Hypertension. Diabetes. Migraines. Joint pain. Sleep apnea. Heart disease. Even cancer.
Those are just a few of the many medical conditions caused by obesity.
Obesity is considered an epidemic in the United States, and pandemic throughout the world. It has devasting effects on people’s health and quality of life. People are dying younger due to obesity-related diseases.
Though many people are able to control their weight through meaningful diets and exercise, others should consider bariatric–or metabolic–weight loss surgery. As a bariatric surgeon, I regularly treat patients who have long struggled to lose weight and who have health issues related to their obesity. These conditions include hypertension, chronic knee pain, diabetes, sleep apnea, and even depression. But after weight-loss surgery, obesity-related health conditions subside, and patients report they are much happier and enjoy an improved quality of life. When I ask them what their primary-care physician thinks of their improved health, many patients respond by saying their health is so improved that they haven’t even spoken to their doctor in a while!
Who Should Consider Bariatric Weight-Loss Surgery
Bariatric weight-loss surgery is a major procedure and is not meant for people struggling to lose a few pounds. Patients who are interested in bariatric surgery must:
• Be more than 80-100 pounds overweight
• Have a body mass index (BMI) of 40 or higher, or of 35 or higher accompanied by sleep apnea, hypertension, diabetes, or other significant, reversible health conditions related to obesity
• Have previously attempted to lose weight through diet and exercise, but found those strategies hadn’t worked
• Be at least 18 years old
• Be nicotine-free for one year prior to surgery, because smoking after surgery can cause serious complications.
Your weight must negatively affect your health.
Types of Procedures
Bariatric surgery is a laparoscopic procedure, done through several small cuts. During the minimally invasive procedure, the doctor puts a lighted tube, or scope, and other surgical tools through small incisions in the abdomen, or belly. The doctor is able to see your organs using a monitor and scope.
Though there are many different types of bariatric surgery procedures, the two that Mid-Atlantic Permanente Medical Group doctors routinely perform are gastric-bypass surgery and vertical-sleeve gastrectomy. This less-painful approach lowers the risk of wound infections, hernias and post-operative pneumonia. It’s a minimally invasive approach, resulting in shorter recovery times. With either procedure, you’ll feel satiated earlier and less hungry between meals.
When we perform Roux-en-Y gastric bypass surgery, we change the connection between the stomach and intestines. We divide the stomach into a smaller upper pouch and a larger lower pouch. The small intestine is then divided and rerouted to connect to just the small pouch, bypassing the larger section. This leaves a smaller space for food to go, meaning you’ll feel full after smaller meals and will not absorb everything you eat.
When we perform vertical-sleeve gastrectomy, we remove 80 percent of the stomach so that the stomach doesn’t stretch and therefore fills faster.
Preparation for Weight-Loss Surgery
The journey to surgery day takes, on average, three to six months. Months before the procedure, patients are screened for sleep apnea, undergo lab work, and consult with a bariatric surgeon.
Patients also meet with a bariatric nutritionist, attend weight-loss classes, and work with mental-health professionals.
Patients are encouraged to start exercising 20 to 30 minutes, three to five times per week.
This extensive preparation is designed so that patients can make dietary adjustments and develop an exercise plan that they will be able to stick with after the surgery–and throughout their lives.
By developing good habits before the procedure, patients are more likely to continue them after the surgery.
After the Procedure
For the first few weeks after surgery, patients follow a liquid or soft diet, gradually reintroducing solid foods. Patients will find they get full quickly, so they will learn to prepare smaller portion sizes.
Patients generally lose a lot of weight in the first few months after surgery, often up to 20 pounds a month for the first six months. As time goes on, weight loss will slow down.
Exercise, such as walking, several times a week is an important part of the post-procedure routine.
Patients should be sure to keep their post-operative follow-up doctor appointments.
Chronic health conditions such as diabetes, high blood pressure, and sleep apnea likely will go away or become easier to manage after weight-loss surgery. We have also found that other medical conditions–including migraines, asthma, depression, degenerative joint disease, gout, and acid reflux–also clear up for many patients. The risk of stroke, heart disease, and fatty liver disease decreases.
Bariatric surgery takes a commitment, but the benefits are countless. Patients will likely feel more active and energetic, enjoy an improved quality of life, and see their overall health restored.
Dr. Anuj Prashar, DO, FASMBS, is the director of bariatric surgery for the Mid-Atlantic Permanente Medical Group. The board-certified bariatric surgeon sees patients at Holy Cross Hospital.
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