Surgical weight loss offers potential health gains

Maryville, TN

While bariatric, or surgical weight loss, procedures can help morbidly obese people lose significant weight, the potential health gains from the surgery are even more impressive. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), recent studies have shown that, in some patients, bariatric surgery can completely reverse type 2 diabetes and can reduce the risk of certain cancers.

Bariatric surgeon Dr. Mark Colquitt, who practices at the Blount Memorial Weight Management Center where 84 percent of surgical patients are female, says that resolving or improving obesity-related health conditions is the primary goal of bariatric surgery. "The reason we do this surgery is to treat co-morbidities, which are medical conditions that exist in addition to obesity and often are a result of being overweight. A lot of people, including some physicians, look at weight loss surgery as a cosmetic procedure, but that is not true. Bariatric surgery is a tool we can use to help save lives and improve the quality of those lives."

The National Institutes of Health has identified obesity as the second leading cause of preventable death in the United States, and recognizes bariatric surgery as an effective alternative for morbidly obese people who have tried, yet failed to lose significant weight. The weight loss achieved through bariatric surgery can help resolve a wide variety of serious medical issues ranging from high blood pressure to joint pain.

Colquitt explains that additional health benefits can be realized from the metabolic changes, which occur when the digestive process is surgically altered. For example, a 2008 study reported in the September issue of the journal Cell Metabolism found that obese diabetes patients who have gastric bypass weight loss surgery often show dramatic improvement in blood sugar control within days, long before significant weight loss occurs.

"A single bariatric procedure has the potential to cure at least five diseases. Following surgery, the cure and improvement rates for adult-onset diabetes, hypertension, sleep apnea, gastroesophageal reflux disease and hypercholesterolemia are remarkable."

Weight loss surgery typically takes one of two approaches -- a restrictive procedure that decreases food intake or a malabsorptive procedure that alters digestion. Some procedures combine both approaches. The Blount Memorial Weight Management Center, which is designated as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery, currently offers three bariatric and weight loss options: gastric banding, gastric bypass and gastric sleeve. Each has proven effective, Colquitt says, in resolving a wide range of conditions ranging from diabetes to depression.

"If you can lose the weight and keep it off, then the illnesses will get better. For people who have repeatedly tried and failed to lose weight, bariatric surgery offers the opportunity to live a full, active and long life. It really is a life saver."

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"Father of obesity surgery" presents talk in Iowa on Jan. 27

Iowa City, IA

Dr. Edward E. Mason, known as the "father of obesity surgery," will present "The History of Gastric Bypass Surgery" from 5:30 to 6:30 p.m. Jan. 27 at the Information Commons West on the second floor of the UI Hardin Library for the Health Sciences. The talk, which is hosted by the UI History of Medicine Society, is free and open to the public.

Mason, UI professor emeritus of surgery, will provide an update on recent research in gastric bypass surgery, along with his firsthand historical account.

For more information, contact Donna Sabin at 319-335-6706 or donna-sabin@uiowa.edu.

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StomphyX: Gastric bypass surgery without a scalpel

East Brunswick, NJ

Imagine having surgery without being cut. No knife piercing through your skin — even if you can't feel it. No ugly, deformative scars. No side effects. It is possible, and Maria McDonald is living proof.

A new type of abdominal surgery — natural orifice translumenal endoscopic surgery — eliminates the need for a scalpel and reduces recovery time, as well as patient pain and infection.

For the 20 percent of Americans who need secondary gastric bypass surgery, this procedure — which uses a device called StomaphyX — is noteworthy because the transoral incisionless insertion has surgeons entering the body through the mouth, not anywhere in the abdomen.

THEN AND NOW:

McDonald thought she was on her way to having the body she always wanted when she underwent Roux-en-Y gastric bypass surgery in 2002. At the time, she weighed 300 pounds and had tried every fad diet.

"I tried the grapefruit diet, the cabbage soup diet, Weight Watchers and Jenny Craig," said McDonald, a social worker from the Somerset section of Franklin. "I just never really was successful at keeping it off."

Gastric bypass helped her lose about 150 pounds, but there were complications — including nausea and indigestion. So when McDonald, 36, found out she needed a second gastric bypass, she was relieved to find out her doctor at Overlook Hospital in Summit was going to use the Stomaphyx technique.

The procedure was much different from her first surgery, which involved a large incision and made her tired for about six months.

"Even though its surgery, it's all through the mouth," Dr. Muhammad Feteiha, director of minimally invasive surgery at Overlook said before the surgery. "So when Maria wakes up, she won't have any incisions. She'll have very minimal pain, and she'll be able to go home."


MYRIAD BENEFITS:

Lack of pain and quick recovery time are not the only benefits of the Stomaphyx procedure. Others include:

# Less risk of infection.

# Shorter surgery time (it takes about 45 minutes).

# Patients can return to work in as little as one day.

If McDonald were to have traditional gastric bypass surgery again, it would involve reopening her incision, removing part of the pouch and small intestine, and then reattaching it, Feteiha said. And she would have to stay in the hospital for seven to 10 days.

LIGHTLY USED:

Only about 150 doctors are using the Stomaphyx technique around the country. It was approved in March 2007 by the U.S. Food and Drug Administration, and physicians starting training with the Stomaphyx device that fall.

To date, about 500 patients have had the surgery, which allows doctors to reshrink the stomach without even using a scalpel. Research is being done to see if Stomaphyx can become a primary surgery in the future, Feteiha said.

BARIATRIC SURGERY:

For patients who are undergoing bariatric surgery for the first time and choosing to have a gastric band, Dr. Ajay Goyal, medical director of the Center for Advanced Bariatric Surgery at Overlook, performs a new technique that requires only two incisions.

Traditionally, the banding procedure requires four or five incisions around the abdomen. When it comes to severe obesity, traditional weight-loss methods — diets, weight-loss pills, exercise programs — do not work for most people.

Bariatric surgery is recognized by the American Heart Association and the American College of Surgeons and endorsed by the National Institutes of Health as a safe way to help people lose weight and minimize or even eliminate diabetes and hypertension, sometimes within months.

The Center for Advanced Bariatric Surgery at Overlook Hospital is available to individuals who are more than 100 pounds overweight and have tried and failed to lose weight, or who suffer from obesity-related health problems such as heart disease, diabetes or sleep apnea, joint disease or infertility.

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3 sisters net triple-digit weight loss after gastric bypass surgery

Joliet, IL

One sister bikes, one walks on trails and one works out on a treadmill. All of them are now living healthier lives after undergoing bariatric weight-loss surgery at Silver Cross Hospital in July.

Together, the three sisters have already lost more than 300 pounds.

"One of the reasons we decided to have the surgery was because our mom was overweight and died at age 68 of congestive heart failure," said Sandra Schmidt. "Our dad was thrilled when we told him and is so proud of all of us that we have stayed committed to losing weight."

Inspired by a co-worker who had weight-loss surgery, Sandra told her sisters, Andrea Russell and Pamela Bricker, about it. They decided to attend a free informational seminar at Silver Cross.

"This was a great way to learn about the entire process," said Andrea. "Once I learned what my options were, my apprehensions were alleviated and I became more determined to live a healthier life. Plus, it has been a great support having my sisters to talk to during the entire process."

Their surgeon, Dr. Christopher Joyce, and his partner, Dr. Brian Lahmann, have performed more than 1,000 weight-loss procedures, including laparoscopic gastric bypass, Lap-Band and the new Realize gastric band system. A Bariatric Center of Excellence as well as a Blue Cross Blue Shield of Illinois Blue Distinction Center for bariatric surgery, the Silver Cross program has a 0 percent operative death rate and a low complication rate. And patients lose an average of 86 percent of their excess body weight four years after gastric bypass surgery.

"Our patients benefit from a multidisciplinary approach," Dr. Joyce said. "We screen them very carefully to ensure their success and safety."

Pamela says you have to be determined to stick to the program, but the support is there to help you succeed. "We couldn't have found a better program. Dr. Joyce, his staff and the nurses at Silver Cross were all so kind, supportive and down-to-earth. We wouldn't have been so successful in our weight loss if it were not for them," said Pamela.

"Obesity is a medical condition, just like heart disease or diabetes," Joyce said. "Unfortunately, there is a lot of prejudice against obese people, but this surgery can help them lose weight and, most importantly, keep it off."

"Prior to my surgery, I suffered from high blood pressure and cholesterol, diabetes and painful joints. Now I'm not taking any of those medications," said Pamela.

"I've lost weight that I never could lose," added her sister, Andrea.

"I should have done the surgery years ago because I wasted my forties being overweight," said Sandra. "My life has changed dramatically. I used to have foot problems and now I don't, and my stamina is so much stronger, enabling me to play with my 7-month-old grandson."

"The sisters are a wonderful example of how life-changing bariatric surgery can be," said Joyce. "Their new passion for life truly shows when you talk with them."

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Tearful testimony at gatric bypass malpractice trial in North Dakota

Fargo, ND

Tearful testimony dominated the second day of a malpractice trial at Wilkin County Courthouse Wednesday over one woman's claim of a problematic gastric bypass surgery.

In 2002, Dr. James Wasemiller, former surgeon at St. Francis HealthCare Campus, performed a gastric bypass surgery on plaintiff Mary Larson, a Fargo resident, in Breckenridge. But hospital records indicate several complications followed the surgery, some of which included an abdominal hernia and leaks from an exterior incision.

Before one male and six female jury members, Larson said she had been overweight her entire life but wanted to take a risk for her children. At the time of the operation, she said she weighed 376 pounds and has lost about 100 pounds since.

"I had two small kids, and...I wanted to be an active part of their life," she said, crying.

After one of her consultations with Dr. Wasemiller, Larson said she recalled thinking, "'I'm going to do this, he's going to help me become the woman I want to be.'"

Larson sought out Wasemiller after hearing the success story of her aunt, who had a gastric bypass surgery performed by him.

Dr. Paul Wasemiller, a brother to James Wasemiller and surgeon, performed exploratory surgery on Larson after nurses reported she had difficulty breathing and drainage was leaking from the incision on her stomach. He said he did not see Larson prior to surgery but gave orders on her care.

William Maddix, attorney for Larson, referred to Wasemiller's pre-operative diagnosis, which included leaking and the possibility of a serious infection. While operating, Wasemiller said he tried to "close the muscle, not the leak" because it would have been too risky for Larson's health. When called to the stand by Maddix, he said it was hard to tell when the infection started.

"My estimation would be a day or two, perhaps longer," he said.

After recuperating at St. Francis Healthcare Campus, Larson noticed her incision began to drain more liquid and she was transported to SCCI Hospital in Fargo by ambulance. After being advised she was free to drink liquids, she was offered cranberry juice and immediately had to go to the bathroom.

"I sat down...heard dripping, and I could see the cranberry juice coming out of the bottom of my stomach, from my suture," she said.

Dr. Brent Hella, MD, a witness for Larson, said he met her the evening she arrived at SCCI. Hella is an internal medical physician at Internal Medicine Associates in Fargo and can refer patients to the hospital.

"In the initial assessment I wrote, I was a little bit dismayed at how sick she was," he said. "Though it's not unusual (to see sick patients at SCCI), I could see she was extremely ill."

A colored-dye test performed on Larson indicated fluid was moving to the part of her stomach supposedly cut off after her gastric bypass surgery, rather than bypassing it, said Hella.

"Part of the gastric bypass wasn't as successful as it should be," he said.

Larson said she was informed of the risks, such as scarring and even death, but did not recall hearing about the chance of getting a hernia. During testimony, Larson's husband, Michael, said her present hernia is "the size of half a basketball in her abdomen." Larson had a hernia in 1997 that she later had surgically repaired.

Both Larson's husband and mother, Vicky Vincent, spoke about how much pain Larson experienced after surgery. But Mark Solheim, attorney for Dr. James Wasemiller, said she was aware the procedure was life threatening.

"You knew you would have the scar...the leaking and possibly undergo a second surgery...and Dr. Wasemiller said the approximate weight loss would be 100 pounds," he said.

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Weight loss surgery improves sexual function in men

New York, NY

Sexual dysfunction that commonly occurs in morbidly obese men improves after weight loss surgery, according to a new study.

"Sexual dysfunction should be considered one of the numerous potentially reversible complications of obesity," the study team concludes.

Dr. Ramsey M. Dallal, from Albert Einstein Healthcare Network, Philadelphia, and colleagues measured the degree to which 97 morbidly obese men suffered from sexual dysfunction and then analyzed the change in sexual function after substantial weight loss following gastric bypass surgery.

Before surgery, the morbidly obese men had significantly lower sexual function relative to that of a previously published reference control group of men before surgery, the investigators report.

After losing an average of two thirds of their excess weight, men experienced significant improvements in sexual function, with the amount of weight loss predicting the degree of improvement.

"We estimate that a man who is morbidly obese has the same degree of sexual dysfunction as a nonobese man about 20 years older," the investigators report. "Sexual function improves substantially after gastric bypass surgery to a level that reaches or approaches age-based norms."

"Sexual function is an important aspect to quality of life and is now well documented to be a reversible condition," Dallal explained.

"We are interested in examining sexual function in females, as well as understanding the mechanism of obesity-related sexual dysfunction," Dallal added.

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Man says he dodged death by losing 430 lbs., going from 640 to 210

New York, NY

Today is the first day of a year that Ernesto Suncar and his doctors feared he might never see.

Weighing 640 pounds, wearing 10X shirts and with a 70-inch waist, the 33-year-old New Yorker was told by doctors he would likely be dead within 12 months.

Realizing it was a choice between losing weight and dying, the proud father of three, who had tried every diet imaginable, underwent gastric bypass surgery - and has shed more than two-thirds of his former self.

"I want people to feel inspired when they look at me," says the Hell's Kitchen resident, who's down to 210 pounds. "Hopefully, if they have a weight issue, they will finally do something about it, starting right now.

"Losing this weight saved my life. Without the operation, I doubt I would be here to celebrate New Year's.

"It's scary to think what might have happened."

The business management student says his body ballooned after he came to the U.S. from his native Dominican Republic at the age 7.

"I was a normal, active kid who used to run and play outdoors in the tropical climate," he recalls. "When we moved into a small apartment where it was cold, I stayed inside and didn't get any exercise.

"The only games I played were video games."

His love of chow didn't help. He would gorge himself on Spanish-style fried pork chops, rice and plantains, McDonald's, pizza and pasta.

"My mom would tell the guys at the corner deli not to serve me, so I'd just walk to another block," Suncar admits.

He once lost 64 pounds on a 1,800-calorie-a-day diet, but then gained 120 pounds. At his heaviest, the 6-foot-2 food junkie tipped the scales at 640 pounds.

"My little son had to tie my shoelaces," he says. "I poked fun at myself, but inside I was hurting."

The turning point came when chronic breathing difficulties and the immense strain on his heart threatened to kill him.

"The doctor said, if I carried on as I was, I would be dead in a year," Suncar says.

Dr. Elliot Goodman, chief of bariatric surgery at Beth Israel Medical Center, performed the gastric bypass.

There were minor complications, but this winter, after following a nutritious eating plan and increasing his fitness at the gym, Suncar has reached - and maintained - a healthy weight.

His waistline has shrunk to 34 inches and, instead of having to buy expensive outsize clothes on the Internet, he shops for stylish gear at The Gap.

"I feel reborn," he says. "These days I can cycle along the Hudson River, play with my kids and this summer, I'm planning on taking a flight. Before, I couldn't have fit in an airline seat.

"I keep some of my old things in my closet to remind me of how I used to look. But there's no going back."

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Gastric bypass surgery economics: Hospitals gain from weight loss

Cincinnati, OH

The owners of Good Samaritan Hospital and Mercy Hospital Fairfield have started comprehensive weight-loss centers, offering services ranging from bariatric surgery to exercise and nutrition classes.

The Good Samaritan Weight Management Center opened in mid-November in the adjacent medical office building in University Heights, housing a mental health counselor, dietitian and exercise physiologist. Fees include $500 for a full pre-surgical program and $75 for a three-month program with a dietitian.

The new Mercy Healthy Weight Solutions is in Springfield Township now but will move to the Fairfield HealthPlex early next year. It includes similar services plus a six-month membership to any Mercy HealthPlex and a wellness coach. Fees range from $300 to $1,200, including follow-up programs after surgery.

While hospitals and doctors have offered similar programs for years, the increasing popularity of weight-loss surgeries have persuaded them to package the services offered both before and after surgery to capitalize on their own brand names and create a bigger revenue stream.

It also comes as obesity rates increase, adding health-care cost to an already overburdened system. That could mean increased demand for a full-range of weight-loss programs, said Tom Urban, chief executive officer at Mercy Fairfield.

“We think it’s a service that’s needed in this area,” Urban said. “We think it will be profitable, but only because it’s a needed service.”

Other hospitals also offer the same services. For example, St. Luke Hospitals in Fort Thomas and Florence has seen 8,000 patient visits during the last three years at its Tri-State Surgical Weight Loss Center and is scheduled to perform its 1,000th surgery in January.

Nationally, obesity and overweight patients cost the health-care system about $117 billion a year, mainly through increased diabetes, heart disease and hypertension, says the American Society for Metabolic and Bariatric Surgery. More than 200,000 people had bariatric surgery last year, the group said, but that still is only 1 percent of the eligible population.

Insurance coverage still is spotty for full-scale bariatric surgery, which can cost $20,000 or more.

For example, Anthem Blue Cross and Blue Shield of Ohio does not cover bariatric surgery as a standard benefit, but large companies can include it as a rider for their employees. Anthem said it tries to identify patients who need surgery and hospitals that provide the best care.

Insurers offer more incentives for weight-management programs, including diet and exercise habits. Corporations are starting more wellness programs to encourage employees to eliminate bad health habits.

George Kerlakian, medical director of the Weight Management Center at Good Samaritan, said bariatric surgery will become even more common as the technology improves and the population ages. About half of 2,500 patients during the last six years have ended up having surgery, and the center is trying to double total volume during the next several years.

“It brings patients in,” Kerlakian said of the center. “Obese patients have or will have a lot of medical problems in the future. That connection is important to us as we take care of them.

“We don’t look at surgery as an end-all,” he added. “We really stress the fact that it’s a tool.”

More than half of bariatric surgeries are gastric bypass, where the stomach is reduced and then attached to the small intestine. A gastric banding wraps a band around the stomach, while an emerging procedure called a sleeve gastrectomy removes about 85 percent of the stomach.

Cindy McBride of Bridgetown, a patient at the Good Samaritan center who also works at the hospital, had the sleeve gastrectomy in April and has lost 107 pounds. She’ll be doing follow-up work for more than a year, including visits with a physical therapist and a nutritionist.

“I think it’s a great way to do it because your physicians and your support staff are all on-site,” McBride said.

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Gastric bypass surgery resolves diabetes in teens

Los Angelos, CA

Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal Pediatrics.

Studies on adults with Type 2 diabetes show that gastric bypass can result in disease remission or better disease control. However, this study is the first to explore the effects of the surgery in children. The study examined adolescents with Type 2 diabetes, which is usually related to obesity and is being diagnosed with alarming frequency in American children and teenagers.

Dr. Thomas Inge, director of the Cincinnati Children's Surgical Weight Loss Program for Teens, studied 11 extremely obese teens with Type 2 diabetes who had gastric bypass surgery and 67 obese teens who were receiving medical management for Type 2 diabetes. Among the 11 teens who underwent surgery, all but one had a remission in diabetes. The response was so rapid, the patients often discontinued medication for diabetes control before leaving the hospital after surgery. These teens lost an average of 34% of their body weight one year after surgery. In contrast, the teens who were medically managed did not have any weight change after one year and were all still taking medication for diabetes. The adolescents who had surgery also had improvements in blood pressure, cholesterol and triglyceride levels.

"The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery," Inge said in a news release.

Inge and his co-authors noted that future studies will be needed to track the long-term health of teenagers who participated in the study. Cincinnati Children's Hospital is home to a study funded by the National Institutes of Health that will collect and report outcomes on 200 teens undergoing weight-loss surgery nationwide.

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