Heavier patients carry increased risk in gastric bypass and other bariatric surgery

Higher risk for heavier patients in bariatric, gastric bypass surgery

Chattanooga, TN

For someone who weighs more than 500 pounds, the options for reaching a healthy weight can seem slim, but local bariatric surgeons say there is hope.

Dr. Jaime Ponce, medical director of bariatric surgery at Chattanooga's Gastric Band Institute, said special measures must be taken to operate on patients classified as super-obese and super-super-obese -- who have a body mass index above 50 and 60, respectively -- but it can be done.

"You have to take a totally different approach," Dr. Ponce said.

That means measuring to ensure the patient can fit on the operating table, working in a hospital certified to handle such patients and putting the person on a strict diet before surgery, he said.

Dr. Ponce performs about 300 bariatric surgeries each year, and he said 25 percent of those are on patients who have a BMI above 50.

Before the procedure, it's essential the patient is clear on what to expect from the experience, he said. Weight loss results often are less in patients with BMIs above 50, compared to those who are in the 35 to 45 range, Dr. Ponce said.

"They need to understand there is more risk," he said. "Every time the BMI goes up, there is more risk of bleeding because you're pulling fat to be able to see, and fat can start bleeding. There's more risk of damaging internal structures, more risk of having a breathing problem when trying to put the patient to sleep."

Despite the increased danger, for some patients the rewards are worth the risks.

Ducktown, Tenn., resident Sonya Standridge, 38, became one of Dr. Ponce's patients two years ago when she had Lap-Band bariatric surgery. She had a BMI of 63 before the surgery, which has dropped to 34 since the procedure.

With the Lap-Band, a small silicone tube is fastened around the upper stomach to create a tiny stomach pouch, slowing digestion and making the person feel full with less food.

Ms. Standridge said she has good days and bad days, but ultimately the surgery was the right choice for her. Being a nurse, she said she knew the risks beforehand and felt it was her "last resort option."

WHAT IS BMI?

Body mass index is a measure of body fat based on height and weight that applies to both adult men and women, according to the U.S. National Institutes of Health.

"If you asked me today would I have the surgery again, the answer is absolutely, 100 percent, no questions asked," Ms. Standridge said. "I had never felt the feeling of fullness before, so I would literally eat until I was gluttoned."

Local bariatric surgeon Dr. Jack Rutledge said there are two main factors that put high BMI patients at a greater risk than other patients.

The first, he said, is that people who fall into that category generally are unhealthy. Secondly, the additional weight creates a situation where it is more difficult to move instruments inside the body.

What he suggests to patients who are super-obese or super-super-obese is to first lose weight.

"I think they do have hope, but it's going to be expensive and it's going to be complicated," Dr. Rutledge said. "But there is a way to lose 100 pounds."

That's what 50-year-old Rossville resident Jimmy Allmond is trying to do now. After being told the increased risks of performing procedures on his 510-pound body, he decided to try to lose weight the old-fashioned way.

But he's still not sure on whether he'll eventually have surgery.

"With all that going on, I'm still not sure," he said. "If I can lose it without it, that would be good."

BARIATRIC SURGERIES

* Gastric band: A ring is fastened on the top of the stomach, creating a small pouch. The ring has a balloon portion that can be filled with fluid to limit the amount of food the patient can eat. The apparatus acts as an hourglass, and food sits on top and slowly trickles down into the stomach. This is the least invasive of the bariatric surgeries.

* Gastric bypass: The top portion of the stomach is cut and stapled to create a small pouch. The rest of the stomach and the first portion of the intestines are then re-routed. The patient can eat only small portions, and some of the food does not get absorbed. This is the most invasive of the bariatric surgeries.

* Sleeve gastrectomy: About 80 percent of the stomach is taken out, creating a small, banana-like sleeve. It allows patients to eat less and feel less hungry because the procedure removes some hormones that signal hunger. This is the newest of the bariatric surgeries.

Source: Dr. Jaime Ponce, medical director of the Gastric Band Institute

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Risks of bariatric rurgery reduced by preoperative weight loss before surgery

Trenton, NJ

As part of the preoperative process for preparing for bariatric (weight loss) surgery, many programs require a strict diet to promote weight loss before the procedure. A new study published in the Archives of Surgery finds that this protocol could reduce the risk of surgical complications.

Dr. Peter Benotti of the Saint Francis Medical Center in Trenton NJ reviewed the medical records of 881 patients who had gastric bypass surgery between 2002 and 2006 for weight loss. All patients completed a 6-month multidisciplinary program that encouraged a 10% preoperative weight loss.

Those who lost more than 10% of their excess body weight were less likely to have postoperative complications such as infections, blood clots, and kidney problems. Conversely, the post-surgery complication rate was nearly twofold higher in patients who gained weight.

The study also affirmed that patients who undergo Laparoscopic bariatric surgery have fewer complications than those who have the more invasive open surgery. This correlation was found regardless of preoperative weight loss. Patients who have open surgery are typically older men with a higher body mass index, according to the results of the study.

Bariatric surgery can be an effective and durable treatment for morbid obesity and the number of operations each year is increasing. According to the American Society for Metabolic and Bariatric Surgery, the number of bariatric procedures in the Unites States increased from 12,775 in 1998 to about 220,000 in 2008. Because Medicare has approved weight loss surgery when performed in a high-volume approved center, patients seeking the surgery have become older and sicker.

In an accompanying editorial commentary, Dr. Patricia L. Turner says “Strategies to further improve outcomes after bariatric surgery are of significant interest. Post operative complications can be particularly difficult to manage and deadly.” As more of the high risk patients seek out surgical weight loss options, doctors are faced with a need to identify risk factors and help patients prepare for successful surgery. The current study suggests that preoperative weight loss may be one step that will help achieve good outcomes.

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Gastric bypass surgery and anemia: Monitoring nurtitional deficiencies needed

Washington, D.C. (National Anemia Action Council)

In recent years, bariatric surgery has become a much more common procedure to treat morbidly obese patients in the United States, with the number of surgeries increasing more than 10-fold in the last decade.1 This growth has occurred in part due to the large number of obese and morbidly obese individuals in need of weight reduction and the relative success of the surgery at shedding excess weight and reducing obesity-related health conditions.

Yet, surgery often creates permanent alterations of the digestive tract, which can lead to a variety of nutritional consequences. Many bariatric patients develop new or worsen preexisting iron and vitamin deficiencies, with some patients becoming anemic in the months and years following the procedure. These patients may then be relying on you, their primary care providers, to monitor their nutritional health. This article explains why bariatric surgery patients are prone to developing nutritional deficiencies and what you can do help them avoid anemia.

Candidates for Bariatric Surgery

In 2008, about 220,000 bariatric surgeries were performed in the United States to help patients permanently reduce excess body weight.2 Only morbidly obese patients are eligible for the surgery, as determined by their body mass index (BMI) – calculated by weight relative to height (kg/m2). Patients with a BMI >40, or a BMI >35 in combination with comorbidities, are considered for bariatric surgery. Comorbidities may include type 2 diabetes, heart disease, hypertension and sleep apnea, among many others. Approximately 15 million people in the United States (about 5%) are considered morbidly obese and about one-third are considered obese, with a BMI >30.2,3

Prior to surgery, morbidly obese patients may have numerous chronic illnesses and health complications, including nutritional deficiencies and anemia. According to Dr. John W. Baker, President of the American Society for Metabolic & Bariatric Surgery (ASMBS), about 60% of his patients have low or deficient levels of vitamin B12 prior to surgery and about 20%, both male and female, had preoperative iron deficiency. This rate is consistent with current statistical data of nutritional deficiencies among bariatric surgery candidates.4

Although prevalent, the etiology of their preoperative anemia can be elusive, with some morbidly obese patients displaying evidence of both iron deficiency and chronic inflammation. In a considerable percentage of candidates, the cause of anemia may be undiagnosed. Dr. Baker advises that preoperative anemia should be treated prior to surgery either by the surgeon or by the patient’s primary doctor. Following bariatric surgery, the surgeon and the patient’s primary care doctor often communicate about continuing care of the patient to decide the roles and responsibilities of each physician in the postoperative period. This coordination is especially important for a patient with any preexisting anemia, which will need to be monitored closely.

The Surgery Itself

Bariatric surgery has a considerable impact on both a patient’s overall weight and many of the obesity-related conditions that affect quality of life. A meta-analysis of over 22,000 bariatric surgery patients revealed that patients lost on average 60% of their excess weight. In contrast, patients treated with conventional diet and exercise reported losing less than 10% of their excess weight for a sustained time period and exhibited only mild effects on reduction in obesity-related conditions.4

Studies have reported type 2 diabetes being resolved in 73-87% of patients following bariatric surgery, depending on the type of surgery.5,6 Risk of coronary heart disease was cut in half5 and sleep apnea was resolved in more than 85% of patients.7 Additionally, when compared to candidates who did not have surgery, patients improved their life expectancy 89% of the time8 and reduced their risk of premature death by 30-40%.9 Risk of death from diabetes, cancer, and from coronary artery disease was also reduced by 92%, 60%, and 56%, respectively.10

Speaking in regards to the effectiveness of bariatric surgery at treating concomitant conditions of obese patients, Dr. Baker said, “This is one of the most durable procedures we have for resolution of chronic diseases. What other procedure can improve hypertension, heart disease, diabetes, sleep apnea and high cholesterol?”

How bariatric surgery affects a patient is largely determined by the type of procedure and how it alters the mechanics of the digestive tract. Weight loss results from reduction in the capacity of the digestive tract and number of calories consumed (restrictive), alteration of the absorption of food (malabsorptive), or a combination of both approaches. Restrictive methods include vertical banded gastroplasty (VBG) and laparoscopic adjustable gastric banding (LAGB). Malabsorptive procedures with some restriction include biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPD-DS). Restrictive procedures with some malabsorption include roux-en-Y gastric bypass (RYGB) and vertical banded gastric bypass.11

Following surgery, a patient’s body must get necessary nutrients from less food with a smaller, less effective digestive system. Although helpful in reducing their caloric intake and fat absorption, these physical and metabolic changes leave them susceptible to nutritional deficiencies and subsequent anemia. Depending on the form of bariatric surgery, alterations to the digestive tract which may lead to an increase in nutritional deficiencies and anemia include the:

* Lower intake of food and essential nutrients
* Decrease in the absorptive surface area in the digestive tract
* Decrease in available stomach acid to help break down food and nutrients
* Possible intolerance to some nutrient-rich foods, such as red meat

Nutritional Deficiencies Related to Anemia

Iron deficiency is the most common cause of anemia after bariatric surgery and can be found in 20-49% of patients. This is especially true after the RYGB procedure in menstruating women (51%) and in patients with super obesity (49-52%).12 Other deficiencies which can lead to anemia are less common, but do include vitamin B12 and folic acid, which are most common in patients who exhibited signs of the deficiency prior to surgery or who are not receiving adequate supplementation. For instance, vitamin B12 deficiencies can occur in older patients, patients taking H2 blockers or proton pump inhibitors (PPIs), or in roughly 12-33% of patients not receiving supplementation after the RYGB procedure.

Baker quoteAlthough these deficiencies are mostly related to the altered absorption in the digestive tract, all forms of bariatric surgery can contribute to lower serum levels or reduced stores of nutrients. Dr. Baker has observed that, “Even in patients who didn’t have a malabsorptive procedure, I still see them coming in with deficiencies at follow-up; often due to preoperative deficiencies or preexisting conditions.”

The ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient states that, “Taking daily micronutrient supplements and eating foods high in vitamins and minerals are important aspects of any successful weight loss program. For the morbidly obese, taking vitamin and mineral supplements is essential for appropriate micronutrient repletion both before and after bariatric surgery.” The surgeon will recommend the necessary vitamins during presurgical education and consultation. Concerning anemia-related nutrients, these recommendations include a multivitamin with at least 100% of daily value for vitamin B12, 18 mg of iron, and 400 μg of folic acid. Following surgery, an additional vitamin B12 supplement or oral iron supplement may be required if monitoring indicates low or deficient levels of these nutrients.12 Patients may also be taking a recommended 1200 mg of calcium citrate daily, but should not ingest it at the same time as an oral iron supplement because the two will compete for absorption.

Continuing Care Following Surgery

Surgical patients are typically enrolled in postoperative programs to help them adjust to their new lifestyle and reinforce compliance with recommended dietary restrictions and nutritional supplementation. All patients in these programs are instructed to take multivitamin supplements, usually with iron. Many physicians recommend life-long supplementation, with iron-deficient patients being treated initially with oral iron. Patients who cannot or will not take oral iron because of gastrointestinal side effects may need to receive the generally more tolerable ferrous fumarate oral preparation or parenteral iron supplementation.

Postoperative nutritional care puts a great deal of responsibility on the patient who may not realize the drastic nature of the procedure as it relates to nutrient absorption and the need to comply with supplementation and follow-up care. It can be difficult for patients to adhere to these programs with many of them dropping out 3-6 months after surgery. Dr. Annette von Drygalski, a hematologic fellow at the University of California-San Diego who has worked with many anemic patients following bariatric surgery, has witnessed this. She said, “Some patients may not be educated enough about the surgery and some may not even remember what procedure they had. And, because bariatric surgery is a relatively new field, some physicians may not be educated about the nutritional implications.” Patients may remain healthy for a short time and may attribute postoperative symptoms of fatigue to the procedure alone while deficiencies develop. Iron deficiency and other causes of anemia can manifest years later, potentially putting primary care physicians in a tough spot.

“Sometimes patients won’t follow-up with anybody until they finally develop a complication,” noted Dr. Baker. “We encourage our patients to identify their primary care physician so that lab work and recommendations can be shared. This way, physicians can identify patients who are not following up after the surgery.”

Monitoring Nutrition & Deficiencies

Patients are often enrolled in a postsurgical program operated by the surgical team. Programs of this nature normally require patients to attend follow-up visits at the first, third, sixth and 12th months to monitor their overall health and address any symptoms they may be experiencing. At a minimum, screening for nutritional deficiencies occurs at the 6-month and 12-month visits. Adjustments to a patient’s dietary supplementation levels, initially set by the surgeon, may occur at these visits, if necessary. Some patients prefer to have these visits coordinated with their primary doctors instead of with the surgical team. In this case, the primary doctor should continue to update the surgical team of the patient’s care and status, and the surgeon should remain available for consultation.

Information for Bariatric Surgery Patients

* Bariatric surgery is not harmless, it drastically alters your body
* There are lifelong dietary and nutritional considerations
* You may not absorb vitamins or iron as well from the food you eat
* It is important to follow vitamin and iron supplementation
* Do not take iron supplements with tea, cola, coffee, calcium citrate or levothyroxine
* Remember the type of surgery you had performed and be sure to tell your doctor

If you are working with a known bariatric surgery patient for the first time, even if you have not had prior consultation with their surgeon, Dr. Baker recommends inquiring about their dietary intake, types of foods they eat, their menstrual blood loss if they are female, and any symptoms of fatigue which could be related to anemia, in addition to monitoring their levels of iron, vitamin B12 and folate as described below. Notable things to watch for include excess tea, cola or coffee consumption, which may interfere with iron conversion to an absorbable form. If taking an iron supplement, it is necessary to wait at least two hours before drinking any tea, taking calcium supplements, or taking the synthetic thyroid hormone levothyroxine. If possible, communication with their surgeon about recommended supplementation and follow-up care should be pursued prior to subsequent visits.

The first step in screening for anemia is acquiring a complete blood count that includes red blood cell indices. If anemia is present – determined by a hemoglobin <12 g/dL in women and <13 g/dL in men – indices can point toward the appropriate further investigation.13 Patients with a microcytic, hypochromic anemia most likely have an iron deficiency. Vitamin B-12 deficiency produces macrocytic red blood cells. Remember that the cause of anemia may be multi-factorial, so indices are not the final answer. Some screening guidelines of anemia-related nutrients, taken in part from the ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient,12 are listed below.

Iron – Ferritin levels should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal ferritin level for men is 15-200 ng/mL and for women is 12-150 ng/mL.12 Also check serum iron (normal range 60-170 mcg/dL), total iron binding capacity (normal range 240-450 mcg/dL) and transferrin saturation (normal range 20-50%). Note that normal ranges vary by lab, so be sure to check for their established levels.
Related Research Review

A recent research review of the study by Coupaye et al prospectively compared the prevalence of nutritional deficiencies after adjustable gastric banding and gastric bypass procedures. Read more about the study in Research Reviews:
Evaluation of Short-term Nutritional Regimens Following Bariatric Surgery

Vitamin B12 – Serum B12 levels should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal vitamin B12 range is 200-900 pg/mL,14 but serum measurements may miss 25-30% of deficiency cases in lower normal ranges. If symptoms of a vitamin B12 deficiency are present (including fatigue, bright red/smooth tongue or tingling/numbness in hands and feet) and vitamin B12 levels are 200-250 pg/mL, MMA and tHcy measurements may help identify the cause.12

Folate – RBC folate should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal RBC folate range is 280-791 ng/mL, with a deficiency present at <305 nmol/L and the presence of anemia <227 nmol/L.12 Serum folate more closely reflects recent dietary intake than actual folate status measured by RBC folate. Although relatively uncommon before and after bariatric surgery, folate deficiencies should be monitored, especially in women who may become pregnant.

The Lasting Effects

Bariatric surgery and the behavioral changes patients adopt have shown to be very effective reducing excess weight and the effects of obesity-related health conditions. However, the physical and metabolic alterations as a result of the procedure must be monitored by patients and their healthcare providers for the rest of their lives.

A dedication to following supplementation recommendations and monitoring nutrient levels should be incorporated into routine care which the patient can follow, the primary care physician can execute, and which allows the bariatric surgeon to remain informed and available for consultation.

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Risk of alcohol abuse increases after gastric bypas surgery

Sacramento, CA

On Friday's Live_Online at 11 a.m., we learned that an unintended consequence of gastric bypass surgery is the risk of alcohol abuse, said Laura Lagge, a certified alcohol and drug counselor with New Dawn Recovery in Citrus Heights.

Lagge told viewers she's seeing more women who turned to gastric bypass for their weight problem now struggling with alcohol abuse.

She said after the surgery, alcohol enters a person's system more quickly and the effects are stronger.

Lagge said, "If you are considering gastric bypass, tell your doctor truthfully about how much alcohol you currently drink." Once the surgery is done, patients must reduce the amount of food and beverages they consume or face serious health consequences, such as alcohol abuse.

Several high profiles DUI cases involving women, most recently the off-duty Sacramento County deputy who crashed into a Natomas Starbucks, prompted Friday's discussion on women and addiction.

Lagge added that alcoholism and addiction is a disease that "strikes all kinds of people, regardless of age, race, economic standing, gender or education."

"Having the disease does not mean you are immoral, weak or defective," and that recovery is a gradual process, like any other chronic disease, she said.

If you're wondering if you have a drug or alcohol problem, Lagge said consider the following questions:

1. Have you ever felt you should cut down or try to control your drinking or drug use?

2. Have you ever felt guilty or bad about your drinking or using drugs?

3. Do you ever take a morning eye-opener to steady your nerves or to get rid of a hangover? Do you use drugs or drink daily or weekly? Do you use prescription medications more often than prescribed?

4. Are alcohol or drugs sometimes more important that other things in your life, such as your family or your job?

5. Do you find yourself lying to your spouse, your kids, or your employer to cover up your drinking or using?

6. Have you ever switched from one type of drug to another to either prove you're not addicted or to help with withdrawal symptoms from another drug?

7. Have you had problems with your job, your relationship, finances, legal or your health due to your drinking or drug use?

8. Have friends or family members expressed concern for you about your drinking or drug use?

9. Have you gone to work or driven while intoxicated or in a drug-induced haze?

10. Have you been drunk or high more than four times in the past year? Do you sometimes stay drunk or high for days at a time?

11. Do you need more alcohol or drugs in order to do something (start the day, have sex, clean the house, socialize, for example) or to change how you feel?

12. Do you need more of the drug or alcohol in order to get the same effect?

13. Are you uncomfortable when you have to be somewhere where no alcohol or drugs will be available?

Lagge said if people answer yes to two or more of the above questions, "they are at the very least abusers and would benefit greatly from stopping."

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Comedianne Mo'Nique becomes weight loss leader

Philadelphia, PA

Lately, the blogosphere has been blowing up over two big sisters: comedian Mo'Nique and President Obama's pleasingly plump new surgeon general, Dr. Regina Benjamin.

There's so much controversy that I'll need two columns to address it all. First, let's talk about Mo'Nique.

Actress-comedian Mo'Nique Imes Jackson, author of "Skinny Women Are Evil" and "Skinny Cooks Can't Be Trusted," has lost 40 pounds. Rumors have been flying that she had gastric bypass surgery, which she flat- out denies. But that hasn't appeased the size-acceptance camp, whose members are angrily abuzz about the weight loss she disclosed in a recent interview with Jet magazine.

In the interview, Mo'Nique says she knew it was time to lose weight when her husband, Sidney Hicks, watched her step off the scale at 262 pounds and said, "Baby, that's too much, and I want you for a lifetime."

Now the 5-foot-6-inch star is making the necessary sacrifices and has vowed to get her weight down to 200 pounds.

"This was truly making the commitment to watch what I eat and commit to working out," she said. "I stopped eating red meat. I want to say to big people, 'Let's be healthy big people. Everybody can't be a size 0, but let's be healthy.' "

Her efforts are worthy of applause. So why the criticism?

It is true that for years, this fat and fabulous one has been a champion for size acceptance. She has made a generous living dissing so-called "skinny bitches" while encouraging fat women to stay, well, fat.

Mo was always the first to say how proud she was to be representing for the big girls. So is this some sinister plan she's made to unleash an internal skinny bitch who's been dying to get out?

I don't think so.

Quite frankly, it has always stupefied me why the plus-size community feels betrayed when a plus-size celebrity - or a friend, for that matter - decides to slim down. Why are efforts at living a healthier lifestyle viewed as a personal affront?

Mo'Nique shouldn't be shunned for losing weight. Even if she reaches her goal of 200 pounds, she'll have a BMI of 32.3, which still makes her medically obese.

Would size acceptance groups prefer that Mo'Nique eat herself into disease, disability or death?

I suspect that fat advocates' swagger and confidence is really false bravado. Embracing your size does not make your health problems disappear. None of us has the luxury of throwing in the towel on a healthy lifestyle of daily exercise and good nutrition.

From where I sit on the front lines, it's clear we cannot continue this masquerade. And this is especially true for black folks. Black women, who have the highest overweight and obesity levels of any U.S. population, cannot afford false bravado. We need solutions. We need to keep it real with ourselves and take control of our health.

Why can't we be honest with ourselves and admit that being overweight or obese is not healthy? Why don't we understand that this hits the black community especially hard?

It's not healthy to carry an extra 20 pounds, let alone 100 pounds. Our bodies are just not designed for this type of trauma.

I have seen enough premature death, disease and disability in the black community to confirm the truth. I don't even have to cite the statistics on this, but I will.

If you are still on the fence about where black women are on the obesity front, then check this out:

_ African Americans, particularly African-American women, need to protect themselves against the ravages of obesity, which strikes us harder than any other group.

According to the Centers for Disease Control and Prevention Web site, 31.2 percent of African Americans were obese in 2001, up from 19.3 percent from the previous decade. That's a whopping increase in just 10 years. And experts say that today, half of all African-American women are obese.

_ African Americans suffer disproportionately from heart disease, hypertension, and diabetes, among other lifestyle-related diseases.

Surely, Mo'Nique is aware of all this. Now she's on the precipice of change.

Mo'Nique has the extraordinary potential to save some lives. Her decision to tackle her weight may influence more women to take charge of their health.

Can you imagine it? Maybe, just maybe, Mo'Nique is going to help lead the battle against obesity. Could she be the one to kick-start Obama's new health initiative? And will she get some help, perhaps, from a recent Obama appointee?

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More than 50% Increase in gastric bypass surgeries over past 12 months in UK

York City, UK

Operations to combat weight gain have increased by more than a half in the past 12 months.

The news follows the tragic death of York mum Kerry Greaves, who underwent gastric bypass surgery to try to slim down so her daughter, Melissa, would not be teased at school. Sadly, complications led to Kerry’s death at the age of only 30.

Figures released by the NHS show that in the 12 months leading up to April this year, 4,324 people nationally underwent operations to have gastric bypasses or gastric bands fitted to help them lose weight. That is a 52 per cent increase over the 2007-2008 figures, when 2,838 opted for surgery.

Operations of this type can cost about £10,000 and most of those who opt to go “under the knife” are women – about three-quarters of the total who opt for surgery.

The treatment is predominantly available for patients whose body mass index (BMI) exceeds 50 – the average BMI is between 18 and 25.

People with a BMI of more than 40 are considered to be morbidly obese while a measurement of more than 30 is classed as obese.

According to the NHS figures, only 38 per cent of people are a healthy weight. The rise in the number of people wanting gastric bypass surgery has been borne out by York GP Dr David Fair, who said he had seen a marked increase in the number of people wanting the procedure.

But surgery should always be seen as the last option when dieting and exercise has failed.

Although low risk, Dr Fair said that potential problems could arise with any type of operations.

That is what happened to Kerry. After having the operation her stomach failed to heal properly, and she underwent a further 14 operations before dying of organ failure.

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Gastric Bypass surgery: Pros and Cons

Tulsa, OK

Gastric bypass surgery is growing more popular every year as America's obesity epidemic tips the scales. Even the elderly, and people with health problems are turning to this surgical solution to obesity.

It is a surgery that saves lives. But some also warn there can be life-changing drawbacks.

"These were 26 - and I wear a size 8 now," said Leslie Blunt as she proudly showed off the pants she will never wear again thanks to gastric bypass surgery. She has lost 140 pounds. "It works. It does. You live a healthier life," she added.

Micah Anderson chose gastric bypass surgery when his weight ballooned to 500 pounds. "Lost little over 200 pounds - easy," he told 2News anchor Karen Larsen. "I'm happy with myself. More confidence."

While gastric bypass is known for bringing on drastic weight loss, what many do not realize are specific changes it may cause for an individual, along with health benefits.

"A lot of this junk food they were eating before - their taste has disappeared they don't want it anymore," according to Dr. Luis Gorospe, gastric bypass surgeon at Bailey Medical Center in Owasso. Both Anderson and Blunt went to Dr. Gorospe for surgery. His patients come from surrounding states, drawn by his surgery success rate, the promise of dramatic weight loss and the immediate health benefits of gastric bypass.

"If they have diabetes - 70 percent of these patients wake up with normal blood sugar and will not require medications - forever," Dr. Gorospe said.

Studies show gastric bypass may improve or even eliminate such health problems as:

Leslie Blunt says she is living proof, "I don't have high blood pressure. I don't have diabetes. I am pill free."

However, Micah Anderson tells a different story. "I'll vomit maybe not every week - but if something doesn't agree it does come right back up."

When surgeons create a tiny new stomach for patients, vomiting is a common problem when patients eat too much, too fast - until they get used to their new, smaller stomach. Micah says he expected that - but then he started fainting - once behind the wheel of his car.

Anderson's wife Katie said, "The passing out has happened four times. Spells where he could potentially pass out... weekly!"

Frightened by the potential danger such episodes represented, the Andersons began researching online and discovered other gastric bypass patients having such problems.

"Describing the same kind of drunk-like symptoms, incoherent, can't talk, slurring the speech. and people were experiencing the same things," Katie added.

The Andersons say they went to numerous doctors and nutritionists, trying to find a physician who was experienced with gastric surgery side effects. After trial and error, they say they have finally found the right doctor to care for Micah. As a result, Micah now follows a diet carefully crafted to meet his personal needs. He eats every two hours, consumes plenty of protein and takes vitamins.

"For me its lack of eating. I forget to eat and that's what causes my issues. It's partially my fault as much as it is the surgery," Micah said. "If I don't follow the rules like they tell you - you do have issues."

Doctor Gorospe agreed. He said healthy eating - the same issue obese patients struggle with before gastric bypass - is more important than ever after surgery. "If you follow the rules, this surgery will be successful," Dr. Gorospe said.

Because some patients do encounter issues following surgery, and with their new lifestyle, Doctor Gorospe offers monthly support groups. "I make it a point of being there," he said. "I want to be available to my patients." The meetings offer patients an opportunity to share their stories and talk with Dr. Gorospe.

Micah did attend the monthly meetings. However, some of his problems did not occur until several years following the procedure. As a result of his struggle, the Anderson's suggest to those considering gastric bypass surgery: do plenty of research, know the rules they will have to live by, and read up on potential side effects.

"There is a list and, by golly, one of those things on the list will affect you," Katie Anderson said. "They just need to tell you flat out - you are trading one set of issues for another set of issues."

However, when asked if he would have the surgery again, Micah's answer is, "Unfortunately, yes." He went on to say he is pleased with his more than 200 pound weight loss. His joints ache less when he gets out of bed in the morning, and it is easier to be active.

Leslie Blunt agrees. Now, this svelte hair stylist says work is easy. No more suffering from carrying too much weight while being on her feet each day. Plus, she loves buying clothes with her new look and the fact that she is setting a good example for her young children by living a healthier lifestyle.

In fact, Leslie says gastric bypass surgery is the best thing she ever did for herself. "Yes! I would do it over and over and over again! I never want to be that way again."

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Gastric bypass: One man's journey

Baltimore, MD

Obesity is a condition that can cause all sorts of serious health and social problems, and they're all too familiar for an 11 News photographer who decided to have gastric bypass surgery.

Obesity can affect many things in life, including fitting into a movie seat, traveling on an airplane or going to a baseball game. They were problems long-time photographer Howard Melnick has been familiar with his entire life. 11 News decided to follow him on his journey through gastric bypass surgery.

Howard Melnick's Interview
Dr. Thomas Magnuson interview

Melnick has struggled with his weight all his life. He said it's tough carrying around heavy equipment, especially when he weighs more than 400 pounds.

"I was the fat kid who was about 10 minutes behind everybody else on the track. I was the fat kid who couldn't do chin-ups," he said.
Howard Melnick
Photographer Howard Melnick chose to get gastric bypass surgery.

His obesity has led to hypertension, sleep apnea and serious knee problems.

"My knees are shot -- just shot, and I need my knees (for work)," he said.

Finally, Melnick and his wife, Debbie, decided he would have bariatric surgery, or gastric bypass.

"It's the curse of my life. With Debbie, we love our lives today ... except for the weight," Melnick said.

Melnick's wife said she was fully supportive of his decision, but still worried because it was a big surgery.

"I'm very nervous, probably more than he is," she said.

Dr. Thomas Magnuson, the chief of general surgery at Johns Hopkins Bayview Hospital, said the surgery would take about three hours to complete and told Melnick the procedure has come a long way since it was first developed.
"Twenty years ago, people would lose weight then gain it back in two years (after gastric bypass). Now, they're more durable," said Dr. Thomas Magnuson

"They're a lot safer and they work better and last long-term. Twenty years ago, people would lose weight then gain it back in two years. Now, they're more durable -- a lifetime," Magnuson said.

Melnick could eventually lose many of the medical conditions caused by his obesity, Magnuson said.

After extensive counseling on nutrition, lifestyle and exercise, Melnick had his surgery.

"It hurts when I sit up and lay back down, but when I'm walking, not so much. They had me up last night," Melnick told 11 News the day after his surgery.

One week later, doctors said the surgery went well, and Melnick said he had already lost about eight pounds and was feeling great.

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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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The trouble with gastric bypass surgery

Phoenix, AZ

Many extremely obese people these days, under the mistaken belief that it will be the answer to their health problems, are flocking to get gastric bypass surgery. Now this treatment option may be pushed on even more people. A study published in The American Journal of Managed Care reports that bariatric surgery can "pay for itself" by diminishing the number of insurance claims filed by people who are grossly overweight.

Gastric Bypass Surgery Is No Picnic

However, gastric bypass surgery has many associated risks. The risks, according to a Mayo Clinic article, include death, blood clots in the legs, leaking at the staple lines in the stomach, incision hernia, narrowing of the opening between the stomach and small intestine, dumping syndrome, iron deficiency anemia, vitamin B-12 deficiency, vitamin D deficiency, dehydration, gallstones, bleeding stomach ulcers, intolerance to certain foods, kidney stones, low blood sugar, body aches, fatigue (like when one has the flu), feeling cold, dry skin, hair thinning and hair loss, and mood changes. Of course, there are also the same risks that go along with any surgery, like bleeding, infections, and adverse reactions to the anesthesia. That doesn't exactly sound like a picnic, no pun intended.

Will Surgery Save Insurance Companies Money?

Unfortunately, there is even more reason to be concerned about gastric bypass surgery. Dr. Douglass warns in an article that the funding for the study that purports that this surgery will save insurance companies money came from a company known as Johnson & Johnson's Ethicon Endo-Surgery, Inc., which is a major manufacturer of bariatric surgical instruments. Additionally, Dr. Douglass points out that Dr. Scott Shikora, a co-author of the study, is the president of the American Society for Metabolic and Bariatric Surgery. It's easy to see that the members of this group would clearly benefit if insurance providers would decide that they could save money if more patients were approved for this course of treatment.

Up to Five Percent Die Within a Year of Surgery

The sad truth of the matter is that, according to Dr. Douglass, up to five percent of the patients who undergo this course of treatment are dead within a year. (That's certainly one way to trim down future medical costs.) While Dr. Douglass believes that surgery should always be a last resort, many other doctors believe that the current requirement by insurance companies that people first try to lose weight by a six-month doctor-supervised weight loss program is unreasonable. Says Douglass: "People like Shikora would prefer that patients go right from the dining room table to his operating table." While natural health advocates might not agree with Dr. Douglass on all of the issues, most certainly appreciate his acerbic wit. Hmmm... was the guy who said that "the way to a man's heart is through his stomach" a bariatric surgeon?

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Study: Gastric bypass not effective diabetics

San Francisco, CA

Gastric bypass has helped thousands of people effectively lose weight, but a new study finds diabetics who undergo the surgery are less likely to see good results.

Researchers at the University of California San Francisco studied over 300 gastric bypass patients a year after their procedure.

They found patients with diabetes were unable to lose more than 40-percent of their excess body weight.

Researchers believe the medications diabetics take like insulin actually stimulate the body's production of fat and cholesterol.

They say changes in the use of these medications could give diabetics a better chance to achieve better weight loss results after gastric bypass.

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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."

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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.

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Gastric bypass surgery: Lifestyle change & lifetime commitment

McAllen, TX

I have been working at my hospital since 1986, and I was obese most of my life.

In 2004, my hospital began offering weight-loss surgery. I had health problems such as hypertension and metabolic syndrome. I was never able to lose enough weight to make a difference in my hypertension.

I made the decision to have a Roux-en-y Gastric Bypass.

Within 3 months postop, I was able to stop taking of my glucophage, as well as medication for my hypertension, which I had taken for 17 years.

I am now the Bariatric Program Manager as well as a Certified Bariatric Nurse and we have achieved ASMBS Center of Excellence for Bariatric Surgery.

I enjoy being a resource person for our patients undergoing weight loss surgery and for those considering weight loss surgery. I want everyone to be as successful and as happy as I am with this life changing procedure.

Weight-loss surgery is not without risks, but neither is being obese. I tell everyone this is a personal decision that only they can make. It is a lifestyle change and a lifetime commitment. Make sure you do your research and put yourself in the most experienced hands possible.

Medicare and some insurance companies are only reimbursing procedures done at facilities that have achieved ASMBS Center of Excellence by the Surgical Review Corporation or American College of Surgeons Level I Certification.

Weight-loss surgery is a treatment for obesity and is done for health reasons. It is not a cosmetic procedure.

To qualify for weight-loss surgery you should have a BMI of 40 or greater, or 35-39 with comorbid conditions such as diabetes, depression, hypertension, urinary stress incontinence or sleep apnea, just to name a few.

Remember, surgery is a tool that should not be taken for granted.

By Paula Kilgore, RN, CBN
McAllen, TX

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60 Minutes segment on gastric bypass surgery effect on diabetes, cancer

60 Minutes reports: Gastric bypass surgery can send diabetes into remission and may reduce risk of other cancers.

It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Surgeons have been performing bariatric, or weight loshttp://www.blogger.com/img/gl.link.gifs operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation. More >>

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Philadelphia woman found it took more than a gastric bypass procedure to maintain her weight loss

Philadelphia, PA

IN THE PAST few years, bariatric surgery, otherwise known as gastric bypass or gastric banding, has become all the rage.

With 65 percent of Americans either overweight or obese, according to the federal Centers for Disease Control, it's not surprising that many people are electing to have this procedure done.

After all, post-procedure weight losses range from 60 to 80 percent of excess body weight in patients with a body mass index of 35 to 60, over the first two years. That could roughly equal a loss of 80 to 150 pounds, depending on your original weight.

Undoubtedly, weight-loss surgery guarantees permanent weight loss, right?

Well, perhaps . . .

Melissa Blanco, 32, once carried a whopping 274 pounds on her 5-foot-4-inch frame. But the Philly native shed 130 pounds after having the gastric bypass procedure.

"I did Weight Watchers, Jenny Craig, and the weight-loss program at the University of Pennsylvania, and had some success to some degree, but could not maintain it. I started feeling tired and wobbly. I knew something had to change," Blanco said.

So, in the winter of 2005, after doing some research, she decided to have gastric bypass surgery that reduced her stomach to the size of an egg. More >>

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Obesity epidemic leading to rise in gastric bypass surgery

Kansas City, MO

For many obese or overweight Americans, shedding weight has led them to lifestyle changes, such as a healthier diet and a new exercise regimen. Many others go the surgical route, as 177,000 Americans opted for weight loss surgery in 2006 alone. The vast majority of those surgeries were Roux-en-Y gastric bypass
surgery. While gastric bypass can seem like a quick fix that enables patients to shed weight almost overnight, the surgery and its ramifications are in fact quite complicated, and should never be looked at as an easy way to drop weight.

What is gastric bypass?

Roughly 80 percent of the weight loss surgeries performed in America this year will be gastric bypass procedures. This is a two-part procedure.

• Stomach pouch: The creation of a stomach pouch is the portion of the procedure many people refer to as “stomach stapling.” During this part of the surgery, the stomach is divided unequally, with one large pouch and one much smaller pouch. After this division, the smaller pouch is sewn or stapled. That pouch can only hold a very small amount of food (roughly one cup). Such a small holding capacity is designed to make people feel full faster, which in turn will make them eat less.

• Bypass: In the second stage the surgeon will employ the Roux-en-Y technique, in which the smaller pouch is disconnected from the first part of the small intestine (the duodenum). The surgeon will then reconnect the stomach to a lower portion of the intestine (the jejunum). Once that has occurred, any food consumed will pass directly from the stomach into this lower portion, where fewer calories and nutrients are absorbed.

What happens after the surgery?

While patients can expect to lose weight after gastric bypass surgery, there are negative consequences as well. Though not all patients will experience such consequences, and death is extremely rare (especially when surgery is performed by an experienced gastric bypass surgeon), some of the following might occur after surgery:

• Wound infections

• Problems with digestion

• Bleeding

• Ulcers

Those are some of the more common complications after surgery. Some of the less common, though extremely serious and potentially life-threatening, complications include the following.

• Pulmonary embolism (blood clot)

• Serious infection and persistent bleeding

• Heart attack

• Leakage in the surgical connections in the intestines

Because of the nature of the surgery, in which food is re-routed into the jejunum where FEWER nutrients are absorbed, certain health problems can arise as a result. For example, the human body needs a certain amount of iron and calcium to remain healthy. However, the jejunum does not absorb these nutrients well, and conditions such as anemia and osteoporosis can arise as a result. Iron and calcium supplements, as well as routine blood tests, can lower the risk of developing such conditions.

Although there can be complications, many gastric bypass patients experience positive results. Weight loss is often dramatic, especially for patients who were considerably overweight.

Another benefit of gastric bypass is that patients who have obesity-related health problems often see improvements in those conditions after surgery. Such conditions include diabetes, sleep apnea and high blood pressure.
While the benefits of gastric bypass surgery are numerous and have helped many a public figure, it’s important to recognize the surgery is not a one-size-fits-all solution, and each case needs to be examined on an individual basis.

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Estimated 120,000 patients will have gastric bypass surgery in 2008

There isn't a magical weight-loss pill, but the way some people talk, there is a magic weight-loss knife. However, Carlos Carrasquilla, M.D., F.A.C.S., director of the Florida Center for Surgical Weight Loss Control in Fort Lauderdale, Fla., cautions that weight-loss surgery isn't an easy fix. It requires adopting new eating and exercise habits for life, as well as coping with the risks of surgery. Still, both bariatric and laparoscopic weight-loss surgery are increasingly common.

One medical analyst predicts more than 120,000 Americans will have the procedures this year, with an average cost of $25,000 per surgery (an amount that is not always covered by health insurance).

We asked the man who brought the laparoscopic surgery procedure to South Florida for the low-down on the answers to the growing number of questions about weight-loss surgery.

Bulletin: Weight loss surgery isn't for everyone. Who is the ideal candidate?

Dr. Carrasquilla: We go by Body Mass Index (BMI). People with a BMI of more than 40 are, on average, 100 pounds above average weight. Those people are considered "supermorbid obese." They have tried everything possible. But once you get above 100 pounds above your ideal weight, there is a 98 percent failure rate in [other] weight-loss treatments. More >>

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Gastric bypass surgery, last resort for morbidly obese

North Andover, MA

Although most people can lose weight the old-fashioned way through disciplined eating and regular exercise, bariatric (the treatment of obesity) surgery is an option for very overweight people who have tried everything else.

"You don't just jump into this," says Dr. Frederick Buckley Jr., F.A.C.S., who practices general, vascular and bariatric surgery in Salem. "We're the last stop, and this solution is intended to be forever."

Weight-loss surgery is not for the slightly overweight, nor is it a quick fix for people who haven't tried other methods first. To be eligible, patients must be at least 100 pounds overweight, undergo psychological and cardiac screening and commit to a new eating pattern for the rest of their lives. Insurance companies may also require them to undergo six months of physician-monitored weight loss (usually by a primary-care provider) during the year prior to surgery or their own six-month phone-monitored system, which Buckley believes is less effective than proceeding directly to what he considers "life-saving" surgery.

Most of Buckley's patients have tried other programs without success. "Our patients have lost and regained hundreds of pounds," he said. "It is not a pure willpower thing and it's not for lack of trying that they come here." More >>

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Sleeve gastrectomy: New bariatric procedure turns stomach into small pool

Indianapolis, IN

Question: Describe the sleeve gastroectomy, a new bariatrics surgery option.

Answer: This is just another version of what's already out there. You can break down weight-loss surgical procedures into two categories: One is called restrictive and restricts how much you can take in, such as the lap-band; the other one is called malabsorption and bypasses portions of the intestine or stomach to keep food from getting absorbed as calories.

This is a new restrictive technique. Basically, it's taking off a large portion of the stomach and making the stomach into a small, narrow tube instead of a boot-shaped pouch. We're basically making your stomach into a very small reservoir. More >>

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Webcast: Laparoscopic Gastric Bypass and Sleeve Gastrectomy to be broadcast at OR-Live.com

Ft. Lauderdale, FL

ORLive.com will broadcast two (2) bariatric procedures: a laparoscopic gastric bypass performed at Flagler Hospital, in St. Augustine, Florida and a laparoscopic sleeve gastrectomy performed at Holy Cross Hospital, Ft. Lauderdale, Florida. Both procedures were recorded live-to-tape and are presented unedited during this combined broadcast.

The gastric bypass procedure will be performed by Robert Marema, MD, FACS, Medical Director of Bariatric Services, Flagler Hospital and CEO of U.S. Bariatric. Michael Perez, MD, FACS, Medical Director Bariatric Surgery, Holy Cross Hospital will perform the gastric sleeve procedure. More >>

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Laparoscopic gastric bypass and sleeve gastrectomy to be broadcast at OR-Live.com

Ft. Lauderdale, FL

On January 15, 2008, at 6 pm, www.ORLive.com will broadcast two (2) bariatric procedures; a laparoscopic gastric bypass and a laparoscopic sleeve gastrectomy, both performed in Ft Lauderdale, FL and recorded ive to tape. The gastric bypass procedure will be performed by Robert Marema, MD, FACS. More >>

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Montana Health Watch | gastric bypass surgery

Billings, MT

In the last few years, more than two hundred severely overweight Montanans have undergone gastric bypass surgery at St. Vincent Healthcare in Billings.

The surgery changes lives but it's not as easy as it looks.

Julie Lovell introduces us to two sisters from Miles City; who found it takes perseverance, family support and a sense of humor to succeed after gastric bypass surgery.

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Gastric bypass surgery, not the easy way out

Kalamazoo, MI

Hospitals in Michigan help patients understand gastric bypass surgery and its aftermath.

The latest developments in weight-loss surgery for the morbidly obese have come not in the operating room but in the classroom. Hospitals that do bariatric surgery, including gastric bypass and gastric banding, have in recent years created programs that emphasize pre-surgery education and counseling for potential patients.

The classes and psychological services can help patients can more fully understand the surgery, evaluate whether it is appropriate for them and comprehend the changes in eating habits and exercise they will have to make if they do undergo it.

Both the Bariatrics at Borgess program at Borgess Medical Center and the Medical and Surgical Weight Loss Program at Bronson Methodist Hospital provide patients with these broad-ranging services.

``I think there is a misconception that if you're considering bariatric surgery, you're taking the easy way out,'' said Dr. Stuart Verseman, medical director of Bariatrics at Borgess. ``You're not. You're taking the long way out. Patients really have to change the way they eat and live. The surgery is just a tool to help them.'' More >>

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