Bariatric surgery has been around for decades, but according to Christopher Still, D.O., the director of Geisinger Health System’s Obesity Institute, the procedure is much more than simply a weight loss tool. “The weight loss associated with bariatric surgery has become secondary to the profound medical benefits that the procedure provides,” he said. “Diabetes, sleep apnea, fatty liver and other conditions can be reversed in many patients thanks to the procedure. A study by Ted Adams in Utah shows it increases life expectancy.” Which all can be music to the ears of those who have battled obesity through diet and exercise yet struggled to find long-term success in their weight loss efforts. “Bariatric surgery shouldn’t be a first attempt at weight loss. Most of the people who opt for the surgery have had challenges with obesity for most of their lives,” Dr. Still said. “The surgery has become recommended now by many societies, including the endocrine society. If you can’t control blood sugar or have other weight-related health concerns, this could be an option. More insurancecompanies are even recognizing that and making sure that patients are aware there is an option.” Dr. Still admits that the earlier such an intervention is done, the better the chances of reversing some of the comorbid issues such as diabetes, obstructive sleep apnea and fatty liver concerns. However, the process of bariatric surgery requires a variety of processes over a period of time. “There is a six-month preoperative process that is multidisciplinary. You meet with a variety of professionals such as a nutritionist, clinical nurse, exercise physiologist and others. Once you complete that and everyone signs off, then you go see the surgeon,” Dr. Still said. “After the procedure, there is a process where we follow the patients indefinitely. The key for success is followup and accountability.” That is because even bariatric surgery patients can revert to old behaviors and regain weight if not careful. “Ultimately the surgery is just an intervention – a tool. Twenty to 25 percent of patients don’t lose as much weight as expected or gain their weight back. We are very cognizant of that and do all we can to provide assistance and accountability to increase the chances of success,” Dr. Still said. “The body has a tendency, after a weight loss, to try to compensate and gain the weight back. This is why it is so important to stick with the process after surgery.” “Those who have the surgery have to stick to a regimented meal plan with specific amounts of things like proteins and limited carbohydrates,” Dr. Still said. “But just as important is to develop a good exercise program. When you lose body weight, you also lose lean muscle mass and that is what maintains proper metabolism. The only way to combat that is to develop and stick with a good exercise regimen.” There are a variety of bariatric surgery options. One procedure that was previously fairly popular — the lap band — is no longer used as much. “The gastric band has fallen out of favor. In fact, there are more surgeries now to explant bands than to implant them,” Dr. Still said. “We didn’t do that many band surgeries even before at Geisinger because we didn’t see the weight loss or benefits with diabetes and sleep apnea that the other procedures offered.” The sleeve gastroectomy is the most common form of bariatric surgery, according to Dr. Still, and involves around two-thirds of the stomach being removed. This leaves behind a sleeve, tube or sock-shaped stomach that reduces area for food and also removes some of the hunger cells. “This helps up front, but the problem is that, over time, those cells tend to regenerate in the remaining stomach,” Dr. Still said. “The remaining stomach is pliant and can stretch some, but you still get the restriction.” A gastric bypass merges both the restrictive and malabsorptive qualities for weight loss. A stomach that is about the size of a small football is reduced to the size of an egg, plus a small section of the small intestine is bypassed. This helps reduce the amount of calories absorbed and can help add to the weight loss. The third type of bariatric surgery is a the duodenal switch, where the sleeve gastroectomy is used, but also 80 percent of the small intestine is bypassed. This is usually only done in extreme cases where BMI is 70 or above and usually these patients will have to supplement with additional nutrients because less are absorbed during eating due to the bypassed intestine. “Overall, this is definitely not a quick-fix solution. It requires commitment and changes in lifestyle, but it is increasingly effective,” Dr. Still said. “For those who are injecting insulin every day or living with a CPAP machine this could be a solution that is safer than most people realize.” Geisinger is trying to take a personalized approach to bariatric surgery to a new level. “We have a free app where a patient can enter his weight and BMI and it will give you the suggested weight loss one, two and even three years out,” he said. “In fact, if you have diabetes, it can calculate your personal chances of remitting blood sugars over three years.” Source
