Grabbing a quick bite at the airport,
dinner meetings and long work days
can leave little time for executives to practice a healthy lifestyle. However, even
the U.S. Surgeon General is quick to point
out that obesity is preventable.
Diabetes, high blood pressure, high cholesterol, asthma, headaches and sleep
apnea are just a few of the medical problems associated with obesity. But David
Oliak, M.D., medical director of the
Chapman Center for Obesity, says that he
frequently hears overweight executives
complain about fatigue and shortness of
breath, and those types of problems can
eventually affect job performance.
“I treated one executive who weighed
close to 400 pounds and just couldn’t get
through his days. Now it has been two
years since his surgery, and his life has
been transformed,” says Oliak.
While bariatric surgery itself is not new,
the procedure has evolved — along with
the knowledge of what helps a patient
achieve long-term weight reduction.
Smart Business spoke with Oliak about
what executives should know before considering bariatric surgery.
Who is a candidate for bariatric surgery?
Every day for the last 20 years, more than
4,000 people in the U.S. have become
obese. Accompanying this trend, we have
seen an increase in the number of patients
for whom traditional weight-loss methods
have not been effective. While maintaining
a proper diet and exercise are still the preferred methods of treating obesity, when
those methods are not successful, sometimes the medical conditions caused by
obesity can pose greater health risks to the
patient than the surgery itself.
Originally, when gastric bypass surgery
was first introduced, the standard was that
people 100 or more pounds overweight were
considered obese and surgical candidates.
Now, we use a combination of factors and
a total evaluation of the patient’s health in
order to see if surgery might be the right
choice. This risk profile — which was developed by the National Institute of Health —
takes into account the patient’s body mass index (BMI) and any personal medical problems. Surgery sometimes is recommended
when a patient’s BMI is lower but other conditions are present.
Are bariatric surgeries becoming more common?
Yes. With both increased demand and the
change to laparoscopic procedures, more
facilities have started to offer both gastric
bypass surgery and the lap-band operation.
However, the increased surgical frequency
has not always produced positive results. In
some cases, patients have not been able to
sustain their weight loss, and there is a
learning curve for surgeons that accompany
the change to the laparoscopic procedure.
What should I consider when choosing a surgeon?
It is important to ask how much experience the surgeon has performing the operation. It is a difficult procedure that
requires the work of two surgeons and has
an extensive learning curve. A surgeon is
not proficient until he or she has completed 75 to 100 operations.
A recent study examined cases where the
mortality rate was four times the norm for the procedure. It found that all of the excess
mortality occurred when the surgeon had
performed fewer than 20 operations.
All physicians should be benchmarking
their results and demonstrating their outcomes, such as the types of complications
and frequency. You should ask for these
numbers and review them before making a
decision.
What are the other program elements that
correlate to success?
The American Society for Bariatric
Surgery has set the criteria for a surgical
center to qualify as a Center of Excellence.
Because the surgery is a tool for weight
loss — not a cure — it is important to have
a program that includes patient education
and support, so that weight loss can be
maintained over time. Approximately one
year after surgery, the body adapts. Then,
only good habits will maintain the weight
loss. That is why a Center of Excellence
must offer a comprehensive program that
includes both pre-operative and post-operative counseling.
What are some of the reasons to consider the
surgery?
After gastric bypass surgery, 80 percent
to 85 percent of the patients with Type 2
diabetes no longer require insulin; in fact,
losing weight often eliminates the need for
certain medications altogether. The laparoscopic procedures are less invasive and
easier to recover from, and the average
patient loses approximately 70 percent to
75 percent of his or her excess weight within one to two years after surgery.
Losing weight is not only good for your
physical health, it is good for your emotional health as well. I performed surgery
on one executive, and — a year-and-a-half
later — not only had she lost almost 150
pounds, she felt so much better that she
actually walked an entire marathon.
DAVID OLIAK, M.D., is medical director of the Chapman
Center for Obesity. Reach him at (800) 554-9544. Web site contact info is www.chapmanmedicalcenter.com/Weightloss and
www.droliak.com.
