Weight-Loss Surgery: An Answer for Some
By Dr. Adolfo “Fuzz” Fernandez
When I was in the third grade, my pediatrician told my mother that she needed to work on helping me lose weight. So she started pushing fruits and vegetables and made me cut back on sweets.
I don’t remember the diet helping much, but I do remember feeling self-conscious about my weight around other kids at school. Eventually I slimmed down, but that experience helps me understand the patients who come to see me for weight-loss surgery.
I believe my patients when they tell me they’ve tried dieting, but that instead of losing weight they end up in a yo-yo of weight loss and weight gain until they’ve gained more than they ever lost. And I know that when they come to me for surgery, they’re not looking for what some call the easy way out. They simply want a life they can enjoy. They want to be seen and heard. They want to come out of the shadows.
More than two thirds of Americans fit the definition of overweight. That means that their body mass index, a ratio of weight to height, lies between 25 and 30. Patients are considered obese with a body mass index greater than 30, but we rarely consider surgery for anyone with an index lower than 35. And most of our patients have a body mass index higher than 40, which for a woman with an average height of 5’4” means a weight of 232 pounds.
[Use our online BMI Calculator.]
For patients who don’t qualify for surgery, we recommend prevention. In another era walking, fresh vegetables and home-cooked meals with family was a way of life. Today, they’re the bullet points in a doctor’s order:
- Avoid restaurants and cook for yourself at home as much as possible.
- Eat five servings of fruits and vegetables each day.
- Choose activities at home that keep you moving and limit screen time – computer and TV – to less than two hours a day.
- Aim for one hour of physical activity each day. You don’t need to join a gym. Walk around the neighborhood. Take the stairs instead of the elevator. Choose a parking spot at the far end of the lot, so you have a longer walk to the store.
But when the quest for healthy living fails – and often it does -- surgery is a good option, especially for a patient with chronic health problems tied to obesity like diabetes, high blood pressure and sleep apnea.
Fortunately the surgical options for weight loss can be performed via laparoscopy which is the least invasive approach for surgery. The benefits of laparoscopy include less pain, fewer wound complications such as infection or hernia, and patients return more quickly to pre-surgical levels of activity. There are three surgical techniques for weight loss offered at Wake Forest Baptist Health. These are the adjustable gastric band, the vertical sleeve gastrectomy and the Roux-en-Y gastric bypass. All of these are performed laparoscopically.
The adjustable band fits around the opening to the stomach. When the band is tighter, patients feel less hunger. We don't understand exactly how it works, but we believe the band interrupts hormone secretions that make us "feel" hungry. The procedure requires several follow-up visits to adjust the band. This procedure has the least weight loss of all weight loss procedures and has a higher rate of needing another surgery in the future compared to the Sleeve Gastrectomy or the Roux-en-Y gastric bypass.
The vertical sleeve gastrectomy is the newest and most common procedure performed at Wake Forest Baptist Health. Most of the stomach is removed during this procedure and a sa result it is not reversible. The weight loss after this surgery is similar to the Roux-en-Y gastric bypass but has less risk.
The Roux-en-Y gastric bypass is the oldest and most well known procedure. A small pouch is created out of the top part of the stomach and a piece of small intestine is coneected to it to bypass the majority of the stomach and some of the small intestine. Food then travels directly from a small stomach pouch to the small intestine. Patients eat less because there's little storage space left in their digestive system. The bypass also makes patients feel less hunger and helps control diabetes. It is the highest risk but offers the best weight loss and impact on obesity related diseases including diabetes mellitus.
Surgery doesn’t cure obesity. It’s simply a tool to help patients control their weight. But it’s a tool that transforms lives. After surgery, my patients still need a healthy lifestyle that includes daily exercise, plenty of fresh fruits and vegetables and home cooking. But at least with surgery their appetites are smaller and they find they make the healthy choices that once seemed impossible.
Studies show that weight loss surgery reduces the risk of cancer, heart disease and diabetes. Patients crippled by joint disease can walk again, even run and play ball.
Anyone with a weight problem knows the embarrassment that comes with excess weight. But patients who are morbidly obese – 100, 200, 300 pounds overweight – live isolated lives of shame. Some of my patients have dropped out of school. They can’t hold a job. They fear any kind of intimate relationship.
Weight loss surgery gives them a chance to leave those shadows behind.