Study to examine Gastric Bypass for treatment of diabetes in non-obese patients

Gastric bypass surgery to treat diabetes in non-obese patients?

New York, NY

Patients with a body mass index below 35 generally do not qualify for weight loss surgery. But, researchers at Weill Cornell Medical Center in New York City are embarking on a new study to determine whether gastric bypass surgery can be an effective treatment for type 2 diabetes in people who are overweight but not obese.

The study aims to explore the correlation of diabetes and clinical obesity. Lead researcher Dr. Francesco Rubino notes that many people with a lower BMI can develop diabetes, and likewise, that someone who is severely obese could be diabetes free.

“For this reason alone, we need to start questioning whether BMI should be the only clinically appropriate way to decide who gets diabetes-targeted surgery,” Dr. Rubino said in a recent press statement. Diabetes affects more than 200 million people worldwide, and several studies have demonstrated that gastric bypass surgery can lead to spontaneous improvement or even resolution of the disease.

Dr. Rubino generally performs the standard Roux-en-Y bypass procedure in patients with a BMI over 35. Now, the potential benefits of the procedure are being extended to 50 non-obese patients as part of the current study.

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After bariatric surgery, bus drive loses weight and gains confidence

Tampa Bay, FL

Jackie Chandler, 51, of Thonotosassa is a longtime bus driver with the Hillsborough County School District. She decided last year to have gastric bypass surgery and has lost at least 65 pounds since. She weighed 300 pounds before the surgery.

Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can't eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can't eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.
Chandler is pictured before her surgery, above, and after it, below. Since the surgery, there are things she can’t eat, like pasta and ice cream. But her sleep apnea problems have subsided, and her diabetes medications have been cut.

Every year, about 250,000 people in the United States undergo surgery to lose weight, paying — or having their insurance companies pay — tens of thousands of dollars for procedures that essentially restrict how much food they can take in.

But are the surgeries safe? Do they work? And can they help treat diabetes, hypertension and other conditions caused or made worse by obesity?

Increasingly, the answer in the medical community is yes, yes and yes.

Doctors and others are bolstered by studies like one this month that showed improved outcomes and lower complication rates among Type 2 diabetes.

And they're encouraged by the endorsements of groups like the American Society for Nutrition and the Obesity Society, which called bariatric surgery "the most effective weight-loss therapy for obesity." Or the American Diabetes Association, which last year for the first time recommended bariatric surgery as a treatment option.

"We would not have imagined that day 10 years ago," Tampa bariatric surgeon Michel Murr said of the Diabetes Association's endorsement. "We've seen quite a shift of attitude."

Such acceptance likely will lead to a continued increase in surgeries, but also place greater pressure on public and private insurers to cover more of them.

Still, Murr and others caution that bariatric surgery is a major medical procedure and isn't for everyone, such as children and adolescents, or adults who are overweight but not considered obese. They also don't consider surgery a magic bullet for curing the country's obesity epidemic.

"We only operate on about 250,000 patients a year from a population of 30 million in the U.S. who are obese," Murr said. "In that regard, what are we going to do with the other 29,750,000?"

• • •

Most patients choose either a gastric bypass, which involves cutting and stapling the stomach, or gastric banding, which places an adjustable silicone ring around the top portion of the stomach. In both cases, a smaller pouch is created — the idea being that with less food filling a smaller stomach, patients lose weight.

Acceptance among the medical community has come slowly. Though the first procedures were performed in the 1960s, it was relatively uncommon even through the early 1990s.

"It was a very narrow field," said Murr, who started the bariatric surgery program at Tampa General Hospital in 1998. Primary care doctors weren't referring their obese patients for surgery. And most insurance wasn't covering it.

Murr said a number of factors helped shift the landscape. For one, more Americans were becoming obese. And second, the surgeries became safer and less invasive with the introduction of the laproscopic approach in the 1990s, which used several smaller abdominal incisions instead of a large one. Another major advance was the introduction of adjustable gastric bands in the past decade.

Then came the studies that showed the procedures were safer, had better outcomes and helped reduce or even eliminate chronic conditions associated with obesity. The most recent study appeared this month in Archives of Surgery, which showed lower complication rates and shorter hospital stays for Medicare beneficiaries who had the procedure after Medicare implemented certain criteria for prospective patients.

Medicare covers the procedures for people who are severely obese (body mass index of 35 or higher) and have a condition associated with obesity such as diabetes.

How much has the landscape changed?

"About half of the patients sent to my practice are directed by physicians," says Dr. John Baker, president of the American Society for Metabolic & Bariatric Surgery, who performs about 240 procedures a year at his Little Rock, Ark., practice.

• • •

But what about losing weight through diet and exercise?

Other studies have shown it is possible. The Louisiana Obese Subjects Study released this past month showed successes when placing participants in a structured medically supervised program.

And then there are the morbidly obese contestants on the popular TV show The Biggest Loser, who season after season lose large amounts of weight through improved diet and an intense exercise regimen.

Baker says those successes tend to be few and far between. Plus, "not all of us have a trainer that's going to push us to the limit every day."

• • •

Murr says people like Jackie Chandler are becoming a more typical obesity success story. The 51-year-old Hillsborough County school bus driver struggled with diabetes and sleep apnea and carried 300 pounds on her 5-foot-8 frame before deciding last year to have a gastric bypass surgery. Her BMI was 44.

Her insurance company, Humana, covered the procedure, which Murr said typically costs about $27,000 (gastric band procedures cost about $17,000).

Since Murr performed the surgery last September, Chandler has lost 65 pounds, no longer has trouble sleeping and is taking one medication for diabetes, instead of five.

Though the results so far have been positive, Chandler knows the surgery was just a tool to help her lose weight. The rest, she says, is up to her.

"I can't eat as much as I'd like to," she says. "Can't eat spaghetti anymore. Can't eat ice cream or chocolate." Patients have some dietary restrictions after surgery, and some experience nausea with certain foods.

And it's early. Studies suggest that bariatric patients can regain a significant amount of their lost weight. One 2004 study in the New England Journal of Medicine found that the percentage of weight lost for gastric bypass patients decreased from 38 percent after one year to 25 percent after 10 years.

But, the study notes, the improvement in their chronic conditions such as diabetes mitigated the fact they regained some weight.

Studies have also found that gastric bypass patients can suffer from vitamin and mineral deficiencies if they don't carefully manage their diets.

• • •

Surgeons say there's still a long way to go toward addressing the nation's obesity problem.

The percentage of obese people having bariatric surgery is small. And though surgery is covered for Medicare beneficiaries who meet certain criteria, insurance coverage for the general population is limited.

Humana, for example, doesn't offer it as a standard benefit; rather, it's offered as a buy-up option for employer groups with more than 3,000 members, said Dr. Jill Sumfest, the company's market medical officer for Central Florida. Currently, five groups in Central Florida offer it.

Members need to meet certain age and BMI requirements, and must have participated in a physician-directed weight management program for at least six months in the last two years.

Murr feels that's too restrictive. After all, he says, you don't tell someone that they have to have breast cancer or heart disease for a minimum period before you cover them.

He says Medicare has led the way for coverage; now it's up to private insurance companies and employers to recognize the benefits.

"There are enough studies now that the operation will pay for itself in two to three years . . . with the reduction of costs associated with other illnesses like hypertension, sleep apnea and diabetes," Murr said.

Both Murr and Baker say the real solution lies in comprehensive obesity management programs that include surgery as a choice. They say programs should include ways to curb the rising obesity rates among children and adolescents, such as better nutrition in schools and increased physical activity.

So, is the goal to get people to manage their weight so they don't get to the point where they need surgery?

"That's too ideal," Murr said.

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Some doctors worry about overuse of weight-loss surgery: Others excited about gastric bypass surgery for moderately obese

Kalamazoo, MI

As gastric bypass and other bariatric surgeries are becoming more popular for weight loss and as minimally invasive surgical techniques are developed, some health professionals worry that the procedures may be overused.

“I think it’s wrong to do it on people who are minimally overweight,” said Dr. Jerome Cooper.

Cooper is the medical director of the Medical Weight Loss Clinic, a Southfield-based business that has 34 locations in Michigan and northern Ohio, including one in the Kalamazoo area.

“Bariatric surgery is a last resort, as I see it,” said Cooper, who was trained as a bariatric physician but has not done bariatric surgery.

He was raising his concerns in response to a recent Los Angeles Times report saying that new, incisionless techniques that are now in human trials at major hospitals may end up broadening the use of bariatric surgery to people who are only moderately overweight or on the lower end of the obesity scale.

“I think 100 pounds overweight or more with co-morbidity (another health condition such as diabetes) is a good rule to follow,” Cooper said.

The clinics that Cooper oversees are devoted to medically supervised weight loss through diet, exercise and medication. “We do some referrals for bariatric surgery” when it’s appropriate, he said.

“Bariatric surgery does offer the best results of any weight-loss treatment available today,” Cooper said, “but it’s not without the possible recurrence of weight gain, and there are post-surgical issues” such as the risks of leakage, bowel obstruction and dumping syndrome, which is involuntary vomiting or defecation.

“The risks of bariatric surgery must be weighed against the risks of being morbidly obese (overweight by 100 pounds or more or with a body mass index of 40 or greater), diabetes, arthritic problems, heart problems, certain cancers,” Cooper said. “It’s appropriate for the right people.”

Divided opinions

Health professionals at major medical centers who were quoted in the L.A. Times report — and in a similar Chicago Tribune story — were about evenly divided on using bariatric surgery in those who are not extremely obese.

Some said the surgery is underused as a way to deal with Type 2 diabetes and other obesity-related health problems, while others said the surgery carries the risk of long-term complications and that diet changes, exercise and medication should be recommended instead for the overweight or moderately obese.

The L.A. Times noted that statistics from the American Society for Metabolic & Bariatric Surgery show bariatric surgery rates have doubled in the United States in the past six years, with 220,000 of the procedures done in 2008.

Diabetes, though, is on the rise, too, and studies show bariatric surgery is achieving good results in controlling that disease in patients with BMIs between 30 and 35, said Dr. Stuart Verseman, who has been medical director of bariatric surgery at Borgess Medical Center since October 2005 and does bariatric surgery at both Borgess and Bronson Methodist Hospital.

“They’re finding a marked improvement in their diabetes after bariatric surgery and a decreased usage of medication,” Verseman said.

An example of someone with a BMI of 30 would be a person who is 5-foot-9 inches tall and weighs 203 pounds. That person would be 35 pounds above the normal weight range for that height, according to the U.S. Centers for Disease Control and Prevention.

While that example might not strike some people as a case of obesity, Verseman said that “even people with BMIs of 30 are considered clinically obese.”

Verseman, following National Institutes of Health guidelines, does bariatric surgery only on those with a body mass index of 35 or more and certain related medical conditions or 40 or more without those conditions.

But he said he finds it “very exciting to think about offering that to a larger population, especially with the number of diabetics increasing astronomically every year.”

Verseman is the only surgeon in Kalamazoo currently doing bariatric operations. Dr. Alan Saber, who had been the main physician doing bariatric surgery at Bronson, left in November and now works at Case Western Reserve University Hospitals, in Cleveland.

Verseman, like Cooper, said bariatric surgery should never be the first choice for weight loss. But he is much more open to the potential of its use in the moderately obese who have diabetes, high blood pressure or other weight-related conditions.

Krista Hampton, a registered dietitian who is Bronson’s bariatric coordinator, sees the value of bariatric surgery for the extremely obese, but she expressed reservations about using it in people who are overweight or moderately obese.

“Coming from my background, I would want someone to exhaust all other weight-management options first,” she said.

Surgery and support

Bariatric surgery is on the rise at Borgess and Bronson, as it is nationwide. In the fiscal year ending June 30, 2004, there were 14 bariatric surgeries at Borgess. From July 2008 through June 2009, there were 187 at Borgess, and in the last six months of 2009 there were 110, according to Rebecca Blades, a registered nurse who leads the Borgess bariatric program.

Bronson, which started its bariatric program in 2007, did 47 surgeries that year, 99 in 2008 and 112 in 2009, said public-relations specialist Erin Smith.

Verseman said his bariatric surgeries have had a major-complications rate of 2 percent, while the national average is 3.5 percent.

Representatives of both hospitals emphasized that they carefully screen those interested in bariatric surgery and offer continued support to those who get the surgery, trying to help them avoid overeating and stay active.

Borgess, for example, offers support groups, both in person and online, and offers classes in active living, Blades said.

“None of these operations are cures,” Verseman said. “They’re tools to help patients. And it’s a team approach we take, involving a dietitian, a psychotherapist, the primary-care physician. Patients need to follow guidelines afterward to improve their medical conditions.”

“If you start grazing, over time you can get a lot of calories in even after surgery,” Verseman said.

But if people getting bariatric surgery have to learn to make dietary and behavioral changes and stick with those changes to lose weight, why not instead work closely with people to support new eating habits and more exercise without doing bariatric surgery?

“I wouldn’t have somebody undergo bariatric surgery who has never attempted anything else before,” Verseman said. “Almost every patient (who undergoes bariatric surgery) has completed numerous diets” but has not succeeded in losing enough weight to improve their medical condition, he said.

“You don’t just wake up one morning and say, ‘I want to have gastric bypass surgery.’”

The surgery helps people feel full and therefore have less of an urge to eat, Verseman said. One type of surgery he does — a sleeve gastrectomy — takes out 75 percent of the stomach and gets rid of the hormone that causes hunger, he said.

Even without bariatric surgery, though, people can learn to ease feelings of intense hunger, Hampton said, by increasing the protein and fiber in their diets and decreasing the kinds of high-carbohydrate foods that cause blood sugar to spike and then drop.

She said some people who enter a weight-management program at Bronson with the idea of getting bariatric surgery decide not to have it once they learn to cook and eat differently, get more exercise and overcome some behavioral issues.

“We need to get back to the basics of how to cook and how to meal plan,” she said. “Convenience food is way too easy to get our hands on.”

Verseman expressed a similar sentiment but said he is glad he can help improve people’s lives through bariatric surgery.

“To see people get over medical conditions and get their lives back ... is really gratifying,” he said.

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Beverly Hills bariatric surgeon claims he performs most lap band surgeries

Beverly Hills, CA

Dr. Michael Feiz, lead surgeon at the Beverly Hills Comprehensive Weight Loss Center, has performed more Lap Band surgeries than any other doctor. For overweight Los Angeles residents, Lap Band surgery is the answer they have been looking for to shed the unhealthy weight and return to a more active life. Performed laparoscopic with almost no scarring, Lap Band surgery has the added benefit of enabling the patient to control their weight loss progress. Unlike gastric bypass surgery, Lap Band surgery does not involve the permanent reduction in size of the stomach. Instead, a small cinched section of plastic is placed around the upper area of the stomach, creating a temporarily shrunken stomach area for food to pass through. The other factor that makes Lap Band surgery so unique from gastric bypass is that the Lap Band is connected to a port that enables adjustment of the amount of solid food that can pass through the stomach. Finally, Lap Band
surgery is so attractive because it can be easily reversed by simply removing the Lap Band if something goes amiss.

A pioneer in successful Lap Band surgery, Dr. Michael Feiz of the Beverly Hills Comprehensive Weight Loss Center has performed the world's most cosmetic Lap Band surgery. With degrees from UCLA, New York Medical College and a residency and fellowship at USC Medical Center and Cedars Sinai, Dr. Feiz is highly trained and skilled in Bariatric and minimally invasive surgery. All prospective Lap Band surgery patients who visit the Beverly Hills Comprehensive Weight Loss Center must first undergo a full 360 degree evaluation of their health - mental and physical - as well as their habits and attitudes toward exercise and food.

Typical Los Angeles Lap Band surgery patients lose multiple pounds per week, but the real success after Lap Band surgery is keeping the weight off. The Beverly Hills Comprehensive Weight Loss Center ensures that their Lap Band surgery patients lose the weight and keep it off. So many people turn to the Beverly Hills Comprehensive Weight Loss Center due to the success rate of this center.

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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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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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On October 30, OR Live to broadcast a laparoscopic adjustable gastric band surgery

Fridley, MN

Allina Hospitals & Clinics' Unity Hospital will present a live weight loss surgery online at 3 p.m. on Thursday, Oct. 30. Jeffrey Baker, MD, will perform a laparoscopic adjustable gastric band surgery, commonly known as Lap-Band® or Realize Band™ surgery, while Frederick Johnson, MD answers viewer questions, and talks about the benefits of adjustable banding procedures.

"This is a great opportunity for individuals contemplating weight loss surgery to learn more about a minimally invasive, proven option for surgical weight loss," said Frederick Johnson, MD, surgeon and co-medical director for the Unity Hospital Bariatric Center.

During the laparoscopic gastric banding procedure, surgeons make several small incisions and use long instruments, called laparoscopes, to place a silicone band around the top of the patient's stomach, creating a small stomach pouch. As a result, the patient feels fuller with smaller amounts of food, resulting in weight loss. The band can be further adjusted to limit or increase the amount of food the stomach can hold, or adapt to future lifestyle changes such as pregnancy.

In addition to weight loss, patients frequently see many other health benefits, including better control or resolution of diabetes, high blood pressure, arthritis, high cholesterol, sleep apnea, asthma, heartburn, cancers and many other illnesses associated with morbid obesity.

This procedure also has significantly shorter recovery times than other weight loss surgeries. "Laparoscopic procedures only require four to six small incisions, rather than the much larger incision required for traditional weight loss surgery," says Jeffrey Baker, MD, surgeon and co-medical director for the Unity Hospital Bariatric Center. "Most of our patients go home after one night in the hospital."

Nationally recognized as a "Bariatric Center of Excellence" by the American Society for Metabolic and Bariatric Surgeons, Unity Hospital's Bariatric Center is dedicated to helping patients achieve significant weight loss, which can lead to a healthier, more active lifestyle.

Unity's Bariatric Center has treated more than 5,000 patients for the disease of morbid obesity since 1996. From its beginning, the center has been a resource for community education, medical training, and patient care. The Center offers a variety of proven weight loss surgery options, including open or laparoscopic Roux-en-y gastric bypass surgery, and the increasingly popular laparoscopic adjustable gastric banding (including LAP-Band® and REALIZE Band™).

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Top ranked bariatric surgery center in Washington to close

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The skinny on gastric bypass surgery

Downey, CA

(Lakewood Regional Medical Center)

The majority of adults in the United States are overweight or obese, and obesity is a leading cause of death. Published scientific reports show that non-operative methods have not been effective in achieving significant long-term weight loss in severely obese individuals.

In recent years, society has shown increased awareness of the need for the treatment and prevention of obesity. Advances in technology and modern medicine have given those people a chance to have a longer and healthier life.

Bariatric surgery has proven to be the only effective intervention for weight loss in the morbidly obese.

“While it’s always best to lose weight through a healthy diet and regular physical activity, weight loss (bariatric) surgery may be the only real long-term solution for those who have been struggling with chronic obesity for years,” says Shyam Dahiya, M.D., a surgeon at Lakewood Regional Medical Center’s Bariatric Surgery Program.

Dahiya, a board-certified general and laparoscopic surgeon with more than 26 years of experience, has perfected the most advanced method of bariatric surgery, the Dahiya Vertical Micropouch. Laparoscopic gastric bypass surgery makes four or five small, half-inch incisions while surgeons view the operation on a television monitor.

“This recent and minimally invasive approach to bariatric surgery will provide the patient with a more rapid recovery, which allows patients to return to their normal activity faster,” said Dahiya, a fellow of American College of Surgeons. “This laparoscopic technique for the bypass allows many patients, many of whom might not consider baratric surgery as a long-term solution for their condition, the opportunity to treat obesity permanently with fewer side effects.”

Psychologists will counsel patients prior to surgery to help prepare them for a lifetime commitment. A team of medical specialists is also available at Lakewood Regional to assist patients in the months after surgery, including nurses, internists, anesthesiologists, cardiologists, gastroenterologists, registered dieticians, plastic surgeons, and registered physical therapists.

As obesity rates creep skyward, so do the number of Americans turning to surgery as a weight loss tool. Although today’s bariatric surgery is safer and more effective than earlier versions, the procedure is not an instant cure. Reserved only for the severely obese (those who tip the scales at 100 pounds or more over their normal body weight), bariatric surgery is a drastic step and patients must make radical, lifelong dietary changes, and permanent weight loss is not guaranteed.

Still, a growing number of doctors are recommending bariatric surgery for severely obese patients who find themselves at wits’ end about weight loss. In its clinical guidelines for obesity treatment, the National Institute of Health supports the use of bariatric surgery in the severely obese, citing studies that show the procedure often alleviates or eliminates many obesity-related conditions.

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Bariatric surgery by itself isn't enough

Los Angeles, CA

Throw out any thoughts that weight reduction surgery is a shortcut to svelte. The surgery, performed on about 200,000 Americans a year, is a last resort to rescue people in danger of dying early from the health consequences of their extreme obesity.

After years of question marks, studies now show the surgery saves lives, sustains long-term weight loss and combats -- maybe even reverses -- diabetes. But although it's much safer today, it still results in the death of 1 in 200 patients and can result in complications such as blood clots, hernias or bowel obstructions. Patients can end up back in the hospital to repair intestinal leaks that can lead to serious infection.

Because of these complications, a National Institutes of Health panel of experts has recommended the surgery only for people considered morbidly obese, roughly 100 pounds or more over their ideal body weight. People whose weight is that far out of control face a risk of death from diabetes or heart disease five to seven times greater than those of normal weight.

"These people don't have a lot of options," says Dr. John Morton, director of bariatric surgery at Stanford's Center for Weight Loss Surgery. "When someone is drowning, I throw them a life preserver. I don't have time to build a bridge."

About 14,000 Californians undergo weight-loss surgery each year. But according to American Society for Bariatric Surgery guidelines, more than 1 million Californians qualify medically: those with a body mass index of 40 or more, or 35 or more if they have conditions such as heart disease or diabetes.

Read more, Bariatric surgery by itself isn't enough.

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American College of Surgeons accredits Mini-Gastric Bypass procedure to settle lawsuit filed by surgical group

Greensboro, NC

Doctors with Cornerstone Health Care in High Point again can be reimbursed for bariatric surgeries after the American College of Surgeons agreed to settle a lawsuit and accredit their procedure.

Without accreditation from the group, Dr. Thomas Walsh and Dr. James Dasher could not have billed Medicare or many major private insurers for the weight-loss surgery. Cornerstone and High Point Regional Health System, where they perform the procedure, sued the college Feb. 5 in the Middle District of North Carolina claiming the group was trying to shut them out of the lucrative practice -- which generated more than $5.1 billion nationally for hospitals last year -- by denying accreditation.

The college agreed to accredit the program last week, and Cornerstone and High Point Regional have dropped their suit.

Dasher and Walsh began performing mini-gastric bypass surgery on morbidly obese patients at High Point Regional in 2002 and have done more than 650 operations since. In their suit, High Point Regional and Cornerstone said the average patient lost 120 pounds to 140 pounds and maintained the weight loss for at least 18 to 24 months after surgery.

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ORLive May 29, 2008 webcast: Experts discuss Lap Band(R) and laparoscopic Roux-en-Y bariatric procedures

Marshfield, WI

Live Webcast: From Saint Joseph's Hospital and Marshfield Clinic: May 29, 2008 at 4:00 PM CDT (21:00 UTC)

Bariatric surgery will be featured on the eighth webcast sponsored by Saint Joseph's Hospital and Marshfield Clinic. It is set for 4-5 p.m. Thursday, May 29.

During the webcast, Marshfield Clinic physicians on staff at Saint Joseph's Hospital and other Marshfield Clinic health care professionals will discuss the comprehensive bariatric program at Saint Joseph's Hospital and Marshfield Clinic. The program will feature Timothy Wengert, MD, performing a laparoscopic Roux-en-Y gastric bypass, and Anishur Rahman, MD, placing an adjustable gastric band (LAP-BAND®). There will also be a live panel discussion and analysis moderated by Marvin Kuehner, MD, who has performed bariatric surgery for more than 30 years. Wengert and Rahman will also participate in the discussion, along with David Winemiller, PhD, clinical psychologist; Chrisanne Urban, MS, RD, CD, Nutrition Services; and Sheila Blackmun, RN, BSN, bariatric surgery program coordinator.

Bariatric, or weight-loss surgery, has proven to be an effective tool to lose a large amount of weight, significantly improving one's health and well-being. More than 90 percent of patients are able to reduce or eliminate medications taken for certain obesity-related health problems, such as type 2 diabetes, hypertension and hyperlipidemia. In a Roux-en-Y gastric bypass, surgical staples are used to form a small pouch at the top of the stomach, thus restricting the amount of food that can be comfortably eaten at one time. This small pouch is then connected to the middle portion of the small intestine, bypassing the rest of the stomach and a portion of the small intestine to limit the absorption of calories. The LAP-BAND® also reduces the size of the stomach but because the small bowel is not involved, it does not interfere with absorption. The adjustable silicone band is placed around the upper part of the stomach and a plastic tube runs from the band to an access port placed just under the skin n the abdomen. This allows the surgeon to inject or remove saline to adjust the "tightness" of the band to facilitate weight loss.

The bariatric program at Marshfield offers a multidisciplinary approach to surgical weight loss in a professional, supportive environment. Health care professionals are sensitive to the unique challenges brought on by obesity and strive to care for and meet the individual needs of each patient.

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Gastric bypass surgery for teens

Creve Coeur, IL

Obesity in Children
Researchers report 30 percent of children in the U.S. are overweight or obese. The excess weight increases the risk for a number of health problems. About 69 percent of obese children have one risk factor for cardiovascular disease (like high blood pressure, high cholesterol or diabetes). 25 percent of obese children have two or more risk factors for cardiovascular disease. Overweight children are also at higher risk for developing asthma, back and joint pain, sleep apnea, depression and social stigmatization/isolation. In addition, overweight children often don’t lose the extra pounds and remain obese as adults.


Gastric Bypass for Weight Loss

In order to lose weight, a person must take in fewer calories and/or use up more calories in activity. Traditionally, that means eating a healthy, low-fat diet and getting more regular exercise.

Sometimes, diet and exercise aren’t enough. Obese patients who have failed traditional weight loss programs may be candidates for surgery. One surgical option for obesity is gastric bypass. Surgeons use staples to partition off the upper stomach into a very small section. Next, a cut is made into the lower intestine. Then the far end of the intestine is brought up to the new, scaled down stomach pouch. The procedure promotes weight loss in two ways. First, the size of the stomach is greatly reduced – limited to holding only a few ounces at a time. Thus, the patient becomes full very quickly. Second, the food goes directly from the new stomach section into the lower end of the intestine, bypassing most of the intestine and limiting the amount of calories that can be absorbed into the body.

Gastric Bypass for Teens

Traditionally, gastric bypass has been reserved for adults. However, more physicians are offering the treatment to obese teens. The National Institutes of Health says gastric bypass should only be offered for obese adolescents and teens who have tried to lose weight for at least six months and have not had success with traditional methods. Candidates need to have reached skeletal maturity (i.e., full adult height) and have weight-related health problems.

Carroll Harmon, M.D., a Pediatric Surgeon with the University of Alabama at Birmingham (UAB), says gastric bypass is not a procedure that should be taken lightly. Patients must be carefully selected and fully aware of the benefits, risks and permanent lifestyle changes associated with the treatment. Once the surgery is done, patients will initially be on a puree diet. After that, the amount of food that can be eaten at one meal is very small. Often a few bites will fill the stomach. Protein shakes are needed to ensure the teen gets enough protein and nutrients. Traditional teen foods, like hamburgers and french fries, need to be avoided. Sodas are discouraged because the carbonation makes the stomach feel full without getting any nutrients. So teens need to learn how to cope with the social consequences of their new food limitations. They must also understand the surgery requires a lifelong commitment to a change in dietary and lifestyle behaviors.

UAB's Center for Weight Management brings together a group of medical experts to help determine if gastric bypass is an appropriate option for a teen. Prior to selection, the teen must be on a medically supervised diet for at least six months. Several weeks before surgery, the teen is placed on the post-op diet and exercise program. The goal of this part of the treatment is to ensure the teen is comfortable with and will stick to the post-op diet and exercise requirements. Harmon says family members play a big role in ensuring the teen’s follow-through with long-term treatment. So patients must have a good family support system.

UAB is studying the safety and long-term effectiveness of gastric bypass for teens. The participants will be followed for five years. Other sites are located at Cincinnati Children’s Hospital, Texas Children’s Hospital and the University of Pittsburgh.

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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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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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Despite risks, gastric-bypass surgeries soar

Herald, FL

Monica Ramos lost about 200 pounds the hard way.

In 2004, a doctor stapled her stomach and rerouted her intestines.

A year later, Ramos collapsed in her home and was rushed to the hospital, where she needed another operation to stop internal bleeding.

Her weight-loss surgery represents the gamble that legions of morbidly obese Americans are taking every year. For many, it is worth the risk.

When Ramos had her initial operation, she was on 17 medications for diabetes and other ailments. Today, she needs no prescriptions. Her diabetes is gone; she feels great.

But the soft-spoken nursing student warns that surgery is not a cure for obesity.

"This is a lifelong commitment, and there are going to be days when you're sorry you've made this commitment," said Ramos, 26, who runs a support group in Orlando for weight-loss-surgery patients.

If current trends continue, she will be busy.

Weight-loss surgery -- commonly referred to as bariatric surgery -- has exploded in the United States from an estimated 16,200 procedures in 1992 to about 205,000 in 2007. 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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Another Complication For Gastric Bypass Patients

November 27, 2007

Obese patients who suffer complications after gastric bypass surgery may face further health risks because their weight exceeds the limits of diagnostic imaging equipment, according to a study presented November 27 at the annual meeting of the Radiological Society of North America. In the study, approximately 27 percent of patients weighing more than 450 pounds needed imaging to diagnose a problem after surgery and could not be accommodated because of their size.

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See also:

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• Today's Healthcare
• Medical Imaging
• Obesity

Matter & Energy

• Ultrasound
• Biochemistry
• Optics

Reference

• Interventional radiology
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• Minimally invasive procedure

"When patients weigh more than 450 pounds, standard diagnostic imaging often cannot be used," said Raul N. Uppot, M.D., an assistant radiologist at Massachusetts General Hospital (MGH) and instructor of radiology at Harvard Medical School in Boston. "In these cases, physicians must resort to other means of diagnosis such as exploratory surgery or using less accurate or more invasive techniques."

According to the Centers for Disease Control and Prevention, obesity has grown dramatically in the last 20 years. Today, nearly one-third of the American population is obese. Along with the rise in obesity among American adults has come an increase in the number of gastric bypass procedures performed.

The American Society for Bariatric Surgery estimated approximately 140,000 gastric bypass procedures were performed in the United States in 2005. In a gastric bypass procedure, the stomach is surgically reduced, and part of the small intestine is bypassed. Like any surgical procedure, gastric bypass is not without risks. Most common complications include suture tears and leaks, pulmonary embolism, pneumonia and infection. Serious complications tend to be more prevalent among the severely overweight.

Dr. Uppot and colleagues conducted an eight-year retrospective study of all patients weighing more than 450 pounds who underwent a gastric bypass procedure at MGH between June 1999 and April 2007. Patient imaging usage and clinical course were tracked using electronic health records and evaluated to determine the outcomes of those who, based on their weight, were denied their physicians' first choice of imaging. The maximum weight limit for a computed tomography (CT) table is 450 pounds.

The researchers found that 12 (27 percent) of the 44 patients who weighed more than 450 pounds required postsurgical imaging because of a clinical condition, but were denied because they were above the weight restriction for the equipment. Four patients who could not be evaluated with imaging for suspected leaks were required to return for surgery.

Two additional patients with suspected lung blood clots could not undergo a chest CT. Of two patients who came in with nonspecific abdominal pain, one was evaluated with ultrasound and the other one had a barium swallow test. Because imaging was not an option, one patient who suffered trauma underwent exploratory surgery in lieu of noninvasive imaging. Another patient was denied a chest CT and received no further imaging evaluation.

"When obese patients cannot be diagnosed using standard-of-care imaging techniques, then other diagnostic measures have to be instituted," Dr. Uppot said. "Patient care may be ultimately affected due to a compromised diagnosis."

Dr. Uppot noted that the obesity trend cannot be ignored. "Unless major changes are made to the American diet or exercise habits, this is a problem that we will have to address," he said. "When an obese person is contemplating gastric bypass surgery, he or she should consider that they will need follow-up imaging but may not be able to get the appropriate tests."

Co-authors of the paper presented by Dr. Uppot are D.V. Sahani, M.D., D.A. Gervais, M.D., P.R. Mueller, M.D., P.F. Hahn, M.D., Ph.D., and S.I. Lee, M.D., Ph.D.

Adapted from materials provided by Radiological Society of North America.

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Gastric Bypass: Star Jones Opens Up About Her Weight Loss

November 22, 2007

For years, Star Jones Reynolds refused to reveal how she lost half of her body size, but now a confident and secure Star is talking in detail about her gastric bypass surgery --- to Access Hollywood’s Tim Vincent.

“The only reason I am talking to you today is to help other women understand they are not by themselves. They are not alone,” Star told Tim.

“Do you regret not having said something earlier?” Tim asked.

“I really wished, god, I could have. I really do. If there’s a regret that’s it,” Star said. “The regret is I wish I was stronger.”

Undergoing gastric bypass surgery in 2003, it wasn’t until August of this year that Star Jones Reynolds finally went public on how she dramatically lost 160 pounds. More >>

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LAP-BAND(R) System Weight-Loss Surgery Associated With More Than 70 Percent Reduced Risk of Death in People With Severe Obesity

November 21, 2007

About Obesity

In the United States, obesity is considered the second leading cause of preventable death (7). Further, research has shown that individuals with a BMI of 35 or more have a reduced life expectancy of nine to 13 years (8). A BMI of 35 or more translates to a weight of 200 pounds or more for a woman of average height (5' 4") when ideal weight at this height is considered to be 140 pounds, and to a weight of 250 pounds or more for man who is six feet tall when ideal weight for this height is considered to be 177 pounds.

About the LAP-BAND(R) System

The LAP-BAND(R) System was approved by the FDA in June 2001 for severely obese adults with a Body Mass Index (BMI) of 40 or more or for adults with a BMI of at least 35 plus at least one severe obesity-related health condition, such as Type 2 diabetes, hypertension and asthma. Used in more than 300,000 procedures worldwide, this simple reversible surgically implanted device has safely helped severely obese adults successfully achieve and maintain long- term weight loss.

The LAP-BAND(R) System was developed to facilitate long-term weight loss and reduce the health risks associated with severe and morbid obesity. Unlike gastric bypass, it does not involve stomach cutting, stapling or intestinal re-routing (9,10). Using laparoscopic surgical techniques, the device is placed around the top portion of the patient's stomach, creating a small pouch. By reducing stomach capacity, the LAP-BAND(R) System can help achieve long-term weight loss by creating an earlier feeling of satiety. The LAP-BAND(R) System is adjustable, which means that the inflatable band can be tightened or loosened to help the patient achieve a level of satiety while maintaining a healthy diet. It is also reversible and can be removed at any time.

Severely obese people who received the LAP-BAND(R) Adjustable Gastric Banding System to lose weight had a 72 percent reduction in their risk of dying compared to obese people who were not offered any specific weight-loss treatment, according to findings published in the December issue of the Annals of Surgery (1). The LAP-BAND(R) System was approved in June 2001 by the U.S. Food & Drug Administration for weight reduction in severely obese adults.

"This research is critical because it shows that people with severe obesity, who are known to be at a much higher risk than the general population for dying prematurely, may be able to significantly decrease their risk with laparoscopic adjustable gastric banding," explains Dr. Paul O'Brien, FRACS a study author from the Monash University Centre for Obesity Research and Education (CORE) in Melbourne, Australia, head of the Centre for Bariatric Surgery in Melbourne and the National Medical Director for the American Institute of Gastric Banding in Dallas, Texas. "What is also particularly compelling is that this study shows it is possible to gain a significant survival benefit without the risks associated with more invasive bariatric surgical procedures, such as gastric bypass." http://www.earthtimes.org/articles/show/news_press_release,228703.shtml

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Luqaimat Diet or Gastric Bypass Surgery

November 16, 2007

Thousands of obese people who had gastric bypass surgeries achieved long-term weight loss. In contrast, the majority of the millions who did dieting, exercise, and used weight-loss drugs failed to maintain their achieved new weights. The scientific reasoning for that observation was described in a medical article at New England Journal of Medicine, May 23rd, 2002.

British scientists found that hunger hormone (Ghrelin) blood levels were raised in those who perform dieting, while it was sharply low at those who had gastric bypass. The lead author David E. Cummings, MD, postulated that if we can block Ghrelin medically we will not feel hunger pains, hence will keep weight off for long. Gastric bypass surgery, works because of two reasons. First, it dramatically reduces the active gastric size to only 5% of the original pre-operative size; therefore, it reduces the food intake volume dramatically. Second, it suppresses the gastric mucosal cells secretion of Ghrelin, due to the contact of food with a very small gastric surface area. more >>

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ORLive Presents: Minimally Invasive Roux-en-Y Gastric Bypass

November 7, 2007

Gastric Bypass Weight-loss surgery is the first surgery PinnacleHealth is scheduled to host on the Internet over the next year. Luciano DiMarco, DO, FACOS, medical director of bariatric surgery at PinnacleHealth, will perform Roux-en-Y Gastric Bypass on www.OR-Live.com. Since 1998, Luciano DiMarco, DO, FACOS, and his partners, have performed this surgery laparoscopically, reducing chance of infection, shortening hospital stay and improving recovery time.

Airing gastric bypass weight-loss surgery online gives prospective and current patients a behind-the-scenes look at what happens during surgery. It showcases the laparoscopic technique.

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The Bariatric Surgery Conundrum

November 18, 2007 - New York Times

This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese.

Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.”

Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ’70s and early ’80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.”

Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some circumstances — one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on — the overall mortality rate is now in the neighborhood of 1 percent.

But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications — physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000.

But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut — in fact, Bessler does consult for companies in the industry — the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced “complete resolution” of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea. From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions. That’s why some insurance companies cover bariatric surgery — as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about?

On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.” More >>

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Allergan, Covidien to Market Lap-Band Gastric Bypass Surgery Alternative

Nov. 12, 2007, 9:28AM

IRVINE, Calif. — Allergan Inc., which makes Botox and sells surgical weight-loss devices, said Monday it will co-promote its Lap-Band product with health care products provider Covidien Ltd.

The Lap-Band is an adjustable gastric band, a device surgically implanted around the stomach to help severely obese patients lose weight by forcibly limiting food intake. The procedure is an alternative to more invasive gastric bypass surgery, commonly known as stomach stapling.

Under the multi-year agreement, which became effective Nov. 9, Covidien will co-promote Allergan's Lap-Band to bariatric and other surgeons in the United States. Pembroke, Bermuda-based Covidien makes medical devices and pharmaceutical products.

Covidien's sales representatives will help educate and train surgeons on the Lap-Band procedure, which costs roughly $12,000 to $20,000. Irvine, Calif.-based Allergan said it will continue to recognize revenue from the Lap-Band. Other financial terms of the deal weren't disclosed.

Allergan acquired the Lap-Band with its 2006 purchase of Inamed.

In late September, the Food and Drug Administration cleared Johnson & Johnson's Realize gastric band, effectively ending Allergan's dominance in the adjustable gastric banding market.

Shares of Allergan rose 47 cents to $65.25 in morning trade, while Covidien's stock rose 12 cents to $39.56.

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Roux-en-Y Gastric Bypass Surgery Live on ORLive, 11/7/2007

ORLive Presents: Minimally Invasive Roux-en-Y Gastric Bypass Weight-Loss Surgery Webcast: November 7, 2007 6:00 PM EST

Weight-loss surgery is the first surgery PinnacleHealth is scheduled to host on the Internet over the next year. On Wednesday, November 7 at 6 pm, Luciano DiMarco, DO, FACOS, medical director of bariatric surgery at PinnacleHealth, will perform the gold standard of weight-loss surgery, Roux-en-YGastric Bypass, at the PinnacleHealth Community Campus, on www.OR-Live.com.

Video-Link Available: http://www2.marketwire.com/mw/frame_mw?attachid=610003

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Gastric Band Competition in the Bariatric Surgery Market

Allergan, J&J face off in obesity market
October 12, 2007: 03:32 PM EST

Oct. 12, 2007 (Thomson Financial delivered by Newstex) --

NEW YORK (AP) - The recent approval of Johnson & Johnson's (NYSE:JNJ) Realize gastric band has stepped up competition in the surgical weight-loss market, which until now has been dominated by Allergan's (NYSE:AGN) Lap-Band.

The Lap-Band and Realize are adjustable gastric bands, which are surgically implanted around the stomach to help severely obese adult patients lose weight by forcibly limiting food intake. This procedure presents an alternative to more invasive gastric bypass surgery, commonly known as stomach stapling.

Analysts predict the Realize will cost about the same as the Lap-Band procedure, roughly $12,000 to $20,000. In what could be a fierce battle for market share, some analysts see the companies eventually splitting the market.

Irvine, Calif.-based Allergan, which also makes Botox, acquired the Lap-Band with its 2006 purchase of Inamed and has so far faced no competition in the U.S. market. But on Sept. 28, J&J's Ethicon Endo-Surgery Inc. unit said the Food and Drug Administration cleared its Realize band, ending Allergan's honeymoon a few months earlier than expected.

J&J plans to launch Realize in December; analysts hadn't expected approval until the end of the year or early 2008. More >>

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