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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Obese student seeks charitable donations for gastric bypass surgery

Seattle, WA

A Seattle college student doesn't want to be the "biggest" man on campus and has started a Web site asking for donations to help him get gastric bypass surgery.

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Weight loss surgery improves sexual function in men

New York, NY

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

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

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

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

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

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

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

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

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

Winter Park, FL

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

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

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

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

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

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

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VBLOC implant: Gastric bypass surgery alternative

Researchers believe that they might be able to combat obesity by blocking the nerve that helps regulate digestion, the vagus nerve.

An implantable device that uses electrical signals to block the vagus nerve, which helps regulate digestion, has shown early success in clinical trials. The experimental therapy, developed by Enteromedics, a medical-device company based in St. Paul, MN, is part of a growing trend to develop alternatives to gastric bypass surgery, an often highly successful but invasive procedure to curb obesity.

"We need an approach to this that is safer than current alternatives and efficient to perform," says Christopher Thompson, a surgeon at Brigham and Women's Hospital who tests new surgical tools and methods.

As the obesity epidemic booms, so has the number of people undergoing gastric bypass surgery, a procedure in which the stomach is surgically reduced to about the size of a lemon. The American Society for Metabolic and Bariatric Surgery estimates that gastric bypass rates have doubled in the United States in the past five years, from about 100,000 in 2003 to approximately 200,000 in 2007.

While gastric bypass often leads to dramatic weight loss, only a small percentage of people eligible for the surgery--those with a body mass index (BMI) of more than 35--actually choose to do it. That may be because the procedure comes with some serious risks and is irreversible, requiring permanent dietary restrictions and nutritional supplements. "Many people who really need the procedure don't seek out medical attention because they're worried about potential medical complications," says Thompson. "We're only treating a small fraction of eligible patients."

A new option is on the horizon. At a neurotechnology conference in Boston last week, Enteromedics described positive preliminary results from a European trial of its vagal blocking therapy, called VBLOC.

The device uses an electrical stimulator to block signals from the vagus nerve, which connects the brain to the gastrointestinal organs, regulating hormones and other factors involved in satiety and hunger. "It controls how the stomach expands when we start to eat," says Mark Knudson, chief executive officer at Enteromedics. "If it doesn't expand, we become full after a few bites."

In the procedure, two small electrodes are laparoscopically implanted next to vagal nerve fibers at the top of the stomach. A regulator implanted under the skin sends high-frequency pulses of electricity to the electrodes, which are thought to block the signals coming from the vagus nerve. While scientists don't know exactly how it works, they theorize that the device blocks signals that would normally tell the stomach to expand to accept food, as well as trigger the release of digestive enzymes and gastric acid, potentially slowing digestion. Many patients report feeling less hungry and feeling fuller earlier, says Knudson.

An analysis of nine patients who were among the first to receive the implant shows that they lost almost 30 percent of their excess body weight after nine months. And preliminary data from a larger group indicates that following the procedure, patients ate an average of 500 fewer calories per day. "That's less than you'd see for a lap band or a gastric bypass, but it's still pretty good," says Janey Pratt, a surgeon at Massachusetts General Hospital, in Boston. More >>

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Despite risks, gastric-bypass surgeries soar

Orlando, FL

Gastric-bypass procedures can be effective -- but require a lifelong commitment.

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 Orlando 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 pa- tients.

If current trends continue, she will be busy. More >>

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Gastric bypass surgery gives 38-year-old new opportunities

December 1, 2007

Four years ago, Wendy Juliano struggled with health problems and could barely walk up a flight of stairs or bend over to tie her shoes, all because of her weight.

The Gilbert 38-year-old wanted her life back. So in March 2004, she underwent gastric bypass surgery, which created a small stomach pouch to restrict her food intake.

At 5 foot, 4 1/2 inches tall, she went from 290 pounds to her lowest at 123 pounds.

She was able to stop taking her heart and asthma medicine, stopped her breathing treatments and has a renewed sense of energy and self-worth.

“I’m a full-time wife, full-time student, full-time employee, full-time mom and full-time grandma,” said Juliano, who is due in March with her third child. more >>

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Carnie Wilson re-gains most of weight lost after gastric bypass surgery

November 29, 2007

Singer CARNIE WILSON is struggling with her weight again after piling on the pounds following the birth of her baby daughter. The Wilson Phillips star underwent gastric bypass surgery in 1999 when she weighed an estimated 300 pounds (136 kilograms) - but insists that wasn't the end of her weight worries. Wilson admits she's still fighting to get fit after weighing in at 240 pounds (108.8 kilograms) following the birth of baby Lola in April, 2005. She says, "I was back to 240 pounds after I had my baby. It's (weight) never going to be what I want it to be, always when I want it to be. I'm struggling with 30 (pounds) now."

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Obese Couple has Gastric Bypass Surgery Together

They're happy newlyweds that once looked like different people.

Dawn Marie holds up an old pair of jeans. "These are a size 30, and now I'm a size 8!" Her now-husband, Frankie does the same, telling INSIDE EDITION, "These are a size 78, and now I'm a size 36."

Dawn Marie and Frankie Hveen can now share a pair of his old jeans! His old shirts look like bed sheets, and his belt, amazingly was almost seven feet-long.
About four years ago, the Long Island, New York couple vowed to go from obese to fit...together. He was a massive 550 lbs! She tipped the scales at 400! But Dawn Marie says, "I saw myself in a box, and I didn't want to die." They were inspired to lose weight after the death of Frankie's 27-year-old sister Margaret, who weighed as much as 700 lbs.

After undergoing gastric bypass surgery, they began a diet of healthy food and regular exercise.

The weight loss from before to after is dramatic. Combined, they've lost an amazing 550 pounds. Dawn Marie is now a trim 160, and Frankie's a shadow of his former self at 235!

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