Surgical weight reduction Featured

7:00pm EDT November 24, 2006

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 and