Weight-loss surgery

The number of people treating their obesity with a procedure known as bariatric surgery has increased dramatically in recent years. In 1999, fewer than 30,000 bariatric surgeries were performed in the United States. By 2003, it had climbed to more than 100,000, according to a study by the Journal of Managed Care.

Unfortunately, only about 9 percent of U.S. adults with private insurance are eligible for bariatric surgery, mainly because some health insurers have excluded it as a covered benefit.

Even more important, bariatric surgery may translate into financial benefits to health-care-conscious corporations if it results in fewer future medical expenditures — which it has been shown to do.

“Bariatric surgery is growing rapidly,” says Walter J. Chlysta, MD, FACS, and medical director of Akron General Medical Center’s Bariatric Center. “More people are considering it, and more and more are having it.”

Smart Business talked with Chlysta about what bariatric surgeries are available, what they can do and how it might impact upon the companies the patients work for.

Why bariatric surgery?
Overweight or morbidly obese patients tend to be more susceptible to other health problems, like diabetes, hypertension and sleep apnea. A lot of them have personal issues, like they can’t take their kids to amusement parks and ride the roller coaster with them. They’re embarrassed or they feel that their kids are embarrassed of them.

For most patients, it’s not a vanity issue. Most are genuinely concerned about their health or how their obesity is affecting their family.

What bariatric surgeries are most common?
With gastric bypass surgery, the stomach is partitioned off into a small pouch, and the intestines are divided and rerouted. So you not only eat less food, but the food you do eat does not get absorbed as well.

Lapband surgery inserts an adjustable band across the top of the stomach. You create a small pouch at the top of the stomach. As opposed to gastric bypass, lapband only works by one mechanism: restriction. It’s not as effective as gastric bypass, but it is the safest procedure.

Gastric bypass surgery takes two to two-and-a-half hours, and lapband takes 45 minutes to two hours.

What are the side effects?
There are side effects, mostly good. Many obesity-associated diseases are resolved completely or improve dramatically with weight loss, whether it’s surgical weight loss or medical weight loss. These diseases include Type II diabetes, high blood pressure, sleep apnea, arthritis, urinary stress, incontinence and many others. There is a decreased risk for certain cancers, stroke, coronary disease, and congestive heart failure. Patients who have conditions like congestive heart failure or emphysema where the damage is already done to the heart and lungs still usually improve with weight loss. This is not because the damaged heart or lung tissue is repaired with weight loss. It is because there is less work for the heart and less restriction on the lungs. These patients see increased mobility, less shortness of breath and overall improvement of their health. These people are able to function better … to take fewer sick days off work, to be more productive. Any business manager would be concerned about those issues.

What are the risks?
Just like any surgery, there’s a risk. The risk also depends on patient and his or her health problems. If they’re young, healthy patients, there’s less risk. If the patient has marginal lungs, marginal pulmonary capacity or has had prior heart attacks, then the risk is increased. There’s healing issues too: if someone is a smoker or diabetic, they’re more likely to get infections.

But the benefits outweigh the risk by far, and you try to tailor the surgery to the patient.

What, generally, is the postoperative prognosis?
First of all, the weight is likely to stay off. Bariatric surgery is the best way to lose and sustain weight, and that’s been proven. Just 10 percent to 20 percent of postoperative patients will have a significant weight gain, and that’s variable.

Patients have to take calcium and B12 vitamins or they can run into problems. The long-term issues are nutritional issues, but as long as you take your supplements, the vast majority of people are OK.

As for aftercare, some people can tolerate things well and some can’t. Many patients don’t need it. They have the surgery, they lose the weight, they move on. A few need continuing support. If they need help, it’s there. We have a support group that means once a month, and we have an online support group on Yahoo. We provide access to a bariatric coordinator and dieticians by phone or with an appointment if needed. Dieticians, physical therapists and psychologists are available for consultations.

WALTER J. CHLYSTA, MD, FACS, is medical director of Akron General Medical Center’s Bariatric Center. Reach him at (330) 344-6000 or [email protected].