Physicians debate best candidates for gastric bypass

Washington, D.C.

Recent studies showing that gastric bypass surgery extends the lives of obese patients is forcing surgeons to make tough decisions about who should go under the knife and who shouldn't.

Internists, cardiologists and endocrinologists, more than ever, are referring patients who traditionally haven't been candidates for the weight-loss surgery, also called bariatric surgery.

"I am being asked to operate on 78-year-olds with co-morbidities of heart disease and diabetes," said Dr. Edward H. Phillips, executive vice chairman of the Department of Surgery and a surgeon at the Center for Weight Loss at Cedars-Sinai Medical Center in Los Angeles. Phillips questions whether these patients will benefit, or if the damage has already been done.
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"So, while it is obvious a 30-year-old will benefit, at what age is too old?" he asked.

The success of gastric bypass is also stoking debate about its use as a treatment for type 2 diabetes. Mounting evidence suggests this type of surgery may dramatically improve patients with the disease, freeing them from a lifetime of diabetes medications.

"There's more acceptance now of the concept that bariatric surgery is a truly life-saving type of therapy rather than just a way to shed pounds," said Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery at Weill Cornell Medical College in New York City.

Still, more long-term studies are needed, and clinicians and policymakers must reach a consensus on who should have access to this type of surgery, noted Rubino, who directed the 1st World Congress on Interventional Therapies for Type 2 Diabetes, held in New York City in September.

An estimated 205,000 bariatric surgeries were performed in the United States in 2007, according to the American Society for Metabolic & Bariatric Surgery (ASMBS). That's an increase of almost 20 percent from two years earlier.

If patients commit to making necessary changes in their diet and exercise regimens, gastric bypass surgery can provide long-term, consistent weight loss, according to the Mayo Clinic.

Not only does it help shed pounds, but a pair of studies published last year in the New England Journal of Medicine found that it can help obese people live longer.

One study, led by Ted Adams of the University of Utah School of Medicine, tracked almost 16,000 obese people, half of whom had weight-loss surgery. After an average of seven years, the death rate was 40 percent lower for people who had the surgery compared with those who didn't. Diabetes-related deaths were cut by a whopping 92 percent.

The other study, led by a Swedish team, involved more than 6,000 obese patients. After an average follow-up of more than a decade, those who had bariatric surgery were 29 percent less likely to die than those who did not undergo surgery.

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Weight loss surgery may cure form of diabetes

Tampa, FL

Gastric bypass surgery helps thousands lose weight, but it may also be a cure for Type Two Diabetes. The drastic weight-loss approach means some diabetics never need insulin again.

Cheryl Bishop's weight has been a life-long battle. “I was always the chunky kid and it just got progressively worse and worse and worse until it was out of control," she said. At 44, she weighed 350 pounds and struggled with Type-Two Diabetes. “It was horrible. It got to the point where I knew I had to have the surgery or I wasn't going to live."

Cheryl had bariatric surgery. Surgeons sectioned off a small pouch of her stomach and attached it to her intestine. The goal is weight loss, but surgeons like Doctor Michel Murr, of Tampa General Hospital, discovered another dramatic effect: Cheryl's Type Two Diabetes disappeared. He says, “There's a function of the stomach that we don't understand very well, but as soon as we divert food away from it, the diabetics control their blood sugar much, much easier."

Studies show up to 90-percent of diabetics go into remission after bariatric surgery. Cheryl says, “I went from taking 100 units of insulin three times a day with blood sugar still 200, 300 plus. Within a week after surgery, probably none."

Right now, bariatric surgery is only for the extremely obese, but doctors believe it could be the key to reversing Type Two Diabetes, regardless of a person's weight.

Doctor Murr says, “We may be looking into this as one of the treatments for diabetics."

One-hundred-thirty pounds lighter, Cheryl's enjoying her new life, one that's healthier and diabetes free. She says, "It's gone. The diabetes is gone."

Almost 18 million Americans are diagnosed with Type Two Diabetes and roughly six million others have it, but don't know. Researchers in Brazil are studying whether bariatric surgery is safe and effective for type two diabetics who are not severely overweight.

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New Weight-Loss Surgery Helps Keep It Off

Miami, FL

New Surgical Tools Allow Surgeons To Reduce The Size Of The Pouch And Stomach Through The Patient's Mouth Without Making Cuts

Each year 200,000 people have gastric bypass surgery, and while about 15 percent of them will regain the weight, there's a new procedure helping those patients get back on track.

Suyin Marti is 42 years old, and had gastric bypass surgery 12 years ago. Her weight has been a lifelong battle.

"I gained weight and I lost it so many times over. A hundred pounds I gained and lost three times. Each time I would gain all that weight back and more," admitted Marti.

The weight is back again, and Marti blames family tragedy and the medication she's taking for depression contributing to her gain.

"Everybody always has the license to tell you how heavy you are but they don't know what it is to have this disease," Marti tearfully proclaimed.

Dr. Nestor de la Cruz Munoz is helping patients like Marti take back control of their lives by introducing them to the Rose procedure.

"It's a new procedure that we're going through the mouth rather than having to go through the abdomen with a camera and a transport system that allows us to put stitches in from the inside instead of from the outside," explained Dr. de la Cruz Munoz.

The Rose procedure restores the patient's pouch and stomach to match original post surgery sizes. That's important because scar tissue in the abdomen could complicate surgery for these patients.

Patients will spend one night in the hospital and wake up with a sore throat but no abdominal pain. They can return to normal activities in a day or two. Still, the doctor said patients still need to exercise and attend support groups for the entire process to work.

"We know that none of the surgeries cure obesity. They're just tools that you have to use. So if you don't use the tools correctly they're not going to work for you long term," warned Dr. de la Cruz Munoz.

Marti is prepared to do what it takes to lose the weight and regain her health. "I'm hoping they can go ahead and do the revision and take out the band and fix the problem that I had originally and it will help me lose the weight," said Marti.

The procedure is not currently covered by insurance, and can cost up to $12,000.

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