For some of us, however, the goal isn’t merely elusive: It’s out of reach. No amount of dieting or exercise is going to lead to significant and lasting weight loss. We are — in medical terms — obese. And the more obese we are, the less likely we are to lose weight and keep that weight off through diet and exercise.
Some people who have made repeated serious-but-failed attempts at traditional weight loss programs are turning to weight loss surgery, which is called “bariatric” surgery. This type of surgery alters the digestive system to help people lose weight by limiting how much they can eat. Bariatric surgeries have become so popular that about 200,000 of them are performed each year in the U.S., a tenfold increase since the early 1990s. Although they were considered to be rather exotic, high-risk procedures not long ago, they have now become a safe, relatively standard, and effective surgical approach to a lifestyle problem.
In fact, these surgeries have become so effective that many healthcare insurers in Virginia and at least 47 other states as well as Medicare and Medicaid cover them, as long as the somewhat stringent eligibility requirements and patient education requirements are met.
In the Lynchburg area, Joshua B. Alley, MD, is the medical director of bariatric surgery for Centra Health. He says that his center’s criteria for people who are seeking bariatric surgery is fairly straightforward and is determined largely by healthcare insurers.
Candidates for surgery at Centra should first speak with their primary care physician or specialist (especially if the patients are being followed by a cardiologist or by a diabetes specialist). If that physician believes that the individual is a good candidate for bariatric surgery, Centra Health holds free monthly seminars to provide detailed information on the surgery. Candidates complete an evaluation by hospital dietitians, pre-surgery educational programs that are run by dietitians and bariatric surgery nurses, an assessment of any related health problems such as diabetes or heart disease, and a psychological assessment.
One key criterion for surgery is having a body mass index (BMI) of 40 and above, if there are no accompanying medical problems. If a person has diabetes, blood pressure issues, sleep apnea, reflux, or any other weight-related ailments, the BMI requirement drops to 35, Dr. Alley notes.
Body Mass Index
BMI is a measurement of body fat based on each person’s weight and height. It’s a numerical score that applies to both women and men, and it is used to indicate whether a person is underweight, of normal weight, overweight, obese, or severely obese. If you score a BMI of between 18.5 and 25, you are considered to be a normal weight for your height. If your BMI is between 25 and 30, you are considered overweight. Medical professionals consider you to be obese if your BMI is 30 or higher and severely obese if you have a BMI of 40 or higher.
About two out of every three American adults are overweight, and one out of three can be said to be obese. In 1990, hardly any states had obesity rates of more than 15 percent; today, all 50 states have obesity rates of at least 20 percent. A 2012 study in the Journal of Health Economics estimated the medical-care costs of obesity in the U.S. in 2005 to have been as high as 190 billion dollars, a figure that is steadily increasing each year.
This is a serious problem because weight gain gives rise to looming health risks. The physical ailments that are associated with obesity include higher rates of heart disease, stroke, diabetes, sleep difficulties, and joint problems as well as an increased risk of certain types of cancers. Obesity, in fact, has become second only to tobacco as a major killer in the United States. This is part of the reason that healthcare insurers cover bariatric surgery. The surgery helps prevent the costs of serious weight-related diseases.
Bariatric surgeries do not remove fat tissue. Instead, surgeons rework the stomach and intestine to help a patient feel full more quickly, ingest fewer calories, or both.
Types of Surgery
At Centra Health, surgeons perform three types of bariatric operations, all of them laparoscopic surgeries. These are types of surgeries in which small “keyhole” incisions rather than one large open incision allow surgeons to introduce a video camera and surgical instruments.
Gastric bypass surgery is the “old faithful” of the bariatric operations. It has been in use for the longest time and often offers the best and longest-lasting results. In this surgery, the stomach is made smaller by creating a small pouch at its top using surgical staples. The smaller stomach is then connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.
In a sleeve gastroectomy, the stomach is surgically narrowed to resemble a sleeve. The smaller stomach pouch is about 15 percent the size of the “original,” and the capacity of the stomach is reduced from about 1½ quarts to between 4 and 6 ounces.
The third approach, gastric banding, is falling out of favor with surgeons and patients alike, Dr. Alley says, because of the intensive level of follow-up that it requires. In this type of surgery, a device is wrapped around the upper part of the stomach to form a ring. A thin tube is attached to the ring, and an access port in the body allows surgeons to tighten or loosen the band by injecting saline solution.
The recovery time with all of these approaches is relatively rapid, with most patients going home a day or two after their surgeries and getting back to work about a month later, depending on the kind of work they do.
Health professionals do say, however, that bariatric surgery does not signal the end to a person’s fight against obesity. For those who turn to surgery after diet and exercise have failed, the surgery can create new and different nutritional, medical, and physical challenges along with changes in their emotional behavior. “The key is that the patient’s eating and fitness habits have to change, lifelong, to keep the weight off,” Dr. Alley stresses. “The surgery can serve like a ‘reset button’ to get the weight off so that a person can finally exercise without pain and be satisfied with a small healthy meal, but keeping the weight off long-term depends on making these habits permanent.”
For more information, you can reach Centra Health bariatric surgery at http://www.CentraWeightLoss.com or call 434.200.3908.
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