Cutting Edge: Fighting The Fat. What Bariatric Surgery Is Right For You?

Bariatric SurgeryWith America’s obesity rate being the second-highest of all the countries in the world, it is no surprise that many of us have little success with the standard program of diet and exercise to lose and maintain our weight. Cutting Edge: Fighting Fat is one of three prime-time health specials produced by the Gannett Broadcasting, airing across the country. This medical special investigates the causes and concerns of our obesity epidemic and examines our options that may offer help for those of us discouraged or overwhelmed by our weight loss progress. From over the counter drugs and herbs to bariatric surgery, learn what option is best for you.

Host of the Cutting Edge: Fighting Fat, Julie Nelson, says that for most of us with extra pounds to lose, dieting is the answer. But a recent UCLA study reported that a majority of people that lose 5% to 10% of their weight on a diet plan will most likely gain that weight back and more.  Unfortunately sustained weight loss was found in a minority of dieters.

There is help out there in various forms, but all must be carefully considered.

Over-The-Counter Pills, Herbs and Supplements
What about all those miracle diets and supplements so heavily marketed?

Dr. Aronne, author of  The Skinny: On Losing Weight Without Being Hungry, tells Cutting Edge  “There is little to no evidence that most of the things that you see on info-commercials, online and the internet actually works.  Fraud is the rule when it comes to these heavily promoted products.  They can sell anything and then it’s up to the regulators to stop them.  And by the time they have stopped them, they’ve sold millions of dollars of this stuff.  People are being ripped off right and left.”

Julie informs us that at the moment the only medicine approved by the FDA for long-term use is Alli (orlistat) which blocks 3% of the fat from being absorbed into the body.  Over a one-year period people can lose an average of 13 pounds.  Most over-the-counter and herbal products for weight loss are appetite suppressants.  They work by tricking the body into thinking it is not hungry. These pills can work in the short term and but long term use can lead to addiction and other health problems. It’s best to check with your doctor about possible side effects.
Beware… Other than Alli, over-the-counter diet pills are not considered drugs and are therefore not regulated by the FDA.

Is Bariatric Surgery Right For You ?
While experts agreed that diet, nutrition and exercise have long been the preferred way to lose weight, a person finding themselves with 100, 150 or even 200 pounds to lose, may feel just too overwhelmed at the effort. Often they will lose the motivation to diet and feel they are too heavy to exercise.  For these people bariatric surgery may be their best choice for getting on their way to better health. These procedures have become much safer today due to the wider use of laparoscopic (minimally invasive) technology.

Philip R. Schauer, M.D, Director, Bariatric and Metabolic Institute, Cleveland Clinic, who has performed more than 4000 operations related to obesity tells Cutting Edge “…obesity is not a case of gluttony, or lack of willpower. It is a severe illness and should be treated as such.  If obesity is not appropriately treated, an individual will be doomed to a life full of disability and will probably not live a normal life span.  For someone who is more than 100 pounds overweight right now, surgery is the only option that provides efficacy, and is safe.”

Michael Schwartz, M.D. Ph.D., Medical Director, Bariatric Care Center Healtheast, St. Paul, Minnesota says “…we do these operations to relieve disease processes that go along with obesity such as diabetes, high blood pressure, elevated cholesterol and sleep apnea… We don’t do them for cosmetic reasons.  We do them to treat diseases.”

Health correspondent Monica Roberts talks with Dr. Schauer about as he explains the different bariatric operations now being offered.

  • Gastric bypass (Roux-en-Y Gastric Bypass or RGB) – This is the most popular surgery and for those with the most severe weight problems. It produces the most weight loss. The average person loses about 75% of excess body weight. And it can also resolve diabetes in some patients. The procedure basically reroutes the food. It starts from a small created stomach pouch, then bypass other portions of the stomach and some of the intestines. This procedure decreases the absorption of calories.
    Patients need to keep in mind that after the surgery if the patient consumes large amounts of sugary, high calorie substances they may experience some negative side effects like cramping and diarrhea and may feel very uncomfortable.
  • Gastric Banding – This is also very popular and is the least invasive of all the procedures. It involves placing a band around the upper stomach. After surgery patients have the volume inside the band adjusted. The tighter the band is the more weight loss. The best candidates would be those with about 50 to 80 pounds to lose.
  • Sleeve Gastrectomy – This procedure involves reducing the size of the stomach to about the size of a banana by removing the outer part of the stomach. This procedure produces more weight loss then band, about 50 to 60% of excess body weight. The best candidates would be those with about 50 to 80 pounds to lose.
  • Gastric Plication – This procedure is still relatively considered experimental. They reduce the volume of the stomach by about 75 to 80% without stapling, cutting or removing any portion of the stomach.
    They achieve this by folding in the outer wall of the stomach and stitching it in place. The best candidates would be those not severely overweight with maybe 30 to about 100 pounds to lose, but more geared to the lower weight threshold.

So what’s next? Monica Roberts reports on a procedure that does not require surgery! Currently it is available only in Europe and South America.

Clinical Professor of Medicine Dr. Louis Aronne, Weill Cornell Medical College in New York explains the Endoluminal sleeve/barrier. “…it’s a thin plastic tube that is inserted with a scope and passes the stomach. It blocks the absorption of food for about 2 feet of the intestine so weight is lost, blood sugar comes down, and someone with diabetes would have an improvement with their blood sugar and would also lose weight…”

Julie reminds us to keep in mind that these surgeries are not without risks and you have to qualify for the procedure. In addition the cost can reach into thousands sometimes up to $40,000 and not all costs are covered by insurance.

How have others faired who have made the decision to undergo bariatric surgery? Meet three people who have generously shared their story with the  Cutting Edge: Fighting Fat.

Related Sites:

Cleveland Clinic – Philip Schauer, M.D

Doctors of Weight Loss – Michael L Schwartz, MD, PhD

The Nutrient Calculator and BMI

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