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.
The least invasive procedure helps control hunger with an adjustable band that 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, but other than that, most patients have few side effects.
The band works well for some patients – but not all. Patients who are not candidates for lap band procedures need surgery that changes the structure of their digestive systems. The most common of these more invasive procedures, the Roux-en-Y gastric bypass, uses a piece of small intestine to bypass the majority of the stomach. 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. Some patients opt for an irreversible procedure that reduces the size of their stomach by 85 percent – the sleeve gastrectomy. The smaller stomach still functions, but patients can’t eat as much as they once did.
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.