Gastric bypass seen as obesity treatment

By Angela Loiacono

Molly Schneider scheduled her gastric bypass surgery to combat her weight problem. She wanted to look better and improve her health. Three days before she was going to undergo surgery, she suffered a stroke. After undergoing open-heart surgery to correct the problem, her new focus was to be healthy enough to have a family and a full life.

When health concerns due to obesity become too much, a potentially dangerous surgery becomes an option in the treatment process. Cindy Abner decided to have gastric bypass surgery so that she would be able to see her children and grandchildren grow up.

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“Bariatric surgery is a safe treatment, especially when it’s compared to staying at an obese weight,” said Kristina Adams, a registered dietician at Carle Hospital. “You’re running into complications with your health when you carry around that extra’re risking longevity, quantity of life, as well as quality of life.”

Obesity surgery will be performed more than 150,000 times this year in the United States, according to the American Society for Bariatric Surgery. In 2003, more than 103,000 Americans specifically underwent gastric bypass surgery, according to the American Society of Plastic Surgeons. Carle Hospital in Champaign estimates that gastric bypass surgeon Dr. Uretz Oliphant conducts between 75 and 100 surgeries each year.

“Our society is increasing in weight overall,” said Dr. David Klem, surgeon at Central DuPage Hospital in Winfield. “The significance of obesity is becoming more well-known because of the media . and the surgery is gaining popularity.”

Nearly one-third of adult Americans, about 60 million, are obese, according to the American Obesity Association.

There are three distinct forms of obesity surgery. With the restrictive procedures, sutures, staples or bands are used to create a small pouch in the upper portion of the stomach that is separated from the rest of the stomach. This pouch holds less than one cup of food. It restricts the patient and forces them to only eat small amounts of food, resulting in weight loss.

“The absorption of nutrients in the GI track, the nutrition, is the same,” said Dr. Jeffrey Rosen, medical director for the Weight Intervention and Surgical Healthcare (WISH) Center in Downers Grove. “All you’re doing is limiting the amount someone can eat . the complications are minimal.”

An alternative form of bariatric surgery is the malabsorptive procedure. This type of surgery reduces stomach size and rearranges the small intestine so that only a small amount of the intestine can absorb food. The rest is expelled as waste.

“These people really don’t limit the amount that they eat,” Rosen said. “They don’t absorb as much . you only absorb the absolute minimum to survive.”

The most common surgery, Roux-en-Y gastric bypass, is both restrictive and malabsorptive. It is a combination procedure involving both elements.

A section of the small intestine is then attached directly to the pouch. This shortened intestine absorbs less food. The new stomach pouch also only holds one cup of food. This forces the patient to eat less and also forces the body to absorb less.

The cost of the surgery, between $20,000 and $30,000 is not always covered by insurance. The surgery also has generally been reserved for patients ages 18 and older. The WISH Center, however, will perform the surgery on adolescents as young as age 13 if it feels the risk of continuing to be obese will outweigh the risk of surgery.

“If they are morbidly obese at 15 years old and they have tried supervised diet, and they’re not losing weight, and there is not a medical reason for it, they will continue to gain weight,” Rosen said. “And they won’t live to 60 years old.”

In 1991 the National Institute of Health convened to determine what qualifications a person must meet in order to be accepted for weight-loss surgery. In addition to being obese, a patient must also go through extensive evaluations. They must also have tried and failed supervised diets and exercise plans. Many surgeons also require that the patient have a consultation with a dietician, undergo a psychological evaluation and also meet with the surgeon.

The health concerns associated with carrying around excess weight are very serious. And in a society that is so heavily focused on weight and appearance, self-esteem and depression also provide a strong incentive to undergo the obesity surgery.

“I would be made fun of by kids in high school as I would walk past their tables during lunch,” Schneider said. “Some of the hardships growing up were . looking at a folding chair and wondering if it would buckle if I sat in it, or trying to find clothes that fit.”

The weight loss associated with the surgery has drastically affected the lives of people.

“I automatically thought people didn’t like me because of the way I looked,” Abner said. “Now, if they don’t like me, too bad for them. I am someone worth knowing, and I finally know it.”

Generally, a patient will lose between 60 and 80 percent of their excess weight. Long-term figures show that 10 to 15 years later, the great majority of patients have maintained at least a 50 percent weight loss, according to Oliphant. Percentage of weight loss, however, varies among surgeons and the education of a patient and how well they follow through with their post-surgery lifestyle.

Obesity surgery has also been proven to greatly reduce several health conditions including diabetes, sleep apnea, high blood pressure and high cholesterol.

There are several risk factors involved with obesity surgery. Complications may include infection around the wound, abdominal hernias, gallstones, nutritional deficiencies, blood clots, leaking at the closure of the staple line and death.

“I was fearful of the risk factors associated with gastric bypass surgery,” Schneider said. “However, I was more fearful of what was going to happen to me if I didn’t have the surgery . I knew that if I kept going on the path I was on that much worse was going to happen.”

Schneider has suffered from kidney stones and reactive hypoglycemia as a result of her surgery. She has also had trouble controlling her emotions and often got sick while eating at work after her surgery due to stress.

Gastric bypass surgery, which also limits food absorption, causes a nutritional deficiency in the body. As part of the post-surgery procedure, a patient is required to take supplements in order to combat the malnutrition that may occur.

But for many patients, the possible negative effects outweigh the positive.

“I can go out to dinner without feeling like people are watching me, and what I chose to eat,” Schneider said. “As a single woman, seeing the way guys look at you is completely different. The response from people that haven’t seen you in a while is the greatest feeling in the world.”

Some experts are becoming worried that the surgery is becoming a quick fix. More and more people are using the surgery in place of diligently following an exercise and diet plan to shed pounds.

“I think it’s shifting down to more people who are copping out and just don’t want to focus on their diet,” said Dr. Donald Layman, professor of nutrition at the University. “They just want the surgery. We happen to be a society that wants to think that taking pills or surgery are good ways to correct bad lifestyles, and that’s a pretty dangerous way to go.”

But for some patients, the risks and hardships associated with obesity will always outweigh the risk and cost of weight-loss surgery.

“It, in a way, is like starting a new life,” Schneider said.