Morbid obesity is a Body Mass Index (BMI) of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight. The disease of morbid obesity interferes with basic physical functions such as breathing, walking, and completing every day tasks. Long term effects of the disease include shorter life expectancy, serious health consequences in the form of weight-related health problems (co-morbid conditions) such as type 2 diabetes and heart disease, and a lower quality of life.
The causes of morbid obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases, significant, underlying causes of morbid obesity are genetic, environmental, and social. Studies have demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
There are two definitions for a co-morbid condition: the presence of one or more disorder or disease in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient. The primary disease of morbid obesity can lead to several comorbid conditions.
Bariatric surgery is a procedure designed to reduce the amount of food the stomach can tolerate so the patient feels satisfied with less food. It is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other weight loss therapies such as diet, exercise, medications, etc. A person with a Body Mass Index (BMI) of 35 or greater and one or more comorbid condition may also may qualify for bariatric surgery.
BMI is a measure used to index a person’s height and weight. BMI allows healthcare professionals and patients to better understand health issues associated with a specific weight classification (classifications such as obesity and morbid obesity).
Patients should have: 100 pounds or more of excess weight; a BMI of 40 or greater or a BMI of 35 or greater with one or more co-morbid conditions. Other common guidelines include: Understanding the risks of bariatric surgery; Committing to dietary and other lifestyle changes as recommended by the surgeon; Having a history of weight loss treatments that have failed and Undergoing a complete examination including medical tests.
Talk with Dr Shillingford about the different surgical treatments, as well as the benefits and risks.
Bariatric surgery is not cosmetic surgery. Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal. The patient must commit to long-term lifestyle changes, including diet and exercise, which are key to the overall success of bariatric surgery. Problems after surgery are rare, but corrective procedures may be required.
As with any surgery, there are immediate and long-term complications and risks. Possible risks can include, but are not limited to: Bleeding Complications due to anesthesia and medications; Deep vein thrombosis; Dehiscence (separation of areas that are stitched or stapled together); Infections; Leaks from staple lines; Marginal ulcers; Pulmonary problems; Spleen injury; Stenosis (narrowing of a passage, such as a valve); Band slippage and Band erosion.
Side effects include: Vomiting, Dumping syndrome, Nutritional deficiencies, Gallstones, Need to avoid pregnancy temporarily, Nausea, Bloating, Diarrhea, Excessive sweating, Increased gas, and Dizziness.
Open surgery involves the surgeon creating a long incision to open the abdomen and operating with “traditional” medical instruments. Laparoscopic, or minimally invasive, surgery is an approach that allows the surgeon to perform the same procedure using several small incisions, a fiber-optic camera, video monitor, and long-handled instruments.
Dr Shillingford is fellowship trained in the advanced laparoscopic approach to bariatric surgery.
The decision to perform minimally invasive or open surgery is made by your surgeon before the operation. For some patients, the laparoscopic, or minimally invasive, technique is difficult due to dense scar tissue from prior abdominal surgery. Also, the inability to see organs and/or bleeding during the operation can cause your surgeon to switch from minimally invasive to open surgery during your operation.
Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States. In this procedure, the surgeon creates a small stomach pouch and then constructs a “bypass” of some of the small intestine. The smaller stomach pouch restricts the amount of food the patient can comfortably eat, and the bypass decreases the number of nutrients and calories absorbed.
Gastric sleeve is a purely restrictive permanent procedure in which the stomach is reduced in size using staples that make the stomach resemble a tube. The smaller stomach restricts the amount of food the patient can comfortably eat and results in decreased caloric intake.
Gastric banding is a purely restrictive, non-permanent, surgical procedure in which a silicone band is placed around the uppermost part of the stomach. The band is adjustable and can be periodically tightened or loosened depending on the patient’s needs.
Studies show that bariatric surgery is successful in helping a patient achieve weight loss. Furthermore, it can effectively improve and resolve many comorbid conditions. A scientific review of more that 22,000 bariatric surgery patients showed: Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea 61.2% reduction of excess weight.
|TREATMENT||WEIGHT LOSS (% OF PATIENTS)|
|Diet and Exercise*||2% to 5%|
|Bariatric Surgery***||50% to 70%|
Because every insurance policy is unique, it’s important that you thoroughly understand your Certificate of Coverage in order to know exactly what is and isn’t covered through your plan. You may need to call your insurance company and ask if bariatric surgery is covered or excluded on your particular policy as even policies within the same insurance company may vary.
The qualification process includes a series of tests. You will meet with Dr Shillingford, a nutritionist, psychologist/psychiatrist, and other support staff members in sessions leading up to surgery. Each healthcare professional will help you prepare for the changes and challenges that lie ahead.
Certain basic tests typically required before surgery include: Complete Blood Count (CBC) ,Urinalysis Chemistry screen, Electrocardiogram, chest X-Rays, and Psychological evaluation. Other tests that may be requested include: Pulmonary function testing Sleep study GI evaluation Cardiology evaluation.
Medical problems, such as serious cardiovascular or respiratory conditions, can increase the risk of any surgery. On the other hand, many serious medical conditions including the heart and lungs may improve or resolve after successful weight loss following bariatric surgery.
Bariatric surgery is like other major abdominal surgery. You can best prepare by knowing the benefits and risks of surgery, and by closely following your doctor’s instructions.
Understand the surgical process and what to expect afterward. Keep in mind that you will never be able to eat the way you did before, and that you will have to watch what and how you eat for the rest of your life. Talk to people who have had bariatric surgery. Write down your reasons for having bariatric surgery and outline your plans to maintain your weight loss long-term. Practice the post-op diet, including the transition from an all-liquid diet, to pureed food, to a normal diet of smaller portions with 4 ounces of protein. Start a journal to record how you feel now, the challenges you face, and the things you hope to be able to do after you’ve achieved weight loss. In the process, reach out to your family and friends for their support. Talk to them about why you want to have bariatric surgery. It helps to have people behind you, ready to help.
There are two definitions for a co-morbid condition: the presence of one or more disorders or diseases in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient.
Type 2 diabetes is a long-term metabolic disorder where the body produces normal leveld of insulin, but resists it. Insulin is necessary for the body to utilize sugar. 83.8% of patients who had gastric bypass surgery experienced complete resolution of type 2 diabetes. 47.8% of patients who had gastric banding surgery experienced complete resolution of type 2 diabetes. Overall patients who had bariatric surgery had lower insulin resistance, and their risk for metabolic syndrome, high blood pressure, and high amount of fats in the blood also decreased.
High blood pressure is when the blood pushes against the walls of arteries to deliver oxygen from the heart with higher than normal force. Excess body weight is associated with an increased risk of heart disease, elevated cholesterol, and high blood pressure. These conditions can lead to heart attacks, strokes, and heart and kidney damage. Bariatric surgery reduces excess body weight over time, which decreases strain on the heart. 75.4% of patients who had gastric bypass surgery experienced complete resolution of high blood pressure. 38.4% of patients who had gastric banding surgery experienced complete resolution of high blood pressure. Lifestyle changes in diet and exercise after surgery can lead to significant improvement of cardiovascular disease.
High cholesterol is a disorder of lipids – the fat-like substances in the blood. Most common in incedences of high cholesterol, where the body has too much of certain lipids in the blood. As these lipids build up inside the artery walls, harmful scar tissue and other debris begin thickening and hardening the walls. Long-term, these effects can lead to heart disease and high blood pressure. 95% of patients who had gastric bypass surgery experienced improved cholesterol health. 78.3% of patients who had gastric banding surgery experienced improved cholesterol health.
Obstructive sleep apnea is when breathing during sleep suddenly stops. This is due to the soft tissue in the back of the throat collapssing and closing off the airway. Morbid obesity can cause sleep apnea and other respiratory problems that may result in chronic fatigue and more serious complication. 86.6% of patients who had gastric bypass surgery experienced complete resolution of sleep apnea. 94.6% of patients who had gastric banding surgery experienced complete resolution of sleep apnea.
Acid reflux, also known as gastroesophageal reflux disease, is injury to the esophagus caused by chronic exposure to stomach acid. It is a serious disease that can cause esophagitis, Barrett’s esophagus, and esophageal cancer (adenocarcinoma). 98% of patients who had gastric bypass surgery experienced complete resolution of acid reflux/GERD. 32.3% of patients who had gastric banding surgery experienced complete resolution of acid reflux/GERD.
Morbid obesity may put you at a higher risk for several types of cancer, such as colon, breast, and kidney cancer. In 2003, an article in the New England Journal of Medicine estimated that obesity could account for up to 14% of all deaths from cancer in men and 20% of all deaths from cancer in women.
Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats, sleeps, thinks, and feels and therefore how he or she interacts with others. There are many reasons people with morbid obesity experience depression. Emotional health goes hand in hand with physical health. Lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health. 47% of patients who had gastric bypass surgery experienced improvement of depression symptoms.
Osteoarthritis is the chronic breakdown of joint cartilage often referred to as wear- and-tear kind of arthritis. It is one of the most common forms of this disease and especially prominent in people living with morbid obesity. When excess body weight is placed on joints, particularly the knees and hips, the result is a rapid wear and tear, and pain caused by inflammation. Bariatric surgery can over time be very effective in treating osteoarthritis following successful weight loss. 41% of patients who had gastric bypass surgery experienced complete resolution of their osteoarthritis.
Especially in women, morbid obesity is a risk factor for stress urinary incontinence, or uncontrollable urine loss. A large, heavy abdomen and reduced pelvic muscle due to morbid obesity may cause control over the urinary bladder to weaken, leading to accidental leakage of urine with coughing, sneezing, or laughing. Bariatric surgery has been found to improve stress urinary incontinence by reducing the weight placed on the bladder. 44% of patients who had gastric bypass surgery experienced complete resolution of stress urinary incontinence.
Reproductive health can be a concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities are common among people with morbid obesity. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS). Additionally, women living with morbid obesity have an increased risk of having children with certain birth defects. A recent study of women following gastric bypass surgery showed improvement of problems related to reproductive health. 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS and 79% experienced complete resolution of excess hair due to PCOS. Overall patients who had gastric bypass surgery experienced restored ovulation and fertility.
The fear of surgery is not irrational or abnormal; in fact, it’s natural. Bariatric surgery works by crating a smaller stomach pouch and, depending on the procedure, may shorten the digestive tract – all while the patient is under general anesthesia. If you have concerns, we recommend you:
For people who have spent years living with morbid obesity, bariatric surgery can transform their lives. This being said, it is important to be prepared for all aspects of the treatment. Surgery changes your body inside and out in a number of ways. Learn more about the different types of bariatric procedures to understand the implications of each option.
For many people, bariatric surgery is covered by their health insurance plan. However, people who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or private-pay. Even though the financing may come out of pocket, most patients find that the surgery is worth the investment in their health and way of life. Ask Nancy about our current prices.
There are two ways to pay for surgery. These include: Health insurance coverage for bariatric surgery and alternative financing options such as medical loans.
Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance coverage for bariatric surgery, there are alternative financing options available, such as medical loans through Care Credit..
It varies from person to person. Generally, the hospital stay (including the day of surgery) is one day for the gastric lap-band procedure and two to three days for a the laparoscopic gastric bypass and sleeve gastrectomy procedures.
Our program is a comprehensive bariatric program that consists of an integrative combination including the following healthcare professionals: a program coordinator, psychiatrist, dietician, and surgeon. Each expert is dedicated to providing support for bariatric patients during both the presurgical and recovery processes.
Yes. However, most doctors recommend that women wait at least one year after the surgery before a pregnancy. Approximately one year postoperatively, your body should be fairly stable (from a weight and nutrition standpoint), and you should be able to carry a normally nourished fetus. Consult your surgeon as you plan for pregnancy.
Many people fear that bariatric surgery will be followed by a long and painful recovery period. However, most patients experience only slight discomfort and soreness. Recovery does, however, vary from patient to patient.
As with any major surgery, there will be a recovery period. Remember that this is a necessary step, and the better care you take during recovery, the more quickly you will return to normal activity.
Recovery time varies from patient to patient. One study found laparoscopic gastric bypass surgery patients spent an average of two days in the hospital and were able to return to work after 21 days.
For people suffering from morbid obesity, bariatric surgery can make a remarkable change in their lives. For the surgery to be effective long term, it must be understood for what it is, a tool to support long-term weight loss. Through lifestyle changes, such as regular exercise and a healthy food plan, many patients are able to make a long-term change for better health.
|TREATMENT||WEIGHT LOSS (% OF PATIENTS)|
|Diet and Exercise*||2% to 5%|
|Bariatric Surgery***||50% to 70%|
Bariatric surgery is not a quick fix. It is an ongoing journey toward transforming your health through lifestyle changes. After surgery, you will feel satisfied and fuller with less food. Positive changes in your body, your weight, and your health are to be expected, if you maintain the diet and exercise routines recommended by your bariatric program.
After the initial recovery period, most patients are instructed to eat 1/4 cup, or 2 ounces, of food per meal. As time goes on, you will be able to eat more. Most people can eat approximately 1 cup of food per meal (with 4 ounces of protein) a year or more post-surgery.
Your ability to resume normal levels of activity depends on a number of factors: your physical condition, the nature of the activity, and the type of bariatric surgery you had. Many patients return to normal levels of activity within three to six weeks of surgery.
Exercise is a keystone of success after surgery. You are encouraged to begin exercising, limited only by discomfort. The type of exercise depends on your overall condition, but the long-term goal is 30 minutes of exercise three or more days each week. Lifting heavy weights is limited for 4 weeks after surgery but aerobic activity is encouraged during that time period.
At first, your doctor may suggest that medications be taken in crushed or liquid form. Over time, most pills or capsules are small enough to pass through the new stomach pouch and you can continue this form instead. As a general rule, ask your surgeon before taking any medication.
Eating simple sugars (such as sugar, honey, and corn syrup) or high-fat foods can cause dumping syndrome in patients who have had gastric bypass surgery. This occurs when these foods, which have a small particle size, are “dumped” from the stomach into the intestine very quickly. Water is pulled into the intestine from the bloodstream to dilute the sugar load. This flush of water causes symptoms such as diarrhea, hot flashes or sweating, increased heart rate, and clammy skin, and dizziness.
Lap-band patients need to work with Dr Shillingford to have their band adjusted several times during the first 12 to 18 months after surgery. Gastric bypass patients typically see Dr Shillingford for three to five follow-up appointments the first year, then once per year thereafter. Over time, gastric bypass patients will need regular blood work to check for anemia (low red blood cell count), vitamin B12, folate, and iron levels.
Support groups are highly recommended as they give patients an excellent opportunity to talk about personal issues. Patients help keep each other motivated, celebrate small victories together, and provide a different perspective on the everyday successes and challenges that patients generally experience before and after surgery. Most bariatric surgeons recport that ongoing support after surgery helps to achieve the greatest level of success for their patients.
Studies show that bariatric surgery can effectively improve and resolve many weight-related health problems. A scientific review of more that 22,000 bariatric surgery patients showed Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea. Overall there was a 61.2% reduction of excess weight.
|TREATMENT||WEIGHT LOSS (% OF PATIENTS)|
|Diet and Exercise*||2% to 5%|
|Bariatric Surgery***||50% to 70%|