How metabolic and bariatric surgery treats obesity

The Atlanta Journal-Constitution

The Centers for Disease Control and Prevention refers to obesity as an “epidemic” in the United States. Statistics show that about 33 percent of adults and 17 percent of children in this country are obese. Obesity is a major cause of death and also contributes to diabetes, heart disease and cancer. It costs the United States hundreds of billions of dollars every year.

iStockphoto Bariatric surgery is used to treat obese patients by reducing the size of the stomach and limit the amount of food it can hold.

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While a better diet and more exercise can help many people lose weight and improve their health, that doesn’t work for everyone. For people who need an effective and long-lasting treatment for morbid obesity, metabolic and bariatric surgery is an option.

The American Society for Metabolic and Bariatric Surgery, based in Gainesville, Fla., is made up of about 3,000 surgeons, nurses, bariatricians, psychologists, dieticians and other medical specialists. The ASMS has a stated mission “to improve public health and well being by lessening the burden of the disease of obesity and related diseases throughout the world.” Part of that mission is educating the public about surgical options that treat obesity. The following information comes from the ASMS website.

Facts about metabolic and bariatric surgery

1. Candidates for surgery should have a body mass index (BMI) of 40 or higher, or a BMI of 35 or more with an obesity-related disease. However, research suggests the BMI standard may no longer be appropriate because it does not take into account gender, race, age, fitness or body-fat composition. In February 2011, the FDA lowered BMI requirements for gastric banding with Lap-Band for patients with a BMI of 30 to 40 and at least one obesity-related condition.

2. About 220,000 people with morbid obesity in the United States had bariatric surgery in 2009 – just 1 percent of the clinically eligible population; 15 million Americans have morbid obesity.

3. Bariatric surgery costs an average of $11,500 to $26,000; insurance coverage varies by provider.

4. The U.S. government’s Agency for Healthcare Research and Quality and recent clinical studies report significant improvements in safety, with low risks of death (about 0.1 percent) and major complications (about 4 percent) from surgery.

5. Bariatric surgery has been shown to improve or resolve more than 30 obesity-related conditions, including Type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol.

6. Studies show that bariatric surgery can result in increased lifespan, long-term weight loss and significant reductions in cardiac and other risk factors.

7. Patients typically reach maximum weight loss within one to two years after surgery and maintain a substantial weight loss, with improvements in obesity-related conditions, for years afterward. Patients may lose 30 percent to 50 percent of excess weight six months after surgery and 77 percent of excess weight as early as 12 months after surgery.

Most common bariatric surgical procedures

1. Gastric bypass: In this procedure, the stomach is reduced from the size of a football to the size of a golf ball. The smaller stomach is attached to the middle of the small intestine, bypassing a section of small intestine (duodenum and jejunum), limiting the absorption of calories. Bypassing the duodenum induces metabolic changes that help improve or resolve Type 2 diabetes.

2. Laparoscopic adjustable gastric banding: A silicone band filled with saline is wrapped around the upper part of the stomach to create a small pouch and cause restriction. Patients eat less because they feel full quickly. The size of restriction can be adjusted after surgery by adding or removing saline from the band.

3. Bilio-pancreatic diversion with duodenal switch: Similar to a gastric bypass, the surgeon creates a sleeve-shaped stomach during this procedure. The smaller stomach is attached to the final section of small intestine (ileum), bypassing approximately 60 percent of the small intestine. Bypassing the duodenum induces metabolic changes that help improve or resolve Type 2 diabetes.

4. Vertical sleeve gastrectomy: The stomach is restricted by stapling and dividing vertically, removing more than 85 percent of it. This procedure generates weight loss by restricting the amount of food that can be consumed.