General information
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Clinically severe obesity - what is it?
This has been described as a disease of excess caloric intake stored in the form
of fat. A simple means to define overweight is by the body mass index (BMI) or,
weight/height squared. A BMI of 40 is roughly equivalent to 100 pounds overweight
for an average adult. Persons at the highest levels can be categorized as having super/super
morbid obesity.2
Those who suffer from this disease are in fact experiencing a condition of physiologic
malfunction. The perception that their condition is solely due to acquired food
habits and desires, either consciously or unconsciously, is simply not true. We
definitely see genetic familiarity in patients who suffer from clinically severe
obesity. Obesity has usually occurred as a result of genetic factors, a body makeup,
lack of exercise and overeating. There is an expanding pool of information stating
a genetic relationship and connecting multiple genetic factors with clinically
severe obesity.
The health implications associated with this condition can be substantial. A person's
overall wellbeing is threatened by obesity-related risk factors such as:
Clinically severe obese patients may experience lack of respect, danger to
overall health, and employment discrimination. Many obese people suffer from
low self-esteem, depression and inability to exercise.
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Why consider surgery for obesity?
Most clinically severe obese people have made numerous attempts to lose weight,
but few have achieved long-term success in maintaining weight loss. Many have
tried diet after diet, losing some weight and then putting it all on again usually
adding a few more pounds.
Research proves that clinically severe obesity is a chronic disease, and we
see genetic familiarity in our patients. Other weight loss methods have a consistently
high failure rate, with many patients progressing to disability or premature
deaths.
Non-operative treatment has been ineffective in achieving sustained weight control
in 95 percent of the clinically severe obese. Weight loss attempts often cause
a starvation syndrome as well as depression, anxiety, irritability and preoccupation
with food.
There is compelling evidence that diseases related to clinically severe obese
patients are reduced or delayed in those patients who have lost weight as a
result of gastric restrictive surgery.
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Why choose gastric bypass surgery?
Among available gastric restrictive procedures, the Roux-en Y Gastric Bypass statistically have the best overall outcomes
for weight loss and long-term weight control.
Research proves that gastric bypass surgery is currently the most effective,
long-term method for controlling clinically severe obesity for patients whose
BMI (body mass index) is equal or greater than 40. A BMI of 40 is roughly equal
to 100 pounds overweight.
According to the American Society of Bariatric Surgery (ASBS), of
the procedures done in the United States, 80 percent are the Roux-en
Y Gastric Bypass. The Roux-en Y Gastric Bypass is considered
the "gold standard" for weight loss surgery.
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Patient selection criteria
The American Society for Bariatric Surgery (ASBS), Drs. Baker and Dr. Johnson,
as well as the Bariatric Center of Unity Hospital apply the following
criteria for patient selection. The patient must:
- weigh 100 pounds or more than the standard for height and sex as estimated
by the Metropolitan Life Table, or have a BMI (body mass index) equal to or
greater than 40
- have been in other structured weight loss programs for a minimum of six months
- have a medical condition that may improve with weight loss, such as diabetes,
hypertension, heart problems, arthritis, high cholesterol, sleep apnea, or
bladder weakness
- have family support
- be well informed about the surgery and lifestyle changes for recovery
- understand and accept the risks of surgery
- be committed to a healthy lifestyle for the rest of their life
- agree to be part of long-term follow-up
- be cancer free for five years.
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Non-eligibility
Individuals are not eligible for weight loss surgery if they:
- are alcoholic or addicted to other drugs
- have active liver disease, i.e. hepatitis
- have a psychiatric disability as determined by a psychologist or psychiatrist
- have a correctable cause of obesity (i.e. thyroid disease)
- have a personality that does not fit program guidelines
- are pregnant or desire to get pregnant in two years
- have an unstable eating pattern related to medications
- have uncontrolled binge eating disorder (BED)
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Insurance coverage
Many insurance companies cover weight loss surgery. To find out about a specific
plan, call the plans customer service number - usually on the back of any insurance
card - and request information about the plan coverage.
The surgeon's clinic works with each patient on an individual basis to aid in
obtaining insurance pre-authorization.
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Interdisciplinary hospital team
Our bariatric surgeons firmly believe that a whole team effort by the hospital staff makes
the procedure and recovery much easier for the patient. As a result, Unity Hospital has
trained a team of people to make every aspect of care the best it can be. Our interdisciplinary hospital team includes:
- Surgeons, Dr.
Daniel Baker, Dr. Jeff Baker and Dr.
Frederick (Rick) Johnson
- Program Manager, Janet
Rudlong RN
- Dedicated bariatric nursing staff
- Bariatric dietitians
- Pharmacists
- Psychologists
- Case managers in OR and on the post-surgical floor
- Exercise physiologist
- Bariatric physician assistants
- Images Support Group staff
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Possible complications
All surgeries carry risks of complication. Roux-en Y Gastric Bypass is a major
abdominal operation, and possible complications are similar to those of any
other abdominal operation (i.e. bleeding, infection, blood clots, risk of hernia).
Our mortality (death rate) from this type of surgery is 1 in 1700 cases (the national average death rate is 1 in 200).
Some complications more unique to this type of surgery include: leakage at the
new suture lines (which would cause an infection called peritonitis), obstruction
of the new stomach pouch outlet and vitamin deficiencies. To check for leakage
during surgery, the surgeons do a pressure test of the new stomach pouch and
the anastimosis (the connection). This is performed by having anesthesia introduce
blue colored solution through an oral-gastric (NG) tube at 65 centimeters of
water pressure, which will identify even tiny leaks of the new pouch and the
anastimosis. This tube is removed in the operating room.
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Lifestyle changes
Diet after the Roux-en-Y Gastric Bypass.
For the first three weeks, a liquids-only diet is required to allow the new
stomach pouch to heal properly. The fourth week, pureed foods are introduced.
During the fifth week, patients may resume a regular diet, adding one new food
at a time.
New eating guidelines:
- Eat only until satisfied.
- Chew each bite 20 - 30 times.
- Eat the protein part of the meal first.
- Don't drink liquids with meals and wait 30 - 45 minutes after eating.
- Don't skip meals - eat breakfast, lunch and dinner.
- Stay away from high calorie, high fat foods and beverages.
- Choose nutritious foods in a balanced diet.
- No alcohol consumption for 1 year after surgery and then limited thereafter.
- Drink 6 - 8 glasses of liquids, primarily water, between meals.
- Limit caffeinated beverages to one cup or less per day - coffee, tea, or
diet cola. Caffeine can prevent the body from absorbing iron and cause iron-poor
blood.
Exercise.
Exercise should be a priority. Exercise strengthens a person's heart and bones,
burns calories, increases metabolism and relieves stress. Walking is the best
exercise after surgery. Start slowly and work up to a least 30 - 45 minutes
each day. Patients can meet with our program's exercise specialist free of charge to design an exercise plan to fit their individual needs.
Follow up.
Follow up is vital to a patient's progress with weight loss. Program nurses
will follow up with patients several times within the first year after surgery.
Patients will need a program check-up at least once a year thereafter.
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Anticipated results
Patients who make the required lifestyle changes can expect significant weight
loss and better health. Typically, patients acquire better self-esteem, relationships
and quality of life. In our program, the average patient weight loss is 100
pounds, or about 70 percent loss of excess weight.
Co-morbid complications of obesity, i.e. high blood pressure, type II diabetes,
sleep apnea, are significantly reduced or eliminated in our patients.
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For more information
To attend a free monthly introductory meeting, please
contact Medformation at 612-262-3333 or 1-800-877-7878 or register online.
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