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Surgical Treatment of Obesity

Unfortunately, obesity and its medical complications have become quite common in our society. Morbid obesity is defined as a Body Mass Index (BMI) over 40. There are many millions of Americans in this category. For these unlucky people, dietary and other conservative measures have failed to control their progressive and insidious weight gain. Many have associated problems such as diabetes, hypertension, sleep apnea and degenerative joint disease, to list a few. Most, if not all, of these conditions would improve or be eliminated if effective permanent weight loss was achieved. For these individuals, an operation is sometimes the best option to accomplish this goal.

The National Institutes of Health has established the guidelines for consideration of bariatric (obesity) surgery. A patient must have a BMI over 35 with any combination of diabetes, hypertension or sleep apnea or another severe complication of obesity, which would be mitigated or eliminated with significant weight loss. Any patient with a BMI over 40 can be considered for surgery. If you do not know your BMI, go to my BMI calculator page. The evaluation process involves an office consultation and examination, laboratory tests and other diagnostic tests such as pulmonary (lung) function studies and echocardiogram (heart). These and other studies are tailored to the individual patient. If you have had these done recently by another physician, those results are considered. If you live far away, most of the initial evaluation and testing can be done in co-operation with your local physician. After the results of the tests are assessed and the risks and benefits have been discussed fully and if you decide to proceed, a letter of concurrence from your primary care physician and a psychological evaluation will be required. These are almost always required for insurance authorization, which can take from three weeks to three months.

My preferred procedure for the surgical treatment of obesity is a Roux-en-Y, divided, gastric bypass. This leaves you with a very small stomach and only a small component of malabsorption. This is the most effective operation and it is time-tested. The operation can be performed laparoscopically, through 6 incisions ranging from 3/8 to 1" long, in most patients-even if you have had previous surgery. I also consider correction or revision of previous bariatric operations if the operation was ineffective or you are experiencing complications. These secondary operations must be done through a traditional incision. Hospitalization is usually only 2-3 days. Many patients go back to work a week after a laparoscopic procedure. Recovery from an open procedure takes anywhere from 3-6 weeks. After surgery, you will have to modify your diet to accommodate your new stomach and remain healthy. You must eat a high protein, complex carbohydrate, low fat diet, chew well, eat slowly and remain well hydrated. I provide dietary counseling on a continuing basis to help you adjust to your new eating pattern. You will have to take vitamins, minerals, B12, calcium and an acid-blocking medicine after surgery.

The complication rate for bariatric surgery is very low in experienced, trained hands. Sadly, there are many newcomers to the field with little true interest or background. Bariatric surgery was a major component of my surgical training program. I performed my first bariatric operation in 1979. I have performed over 2500 of various types of bariatric procedures since then and over 750 laparoscopic gastric bypasses. I maintain equipment and facilities specifically designed to optimize outcomes. I personally train all staff involved in the care of my bariatric patients. If you come from far away, I arrange for appropriate local follow-up.

The success rate for bariatric surgery is very high. More than 80% of patients lose to within 10% of normal weight. The majority of patients reach what they consider to be their normal weight. Most of the weight loss is in the first year with some continuing for as long as18 months. Medical problems caused by obesity either disappear or are minimized. Many experience a transformation of their personality, life-style and job performance.

The decision to choose the surgical option for treatment of obesity is a momentous one. Your family should be involved, if possible, to insure maximal post-operative support. It is also a personal decision. You should make the decision based on what you feel is best for you. I will provide all the information you need to help you make this decision. I have a large pool of patients who can give you their perspective. A support group is available either in person or on-line for either pre-operative or post-operative help. Please contact our office by phone, fax or e-mail if you need further information.