Ask the Doc: When is bariatic surgery an option?

Sep. 18, 2013 @ 11:34 AM

Dear Doc Littleton,

Does weight loss surgery work? Who can have it?

This is a common question I hear, and the answer is yes if the patient truly needs it and will persist with the discipline weight loss surgery and counseling can teach.

There are three common surgeries done for weight loss (bariatric surgery). There are some interesting experimental techniques also ongoing. We will cover these in a future column.

The qualifications for surgery usually include a person who has a body mass index (BMI) of 40 or a BMI of 35 with a medical condition related to obesity such as diabetes, high blood pressure, high cholesterol, sleep apnea, severe reflux, etc. In other words, a 6-foot person weighing 290 pounds or 260 pounds with an illness would be considered.

There are roughly 200,000 bariatric surgeries done in the United States every year, mostly in accredited medical centers. Think of it as two full Neyland Stadiums of patients losing weight from surgery.

The benefits can be enormous and life-changing, if not life-extending.

Beyond physical appearance, diabetes may be resolved 77 percent of the time, high blood pressure nearly resolved, sleep apnea reduced and joint pain significantly lessened by the weight loss. The vast majority of the successes are seen in medical centers who focus a team of physicians, nurses, and counselors who prepare the patient mentally for the change and follow-up frequently after surgery.

Simply expecting to meet a surgeon and have a surgery is risky and full of failure and complications.

The key — isn’t this true in most things? — is mental. Learning to be satisfied with less calories and why certain food choices were made before is a significant part of success. Some of us eat for comfort and some of us just eat out of habit or boredom. The psychological motives and outcomes of weight loss must be addressed and followed for any success to occur.

Most patients succeed in losing weight with the variables being which surgery, amount of follow up and motivation. Some don’t. There are ongoing long term studies to determine which surgery is best for weight loss, has the least complications, and doesn’t cause malabsorption in the gut.

There are risks, too. There is always a risk of surgical complications including death, especially in the obese patient. Complications down the road may be malabsorption in the gut, pain, severely irregular bowel movements, internal bleeding and difficulty swallowing just to name a few.

Nevertheless, the significant improvement in fatigue, diabetes, high blood pressure, ability to sleep well, less pain during the day from arthritis, and reduction in risk of heart attack and stroke, make bariatric surgery something an obese patient should consider with their physician.

I have seen some patients really struggle with surgeons who set up in smaller hospitals, perform some surgeries and leave town for the next better opportunity in a small hospital needing revenue. My advice is to use and accredited medical center with a physician team that has done a lot of surgeries and diligent follow up.

There are clear and definite benefits of an obese patient losing weight, up to and including extending life. A person must look in the mirror, at their family, and especially at their children and decide whether the risk of surgery is something they want to take. Doing nothing for an obese person, either surgically or non-surgically, will make life clearly more difficult, if not shorter. I would encourage any obese patient considering weight loss not to feel frustrated or defeated, but encouraged by the thought of increased energy and enjoyment of life to be gained. It is a wonderful thing to see a patient gain their confidence and reduce their number of pills.

Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN and is a graduate of Tennessee Technological University and University of Tennessee College of Medicine, Memphis. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician.