Obesity is when a person is more than 20 percent overweight, and there are increased health risks associated with the condition. Once considered a mere aesthetic situation, doctors are realizing that many serious conditions -- such as hypertension, diabetes, increased tendency for blood clots, and heart disease -- often plague obese patients. Severe obesity is a chronic, frequently progressive, life-threatening disease.
When repeated dieting doesn't work or when a physical condition takes a turn for the worse, a doctor may recommend a more drastic way to lose weight. Weight-loss surgery options include lap-band surgery, the duodenal switch procedure, the Roux-en-Y gastric bypass procedure and divided gastric bypass. Each procedure is designed to reduce the size of your stomach and decrease absorption of fat and calories as food passes through the intestines. Any surgery carries risks; the doctor and patient must decide together whether surgery would improve the quality of life and decrease many of the complications of obesity.
From the American Society for Metabolic and Bariatric Surgery comes this information on common types of surgeries:
--Stomach reduced from size of football to size of golf ball.
--Smaller stomach is attached to middle of small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories.
--Patients eat less because stomach is smaller and absorb fewer calories because food does not travel through duodenum.
*Laparoscopic adjustable gastric banding
--Silicone band filled with saline is wrapped around upper part of stomach to create small pouch and cause restriction.
--Patients eat less because they feel full quickly.
--Size of restriction can be adjusted after surgery by adding or removing saline from band.
*Biliopancreatic diversion with duodenal switch
--Similar to gastric bypass, but surgeon creates sleeve-shaped stomach.
--Smaller stomach is attached to final section of small intestine, bypassing the duodenum.
--Patients eat less because the stomach is smaller and absorb fewer calories because food does not travel through the duodenum.
*Vertical sleeve gastrectomy
--Stomach restricted by stapling and dividing it vertically, removing more than 85 percent.
--Procedure generates weight loss by restricting the amount of food that can be eaten.
--Currently indicated as an alternative to gastric banding.
These surgeries usually cost between $10,000 and $35,000. Post-surgery behavior, nutritional counseling and cosmetic surgery to remove the excess skin are not included in that. Insurance companies and plans vary on coverage, so it is necessary to contact them first. Medicare recently announced it will cover three types of weight-loss surgery for patients who are treated in "high-volume centers that achieve low mortality rates." The three surgeries Medicare says it will cover are the Roux-en-Y bypass, open and laparoscopic biliopancreatic diversions, and laparoscopic adjustable gastric banding.
Patient TL (name withheld by request) suggests that a potential surgery patient thoroughly interview the surgeon before making any final decisions. Some of the questions he recommends asking include: Where did the doctor go to school? Did the doctor ever serve as chief resident or receive post-residency fellowships? What are the doctor's professional credentials and affiliations? What is the doctor's personal experience performing bariatric surgery? How available will the doctor be before and after the surgery for any problems that arise? TL says: "You want the confidence that you have the best working on you, so don't be afraid to ask questions. I would worry if the doctor were uncomfortable answering your queries."
Dr. Dennis Smith of The Advanced Obesity Surgery Center, in Marietta, Ga., performs the four major bariatric surgeries laparoscopically. Forms of bariatric surgery have been around for decades, but Smith says, "Surgeries today are not just better and safer but there is also a greater emphasis on follow-up." Smith is a committee member in both the American Society for Metabolic and Bariatric Surgery and the Society of American Gastrointestinal Endoscopic Surgeons. "There are still risks associated with any surgery," he says, "so this should be the last resort for losing weight."