The new year is a time when resolutions to shed excess pounds occur. For those struggling with morbid obesity, however, lifestyle changes like diets and exercise may not bring the dramatic weight loss needed.
Morbidly obese adults can find a solution in bariatric surgery. As defined by the National Institute of Health, (NIH), surgical candidates must have a body mass index (BMI) of 35 with co-morbidities of diabetes, hypertension or sleep apnea, or a BMI of 40 without such conditions.
A surgical procedure should be viewed as a tool to help patients in their weight battles. It requires effort to change one’s lifestyle to obtain optimal outcomes. The operation is one element of a comprehensive, multidisciplinary approach to weight loss including healthy diet and exercise.
There are choices in bariatric surgery. The gold standard of procedures is gastric bypass, in which part of the stomach is excluded and a portion of the small intestine is bypassed — restricting the amount of food consumed as well as reducing the absorption of calories. The bypass has the best longstanding data on resolution of Type 2 diabetes, with over 85 percent of patients seeing resolution of this life-threatening condition within a month of surgery.
Another surgical option is the gastric sleeve, which reduces the capacity of the stomach, creating a banana-sized pouch. Food consumption is restricted, but the absorption of nutrients and calories remain unchanged.
Both the gastric bypass and gastric sleeve can be performed laparoscopically with six tiny incisions in approximately an hour. Both require an overnight stay in the hospital, with the patient returning to work in one to two weeks.
Most insurance companies offer coverage for bariatric surgery if patients meets NIH criteria and their policy requirements.
The newest procedure, the gastric balloon, is an endoscopic procedure involving inserting a silicon saline filled balloon into the stomach, creating a feeling of fullness. The balloon procedure is currently not covered by insurance. It must be removed six months after placement — thus results may not be lasting. Until further data is available, this procedure is not yet available at most bariatric centers.
The choice of which procedure is best for each individual should be determined through consultation with a bariatric professional. Consideration of past medical, psychological and surgical history, medication needs, dietary preferences and ability for activity should all be taken into consideration. Successful patients must be educated, coached, supported and followed by an experienced multidisciplinary bariatric program involving a surgeon, allied health professionals, bariatric nurses, a dietician and an exercise physiologist.
Bariatric surgery is now the recommended treatment for long-term results for morbidly obese adults meeting requirements by the NIH. Choosing the right experienced surgeon, program and procedure and a determination for lifestyle change is imperative for excellent results.
Dr. Joshua P. Steiner and Karen M. Hillenmeyer are with KentuckyOne Health at Saint Joseph East.