SUNDAY, Feb. 12, 2006 (HealthDay News) -- When diet, exercise and weight-loss medications fail, surgery can offer hope to some of the 23 million "morbidly obese" Americans who are 100 or more pounds overweight.
Demand for the surgery -- known as bariatric surgery -- quadrupled between 1998 and 2002, according to a recent study in the journal Health Affairs, with more than 71,000 procedures done in 2002. Another study found that more than 100,000 procedures were performed in 2003.
The surgery, while not simple, can change lives, said Dr. Howard Beaton, chairman of the department of surgery at North General Hospital and an attending surgeon at Mount Sinai Hospital, both in New York City.
"I've had patients who are able to get jobs they weren't able to get before, people who have gone back to school, gotten college degrees, people who have gotten married and were convinced their spouse would not have looked at them when they were morbidly obese," he said.
"There are little things, too," Beaton added. "These people are grateful just to be able to go to the movies. They couldn't fit in the seat before. They couldn't tie their shoes."
There are three types of bariatric procedures done today, said Beaton. "One is a restrictive procedure which restricts the amount of food you eat -- it's called laparoscopic gastric band surgery. A silicone band is put around the top portion of the stomach so people can't eat as much," he said.
Another procedure is called biliopancreatic diversion, he said. This technique bypasses a large amount of the small intestine and produces weight loss by limiting the number of calories and nutrients the body absorbs.
"The most common operation combines features of both of these, and it's called the Roux-en-Y gastric bypass," Beaton said.
To be eligible, patients must have a body mass index (BMI -- a ratio of height to weight) of either 40, or 35 with attendant obesity-related problems such as diabetes or heart disease, said Dr. Neil Hutcher, president of the American Society for Bariatric Surgery and a bariatric surgeon in Richmond, Va. A person who is 5-feet, 5-inches tall who weighs 215 pounds has a BMI of 35; if he or she weighs 245 pounds, the BMI is 40.
Some patients are better candidates for the bypass procedure than the band operation, Hutcher said. With bypass surgery, "patients have been shown to maintain a loss of at least 50 percent of their excess body weight," he said.
But maintaining the loss requires effort on the part of the patient, both Hutcher and Beaton stressed. "They will never eat the same again," Beaton said. Because the stomach is much smaller, those who have the surgery must eat small amounts at a time, he said.
And they're advised not to eat foods high in sugar or fat, said Beaton. If they do, it will produce what is called the "dumping syndrome," which includes abdominal cramps, sweating and a racing heartbeat, Beaton said.
It's crucial to find a surgeon experienced in the weight-loss surgery, Beaton and Hutcher said. One way is to find a doctor through the American Society for Bariatric Surgery, which maintains a list and has standards for membership. And the doctor should be board certified in surgery, Hutcher said.
But even in the best of hands, there can be complications and even deaths. Recent research has found that about one in 500 patients die from the surgery, Beaton said. "That is no different than the mortality for other major abdominal surgery," he said. "And the morbidly obese cut 10 to 20 years off their lives" due to their excess weight.
Insurance coverage for the surgery, which averages more than $13,000, is getting more restrictive, Hutcher said. "Patients are less likely to get coverage this year than last," he said.
A 2003 survey by Mercer Human Resource Consulting found that 77 percent of employer-sponsored health plans don't cover the surgery.
More information
To learn more, visit the American Society for Bariatric Surgery.
