Obesity. It’s a hot-button word in the media right now because it’s reached epidemic proportions in the United States. According to the American Obesity Association, 127 million adults are overweight, 60 million are obese, and nine million are severely obese.

Even Colorado, known for active outdoor types, had a 42-percent obesity rate in 2000. Close to two-thirds of the U.S. adult population is struggling with the negative health and social effects of excess weight. Is there a cure in sight?

Sadly, there is no magic pill, but for those who are morbidly obese, or 100 pounds or more over their ideal weight, there is hope. Enter bariatric surgery — known widely as “stomach stapling” or “weight- loss” surgery — this procedure stops the weight gain where it starts, with calories.

What is bariatric surgery?
There are a few commonly performed weight-loss surgical procedures in the United States right now. The most widely available is gastric-bypass surgery, where a stapling device is used to divide the upper stomach and create a small pouch at the upper end. Food leaves the pouch into a segment of the small intestine, which is brought up from the mid-abdomen and surgically attached to the stomach pouch.

The new stomach pouch, about the size of your thumb, holds about two or three bites of food, less than a shot glass full. Restricting how much food is eaten is the main way gastric bypass works its weight- loss magic. Another feature that is helpful in behavior modification: The small intestine attached to the pouch cannot handle foods with a lot of fat or sugar. Eating high-carbohydrate food results in a temporary but horrible illness called dumping syndrome.

The second most common procedure does not require cutting or resectioning the stomach. Instead, an adjustable band or belt-like section of plastic known as a Lap-BandA8 is placed around the upper stomach to create a tiny stomach pouch. This creates a funnel-like narrowing that makes it easy to fill up the stomach pouch with small amounts of food, resulting in a sense of fullness.

Weight loss with the Lap-Band is much more gradual than with gastric bypass since the balloon inside the band is inflated over the weeks and months after surgery, increasing the restriction to eating in accordance with the patient’s needs.

Curative powers
Excess weight takes an enormous toll on the body, stressing major organs, structures and systems. Morbidly obese people often suffer from diabetes, high blood pressure, heart disease, gastroesophageal reflux disease (GERD), high cholesterol, sleep apnea and knee and back pain.

A study published by the Journal of the American Medical Association found that surgery to lessen the size of the digestive tract resulted not only in weight loss but also reversed diabetes in 77 percent of obese patients, eliminated high blood pressure in 62 percent, and lowered cholesterol in at least 70 percent.

The Bariatric Surgery Center of Excellence at Presbyterian/St. Luke's Medical Center in Denver reports similar results. According to the Center’s Web site (www.pslmc.com), “Within three months of surgery, diabetes resolves in 94 percent of patients. At six months, we see a 66-percent resolution in hypertension, and at one year a 64-percent resolution in sleep apnea.”

From the standpoint of preventing or reducing significant damage to the body, sometimes earlier surgical intervention rather than later is appropriate.

Myths and misconceptions
Since weight-loss surgery is relatively new in the world of surgical procedures, there are still many misconceptions about it, including:

Myth #1: You can’t regain the weight after surgery. The initial weight loss in the first weeks and months after the surgery is rapid and dramatic. During this time the stomach pouch created gradually increases in size to a capacity of about five to six ounces. Bariatric surgical patients can expect to lose up to 65 to 75 percent of excess weight by one year and additional weight in the second year. Usually weight loss stabilizes at this point. If healthy eating habits and regular physical activity aren’t well established by then, maintaining the weight loss can be difficult.

Myth #2: I can’t afford it. How much is your life worth to you? Gastric-bypass surgery costs about $25,000. Morbidly obese people often spend hundreds of dollars a month for medication, but after surgery, many don’t need the medication anymore. In addition, food bills drop drastically since the new stomach can hold only a few bites of food per meal. In perhaps the best news of all, Medicare announced in March it will pay for three forms of weight-loss surgery. Since private insurers often follow Medicare’s lead, it bodes well for people looking for the procedure to be covered by insurance.

Myth #3: Weight-loss surgery is the easy way out. The real work begins after surgery. It requires a complete change in lifestyle — from learning how to increase activity levels to establishing new eating strategies. The aftermath of the surgery is anything but easy.

Myth #4: I won’t be able to eat anything again. While it’s true that people who have gastric-bypass surgery must limit their intake of fats and sugars, it’s not true that they never enjoy dessert again. It’s all about making healthier choices with an eye toward controlling quantities. Successful patients transition from eating the whole cake to eating a couple of bites of cake and feeling satisfied.

Myth #5: All you need to do is eat less and exercise more. For people looking to lose 20 pounds, that statement is true. For those who are 100 pounds or more past their ideal weight, it’s a fallacy. For morbidly obese people who have repeatedly failed multiple medical therapies and generally have several serious obesity-related diseases, such as diabetes and hypertension, bariatric surgery is often their only hope of significant weight loss and an improved quality of life.

Don’t settle — Find a Center of Excellence
Not all surgeons, hospitals or bariatric programs are created equal. Even Medicare stipulates the procedure should be done at a “high-volume center that achieves low mortality rates.” At high-volume centers, the mortality rate from surgery is less than 1 percent, Medicare says. Overall, the rate is in the 4- to 6-percent range.

The American Society of Bariatric Surgery (ASBS) has taken the lead and implemented a "Bariatric Surgery Center Of Excellence" program with rigorous criteria. There are only five programs that have received the designation in Colorado, with two of them in Denver — the Colorado Bariatric Surgery Institute at Presbyterian/St. Luke’s Medical Center and The Denver Center for Bariatric Surgery at Rose Medical Center. Both centers do hundreds of bariatric procedures a year. The ASBS endorsement highlights the consistent quality of care and expertise demonstrated by the surgeons, hospitals and support staff at these centers.

If you’re considering surgery, make it a point to interview potential surgeons and ask them how many cases they have performed, how many of their patients have died and what their practice’s average weight-loss results are. Increase your odds for success by choosing an ASBS Center of Excellence with a dedicated post-surgery support program with mental health experts, exercise physiologists and dietitians.

Resources:
asbs.org — American Society of Bariatric Surgery
pslmc.com — The Bariatric Surgery Center of Excellence at Presbyterian/St. Luke's Medical Center
coloradobariatric.com — Colorado Bariatric Surgery Institute
rosebabies.com — The Denver Center for Bariatric Surgery at Rose Medical Center
ObesityHelp.com
WeightWise.org