RISKS OF LIVING WITH MORBID OBESITY

Weight loss for patients with morbid obesity is generally recommended because of the improvement in physical and mental health with weight loss. There are over 300,000 deaths annually in the USA due to complications from morbid obesity. Presently, surgical intervention has been shown to be most successful, and often the only way, that weight loss can be achieved and maintained.

Morbid obesity is a significant risk to life. It leads to such conditions as:

• High blood pressure.
• Heart failure and Heart attack.
• Stroke.
• Increased risk for multiple types of cancer, including uterine, breast, prostate, esophageal, pancreatic, colon, kidney, and gallbladder cancer.
• Diabetes mellitus with all of its complications.
• Sleep apnea syndrome, which can cause sudden death.
• GERD (acid reflux/heart burn), which can lead to esophageal cancer.
• Urinary incontinence.
• Gallbladder disease.
• Arthritis.
• Fatty Liver and Liver Cirrhosis.
• Immune compromise with frequent infections.
• High blood lipids
• Premature death
• Infertility.
  

• Increased risk of depression.
• Less chance of employment.
• Lower quality of life.

SURGERY FOR MORBID OBESITY

Due to the high incidence of failure of non-operative methods of weight control in the morbidly obese, surgery is considered an acceptable method of treatment. Gastric operations for treatment of morbid obesity were introduced in 1967. Gastric restrictive surgery limits oral intake by closing off the upper part of the stomach using intestinal staples so ingestion of small quantities of food produces a "feeling of fullness". The change in the absorption length of small bowel allows fewer calories to be absorbed. In 1991 a National Institutes of Health consensus development panel endorsed gastric restrictive surgery as appropriate treatment for patients with medically severe obesity.

Gastric Bypass - Weight loss has been shown to occur more rapidly and over a longer period of time with gastric bypass than with stapled gastroplasty. The reasons for superior weight loss with gastric bypass stem from the small degree of malabsorption caused by passing nearly all of the stomach and the first two feet of the small intestine. To date, weight loss with gastric bypass has been much more consistent than with other surgical techniques.

Distal Gastric Bypass - This modification of the standard gastric bypass is available for patients who are "super obese," - more than 200 pounds overweight. This operation adds a greater component of malabsorption to restriction of intake. The stomach-stapling component of the distal modification is the same as in the standard procedure. The only difference is the location of the distal connection of the intestine, which is reconnected much closer to the colon. Adding this additional malabsorption increases the risk of several nutritional (metabolic) complications.

Minimally Invasive (Laparoscopic) Surgery - Surgeons at this institution performed gastric bypass using minimally invasive techniques. This approach uses five or six tiny incisions instead of one large one to perform the operation. These operations require two skilled, well-trained surgeons, skilled assistants and many new specialized instruments. Our program incorporates these new techniques in most patients. The main advantage of the laparoscopic approach is less pain postoperatively and earlier discharge. Patients also have a quicker recovery with much less wound complications. Weight loss is the same, as the intestinal alteration is the same. Major complication rate is similar between open and laparoscopic surgery.

Other surgical procedures - Other surgical techniques are currently being developed. Most of them are presently variations on the gastric bypass, and at this time do not appear to have a clear advantage. Others, such as the gastric banding, are not as successful in weight loss, and therefore are not routinely recommended in this clinic. If you are interested in other surgical procedures, please ask your surgeon about them.

WHO CAN HAVE GASTRIC RESTRICTIVE SURGERY

Individuals who weight at least 100 pounds above ideal body weight as determined by standard life insurance tables or body mass index (BMI) > 40 kg/m2. Exceptions have been made in patients with coexisting medical problems who are almost 100 pounds over ideal body weight with a BMI > 35 kg/m2. Click here to calcualte your BMI.

Individuals who have failed after serious attempts at weight reduction such as a physician-prescribed diet, behavior modification, counseling with a dietitian, or enrollment in a group weight reduction program such as Weight Watchers, Nutri-Systems, or Overeaters Anonymous.

Individuals who fully comprehend the expected results of surgery, and are motivated to improving their health. Patients must be aware that surgery will help them to lose weight without going hungry, however, it will fail if patients continue to eat large quantities of high calorie foods (junk food).

PREOPERATIVE EVALUATION

All prospective patients considering gastric restrictive surgery at Easton Hospital undergo separate screening interviews with the operating surgeon and the nutritionist, each of whom must individually approve the patient for surgery.

Glandular (endocrine) disorder must be ruled out as the major contributing factor to morbid obesity. The surgeon will evaluate for these disorders during the initial visit.

Psychological stability must be determined by pre-operative interviews and psychological tests given by the psychologist. There must be understanding of the risks associated with the operation and acknowledgement of the fact that the operation is not guaranteed to lead to a specified amount of weight loss in the long term.

Reasons not to perform gastric restrictive surgery include the presence of active peptic ulcer disease or advanced cardiac (heart), pulmonary (lung) or renal (kidney) disease.

A blood test for H. Pylori (a bacteria which causes ulcers) and ultrasound of the gallbladder are performed following the screening interviews. The blood test is performed to rule out unexpected (occult) peptic ulcer disease. The ultrasound is performed to determine if you have gallstones. If gallstones are found, we recommend having your gallbladder removed as part of the gastric restrictive procedure. After the results of these tests are reviewed and the results of the psychological tests and interview have been analyzed, admission to the hospital for the operation is scheduled.