, which is better than just being the fat kid," said White, who speaks openly and often comically about her situation.

"What I can't do physically, I make up mentally."

Her band director, Chip Williams, called her a "very good student."

"She is one of my top players," he said after class Friday.

However, White said she cannot both play her clarinet and march because it requires too much air and energy.

Her size keeps her from sitting at classroom desks. Instead, she sits at a table outside the rows other students fill.

For school dances, she has worn a purple pin-stripe suit. "It is hard to be girly in this body," she said.

A new chapter

She is looking forward to shopping for a prom dress after her surgery, which could help her lose 100 pounds by her birthday in January.

Her goal is to lose at least 200 pounds.

The surgery is about 90-percent successful in spurring and maintaining weight loss, said Dr. Henry Buchwald, professor of surgery at the University of Minnesota in Minneapolis, who has specialized in metabolic or bariatric surgery for decades.

The mortality rate in surgery is about 0.5 percent, he said.

Long-term effects of the operation on teens have not entirely been explored because the surgeries have been performed for about 20 years. But the procedures have held up over five-, 10- and 20-year periods, Buchwald said.

"What we hope we are doing for these adolescents is giving them time. Obesity is a fatal disease," Buchwald said.

The Tuesday surgery likely will keep White in the hospital for a week and a half, she said.

Her diet will be seriously limited in the weeks after surgery, as it has been in the weeks leading up to surgery.

For lunch Friday, she ate applesauce, a protein shake and yogurt, in compliance with a liquid diet she has been required to follow since Aug. 26.

To avoid temptation, all solid food has been removed from the house, Patricia White said.

After surgery, patients have to stay on course and maintain healthy life style habits to be successful, Woolford said. "Weight-loss surgery is not a magic bullet."

White has made the necessary changes, including incorporating physical activity into her weekly schedule, Woolford said, and has a strong family support structure.

She is rarely, if ever, negative, her friend Weathers said.

Some of the dietary restrictions have been difficult, Sarah and Patricia White said, but the payoff will be worth it.

"It's a small sacrifice to live longer," Patricia White said.

Labels: , , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Saturday, September 6, 2008

Top ranked bariatric surgery center in Washington to close

After several years of operations and more than 600 patients served, Valley Medical Center’s Washington Bariatric and Weight Loss Center is closing.

The center stopped performing surgeries last month and will close Oct. 10.

In an e-mail, Pamela Fowler, a Valley Medical spokeswoman, wrote that “Valley Medical Center made the business decision after careful consideration of the current health-care climate and the demand for by-pass surgeries.”

The center simply wasn’t “a good business venture,” said Don Jacobson, president of Valley Medical Center’s Board of Commissioners.

“I guess the need wasn’t there, and there wasn’t enough demand to support it,” Jacobson said.

As of spring 2007, the center had served about 600 patients. But the number of patients has been declining.

In an interview last spring, Gabriel Alperovich, the center’s medical director, said the center averaged 20 patients a month in its early days. But last April Alperovich said the center was down to four to six cases a month.

In its early days, Fowler said Washington Bariatric and Weight Loss Center was one of the few of its kind offered by hospitals or surgical centers. But she said the last few years have “seen a proliferation of hospitals and service centers making bariatrics core to their services.”

The increased competition meant fewer patients at Valley Medical Center. Fowler said patient numbers weren’t helped any by insurance companies, which often don’t cover bariatric services, or the economy’s downturn.

“Fewer and fewer were willing to self-pay,” Fowler said.

Furthermore, Fowler said Valley Medical Center no longer sees bariatrics as a “core” of its future medical services.

Still, Washington Bariatric & Weight Loss Center enjoyed success while it lasted. The center was ranked No. 1 in Washington in 2007 and in the top 10 percent in the nation for bariatric surgery by HealthGrades, an independent healthcare ratings organization. The rankings were based on outcomes from gastric bypass and laparoscopic procedures in hospitals in 17 states during 2002, 2003 and 2004.

Washington Bariatric & Weight Loss Center had one of the lowest complication rates in the nation for bariatric surgery. But complications did exist. One patient died while undergoing bariatric surgery there and others suffered from complications or were unsatisfied with the amount of weight lost.

Washington Bariatric & Weight Loss Center featured a multidisciplinary treatment focused on diet, exercise, mental health, surgery, and education.

Surgeries included gastric bypass and lap-band. Both reduce the size of the patient’s stomach so he or she can comfortably eat small portions.

Fowler said the center will continue providing post-surgical patient care until it closes. Valley Medical Center will also continue providing limited follow-up care and monthly support meetings for post-surgical patients until mid 2009.

Fowler said Valley Medical Center has notified patients of the Washington Bariatric and Weight Loss Center’s closure and has informed them of options available at other hospitals. Those seeking additional information can contact a case manager at 425-251-5111.

Labels: ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Gastric bypass surgery can reverse metabolic syndrome

Rochester, MN
Metabolic syndrome, a cluster of conditions that increases the risk of heart disease, stroke and diabetes, in extremely obese patients can be cured by gastric bypass surgery, according to the findings from a new study.

"Reversibility of metabolic syndrome depends more on the percentage of excess weight lost than on other clinical or demographic characteristics," the research team reports in the journal, Mayo Clinic Proceedings.

To determine the effect of major weight loss on the metabolic syndrome, Dr. Francisco Lopez-Jimenez and colleagues evaluated patients being considered for bypass surgery at the Mayo Clinic in Rochester, Minnesota, between 1990 and 2003.

All patients met at least three of the five criteria for the metabolic syndrome - high levels of triglycerides (a "bad" fat), low levels of high-density lipoprotein "good" cholesterol, increased blood pressure, high blood sugar levels and obesity.

The study group included 180 patients who underwent gastric bypass and 157 patients who did not undergo the procedure, either because they declined surgery, were denied coverage by insurance providers, or did not maintain lifestyle interventions during their evaluation. All patients received medical and dietetic care and extensive counseling about the importance of physical activity.

The mean body mass index (BMI) was 49 in the surgical group and 44 in the nonsurgical group. A normal BMI is considered to be between 18.5 and 24.9.

During an average follow-up of 3.4 years, the prevalence of metabolic syndrome decreased from 87 percent to 29 percent in the surgical group, and from 85 percent to 75 percent in the control group. The authors estimate that the number of patients needed to treat with bypass surgery to cure one patient of metabolic syndrome was 2.1.

Weight loss averaged 44 lbs in the surgical group and 0.2 lbs in the nonsurgical group. Additional analysis showed that the percentage of excess weight lost was the primary factor that determined the resolution of the metabolic syndrome.

"Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients," Lopez-Jimenez and his associates conclude.

They recommend "gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures" in those eligible for surgery.

SOURCE: Mayo Clinic Proceedings, August 2008.

Labels: , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Monday, September 1, 2008

Teens turning to gastric banding weight-loss surgery

Wilmington, DE

Gastric banding isn't just for adults anymore -- many young obese patients at Alfred I. duPont Hospital for Children have found the procedure a success.
For most of her young life, forgetting to eat was not something Nicole Herman ever worried about. She often woke up with hunger pangs so intense they made her nauseous.

But these days, Herman has to remind herself to grab breakfast. Otherwise, it may be the afternoon until she gets those familiar stabs in her stomach to signal her body needs food. That feeling of always being hungry is gone.

So is 77 pounds -- and counting -- from her 5-foot-3 frame. After spending most of her teen years trying to lose weight, Herman has finally found success by exercising, watching what she eats -- and by having a silicone band inserted around her stomach to restrict the amount of food she can eat.

The 19-year-old college sophomore is one of 11 teenage patients who have undergone gastric banding surgery at the Alfred I. duPont Hospital for Children in the last year. The hospital is one of four nationwide participating in a five-year study by the Food and Drug Administration to evaluate the safety and effectiveness of gastric banding, also known as LAP-BAND, in teens.

"I wanted to have it done because I've been overweight ever since I was little," said Herman, who lives in Middletown when she's not attending the University of South Carolina in Columbia. "I had it done in hopes of trying to lose weight and keep it off."

Of the patients who have had the gastric banding procedure at A.I. duPont -- including Herman -- all have had similar levels of success with weight loss, said Dr. Kurt Reichard, a pediatric surgeon who performs the minimally invasive procedure at the hospital. About 50 more children ages 14 to 17 are in some stage of preparation for the surgery.

Although the LAP-BAND can radically change the life of a morbidly obese teen, it's not for everyone, Reichard reminds prospective patients and their families. The actual surgery is only one aspect of a multidisciplinary weight-loss effort that also includes psychological counseling, fitness assessments and training with an exercise physiologist, and extensive education in food nutrition with a registered dietitian before and after the operation.

"It's about what the kids can do for themselves," said registered dietitian Michell Fullmer, who works with teens in the weight management program. "The LAP-BAND, it's not a magic bullet. It's a tool. I hope we give them what they need to use this tool well."

For Herman, it was the right tool at the right time. After years of yo-yo dieting and feeling frustrated by her lack of success, she was ready for the challenge. "I realized it would be a big life change, but I was ready," she said. "I realized I have enough self-discipline to make this work."
A national problem

Nationwide, more than 1 million teens -- about one in six -- are obese. The effects of carrying that extra weight are more than just bigger waistbands. Many obese children also have other health problems such as diabetes, high blood pressure, sleep apnea and even worn-out joints.

The majority of obese teens can lose the extra weight through a combination of diet and exercise. But when an obese person becomes more than 100 pounds overweight, they are considered morbidly obese, and for them, it's much harder to lose the weight through traditional means.

Fortunately for Herman, she never suffered from high blood pressure, diabetes or other associated health problems. She ate well and got regular exercise as a dancer. "I was a healthy fat person," she said.

But she also has Ehlers-Danlos syndrome, a connective-tissue disorder that affects the joints and makes them more prone to dislocation. She has undergone 12 surgeries to address tissue and joint problems. Her most recent was this summer on her right ankle.

While the Ehlers-Danlos isn't directly affected by her weight, the excess pounds put pressure on her joints. For that reason, any weight loss would help her.

Still, losing weight proved to be a challenge over the years. By the time Herman was 9, she was considered obese. The last time she and a friend could wear matching clothes was the fifth grade. Among her family, she was the only one with a weight problem.

As a teenager, Herman tried Weight Watchers, Jenny Craig and NutriSystem. Such diets worked in the beginning, but soon she got bored and hungry. "It was like a roller coaster," she said. "I think probably I got frustrated with not succeeding."
'Off-label' use in teens

Gastric banding was approved by the FDA in 2001 for use in adults. In teenagers, it's considered an "off-label" use, meaning the operation wasn't intended for that purpose. The FDA trial, in which duPont Hospital is participating, aims to discover if gastric banding can be an effective tool in helping morbidly obese teens shed the weight that threatens to shorten their lives.

In the cases where gastric banding may be an option for teens, their youth may actually be a benefit. "Although there's a perception that teenagers are noncompliant and uncooperative, I don't find that to be the case," Reichard said. "Kids are more open to lifestyle changes."

Health professionals don't know what kind of long-term effects await obese teenagers as they age, particularly if they have other health problems, Reichard said. That's why it's important for them to try to lose any amount of weight they can.

Earlier this summer, Morgan Stanley Children's Hospital of New York-Presbyterian released preliminary data showing that teens who underwent gastric banding had improvements in their obesity-related medical complications just six months after the operation. The six boys and eight girls in the study lost an average of 20 pounds and saw significant reductions in abdominal fat, triglyceride and blood-sugar levels. Their liver function also improved.

Some of the teens who saw improvements in their blood-sugar and cholesterol levels didn't have excessively high numbers to begin with, said Dr. Ilene Fennoy, a pediatric endocrinologist with New York-Presbyterian, which is also part of the FDA study. That their health data were already within a normal range and still improved reaffirms that weight loss has beneficial effects beyond dropping a few clothing sizes, she said.

More data are needed to fully understand the benefits of gastric banding in teens and what potential long-term effects may result, but so far the results are mirroring the success found in adults, said Fennoy, lead author of the study and clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons.

"This is early on but it's reassuring," said Fennoy, who presented the results in June to an annual meeting of the Endocrine Society in San Francisco. "It's showing we're already seeing changes in [symptoms of other ailments], even with not a huge amount of weight loss."
Making it work

In April 2007, after not finding success with any other weight-loss plans, Herman and her parents attended an informational meeting on gastric banding at A.I. duPont. She wasn't immediately sold. She was hesitant about having an operation to help her eat less, but the healthy eating and exercise components convinced her it could work if she believed in what she was doing. Her parents and friends pledged their support no matter the outcome.

"It helped that everyone was behind me on this," she said. "My family, especially my mom, has been so supportive of me."

Although her daughter has an outgoing personality, Sue Herman knew there were occasions where she felt singled out because of her size. She also she worried that her daughter's weight would impede her success in college and beyond.

"To watch her struggle was hard," she said.

When Nicole said she wanted to consider LAP-BAND, her mom went online and looked up information about the procedure. After extended discussions with the family's insurance company, which eventually agreed to cover the cost of the operation, they decided to pursue it.

Gastric banding works by making the stomach smaller. Unlike gastric bypass surgery, the stomach is not cut. Instead, a silicone band -- about the size of a shower curtain ring -- is inserted laparascopically around the top of the stomach. The band creates a small, egg-sized pouch for food consumption. It can be tightened or loosened by adding or removing saline solution into the band.

Compared with other weight-loss operations, gastric banding is less invasive. It also can be reversed, unlike gastric bypass surgery, which cannot. Still, like any operation, gastric banding carries some risks, including infection at the site of the incision. Gallstones also can occur in patients who undergo the surgery. Once the band is inserted, there is a small risk that it can slip out of place and cause pain and discomfort.

After the band is on, patients usually can eat only about 4 ounces of food at a time, far less than what they had been eating. Most of their meals are high in protein to prevent the loss of muscle mass. One of the first signs of not eating enough protein is hair loss, but later on, lost muscle mass from protein deficiency can effectively halt calorie loss.

Fullmer, the dietitian, holds monthly information meetings for prospective patients considering gastric banding. She said the first question asked is usually about the post-surgery diet.

"When I pull out a plate of what their diet is going to look like after surgery, I routinely get a gasp from the whole audience," she said. "It's sort of disbelief."

The first week after surgery, Herman was on an all-liquid diet while her swollen stomach adjusted to the band. She was still eating only liquids when she moved into her dorm. For the first months, she ate most of her meals in her room. She shared details of her surgery with only a few close friends.

Nowadays, a typical breakfast for Herman is a container of yogurt mixed with protein powder. Lunch may be a salad with half a piece of chicken. Dinner is a small portion of chicken or fish and vegetables. Post-surgery, she discovered she can no longer eat red meat, bread or rice because it upsets her digestion. She takes vitamin and calcium supplements to get enough nutrients and omega-3 fatty acids.

In addition to changing her diet, Herman has made exercise a priority. At school, the pre-med major fits in a workout no matter how crammed her schedule is, penciling it in as she would a class. The importance of working out was hammered in by exercise physiologist Lauren Falini, who tells patients exercise will not only help them lose weight but tone their bodies.

"Exercise is the other half of the equation," said Falini, who has patients keep track of their workouts with an exercise log. "It's about energy in and energy out."

The weight started disappearing rapidly within a month of Herman's surgery. By the time she stepped off the plane to visit her family in October, she was 40 pounds lighter. And she had already reached her first goal -- to fit in a size 18 pair of American Eagle jeans, something she had never done.

For Sue Herman, who hadn't seen her daughter since she left for college, the sight of her trimmer daughter was more than she expected.

"Beforehand I thought, 'What am I going to say if she's the same size? How am I going to inspire her to keep going?' " she said. "When I saw her, I couldn't stop looking at her."
A new person -- on the outside

Reichard attributes the early success of the gastric banding program to the extensive preparation the teens undergo before the procedure. Teens participating in the study spend about six months learning how to eat better, move their bodies more and understand the underlying emotional issues that may affect their success at keeping the weight off long term.

"We spend a huge amount of time getting to know them and their environments," he said. "It's the most important part of the program."

As part of the preparation, teens are expected to lose or maintain their weight before they have the gastric banding done. When the time comes for surgery, they must write a letter to the team requesting the procedure and laying out the reasons why they're a good candidate.

Working with the therapists in the weight management program, teens begin to realize the impact of the lifestyle changes they're incorporating, said Meredith Lutz Stehl, a clinical psychologist who works in the program. They begin to feel they have control over their weight, provided they follow the steps outlined by the weight management staff.

"It's such a crucial time to be able to get some hope, to believe they can feel like they can make some changes," Lutz Stehl said. "It's such a pivotal time for that, as opposed to people who have perhaps waited until their 20s or 30s to consider this."

In her letter, Herman spelled out some of the challenges in her path -- her Ehlers-Danlos, heading to college and adjusting to dorm life. But it's clear those are just small hurdles she intended to overcome.

"When I first heard about the LAP-BAND, I was a little skeptical and I wondered if it would really work and how hard it would be," she wrote. "You all changed that for me and made me believe that if I really want this as bad as I do, that I can work hard and get to where I want to be."

A year later, there's no denying Herman has changed from the 291-pound young woman who used to succumb to aching hunger pains. Now down eight pant sizes, she shops with friends at Old Navy and American Eagle, stores she bypassed on the way to plus-size clothier Lane Bryant. At her latest doctor's appointment this month, she weighed 214 pounds, down another 25 pounds from when she left school in May. She hopes to lose enough to wear a size 12 or 14 pants, about two sizes away.

Her megawatt smile is the same as it was before, but there's a new confidence that radiates from her, a self-assuredness strengthened by her weight-loss success. She feels healthy, strong, energized.

"Being overweight wasn't a big thing in my life. I've never wanted to be a size 2," she said. "I've always felt pretty good in my own skin."

But even she's surprised sometimes by the changes she sees.

"You catch a glimpse of yourself in the mirror, and you can't believe it's really you," she said.

Labels: , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments

Risks of gastric-bypass surgery are often underplayed, some experts say

Greenwood Lake, NY

Despite the growing popularity of obesity surgery, it’s no easy path. Four in 10 patients developed complications within the first six months, according to one study.
Eileen Wells was smiling as she was wheeled into surgery. She was too excited to feel nervous. At 38, she was about to get “a new lease on life,” she says, echoing jargon in weight loss surgery ads. She had seen the before and after pictures in celebrity tabloids, watched the TV infomercials, listened to the patient testimonials and researched online. She was ready to begin her own transformation. At 5 foot 3 and 290 pounds, she was sick of being fat. Her joints ached. Her feet hurt. A stroll through the mall near her home in Greenwood Lake, New York, was enough to leave her sweat-slick and gasping for air. She was anxious to say good-bye to sleep apnea and dieting, ready to take control. And so in March 2005, Wells underwent a laparoscopic gastric bypass. She was grinning right up until the anesthesia knocked her out.

From the menu of weight loss (bariatric) operations, Wells had chosen the Roux-en-Y bypass, the most popular option in the United States. The surgery sectioned off her stomach to a thumb-sized sac — sharply limiting the amount of food Wells could eat — then connected it to a deeper portion of her small intestine, to limit absorption of the calories she did consume. (An increasingly popular alternative, gastric banding, cinches in the stomach to restrict its capacity.) The rearrangement required Wells to radically overhaul her eating habits. She learned to eat tiny, frequent meals, cutting her food into pencil eraser–sized bites. On her doctor’s orders, to replace nutrients no longer absorbed by her digestive tract, she faithfully swallowed a multivitamin, calcium and B12 supplements and two protein shakes daily. Soon she resembled the women in those weight loss infomercials: Fifteen months post-op, Wells had lost an amazing 160 pounds — more than half her body weight — bringing her down to a trim 130.

But although Wells looked like a satisfied customer, she didn’t feel like one. Seven months after surgery she had developed an agonizing ulcer on the new inner seam between her stomach and intestine, which required a second operation. Not long afterward, Wells recalls eating a bite of tuna steak her husband, Ron, had prepared and doubling over in pain; an ambulance rushed her into surgery yet again, this time for an intestinal hernia — her bowel had snagged on a slit in her abdominal wall. A fourth procedure followed to ease the pain of the abdominal scarring from her previous surgeries. Meanwhile, Wells’s gastrointestinal pain had become so severe that she could barely eat. One day while shoe shopping, she realized she couldn’t flex her right foot. Within weeks her limbs began to tingle, her energy evaporated and her weight plummeted. She stopped menstruating. By late 2006, Wells had shrunk to 105 pounds.
Read more, "Risks of gastric-bypass surgery are often underplayed, some experts say"

Labels: , ,

 Subscribe to Gastric Bypass Surgery News

Bookmark and Share
posted by iLitigate at 0 Comments