Nearly two-thirds of the U.S. population is considered overweight, and 5
percent of all Americans fall into the morbidly obese category. Excess weight
substantially increases the risk of numerous health problems and is also associated
with an increase in mortality.
Bariatric surgery is designed to help people fighting obesity improve their health by
using surgical intervention. Although
bariatric surgery can be an effective tool in
weight loss, patients must also commit to
long-term lifestyle changes.
“Bariatric surgery is ideal for people
who are willing to take personal responsibility for their well-being,” says Dr. Amir
Mehran, assistant clinical professor of
surgery and director of bariatric surgery
at UCLA Medical Center. “It really helps
them as long as they are willing to help
themselves.”
Smart Business spoke with Mehran
about the types of surgical weight-loss
techniques that are available, what eligibility requirements must be met and what the
recovery process consists of.
What are some health risks associated with
obesity?
Obesity is associated with several risks,
including cardiac disease, high blood pressure, diabetes, hyperlipidemia and obstructive sleep apnea. There are also risks for
malignancies such as ovarian, prostate,
colon and kidney cancers.
What types of methods are available for the
surgical treatment of excess weight?
Several are available. The caveat, however, is that none of them will work unless the
patients change their lifestyle and eating
habits before surgery.
The most common procedure is the
Roux-en-Y gastric bypass, which has been
done since the late 1960s. It has been
shown to be quite effective with minimum
number of side effects. Another available
method is adjustable gastric banding. It is a
newer operation whose U.S. results have
been mixed. The biliopancreatic diversion/duodenal switch is a much more drastic and less commonly performed operation. It results in the most amount of mal-absorption.
Once again, however, if a person is not
committed to the whole pathway of changing his or her life, nothing will work.
In order to have a surgery, what eligibility
requirements must a patient meet?
The general eligibility requirements are
based on guidelines set by the National
Institutes of Health. Essentially, they go by
body mass index, which is defined as kilograms divided by meters squared. People
with body mass indexes over 40 are considered to be morbidly obese. If their body
mass index is over 35 but they have other
problems such as high blood pressure or
diabetes, they are considered to be candidates for surgery as well.
People are generally between the ages
of 18 and 65, although there is currently
much debate about what to do with children who are morbidly obese. Obesity
must have been present for several
years, and patients should have been on
several supervised diets in the past.
They must also be free of any major psychiatric problems.
What are some possible risks and complications that can arise from bariatric surgery?
Speaking for the gastric bypass procedure, the mortality rate is roughly one in
500. The risks include intestinal leakage,
which occurs in less than 1 percent of
cases, and deep venous thrombosis in the
leg with resultant pulmonary embolus,
where a clot from the leg travels to the
lung, which occurs in about less than 1 percent of all cases. Other potential problems
include bowel obstructions, marginal
ulcers and sagging skin.
How should a person decide if a surgery is
the most viable option?
It’s a very personal choice. It has to be
made with the help of family, a good social
support system and a trusted primary care
physician.
This type of surgery is really geared
toward people who have tried everything
else to lose weight. They’ve been on all
kinds of diets and exercise programs and
have lost a certain amount of weight.
However, after a while they stop losing
weight, get discouraged and gain all of
their weight back plus an additional
amount.
Once surgery is completed, what does the
recovery process consist of?
For the laparoscopic Roux-en-Y gastric
bypass, which is what we do at the UCLA
Medical Center, the recovery time is roughly
two to four weeks. Then during the first year
or two, the patient needs to be followed
closely with blood work done every three
months. After that, a yearly follow-up is fine.
For the gastric bypass procedure, as long
as patients take their vitamins and are
watchful of what they do, the downsides
are very minimal. It is critical to have a
good primary physician who can follow
their progress closely.
DR. AMIR MEHRAN is assistant clinical professor of surgery
and director of bariatric surgery at UCLA Medical Center. Reach
him at (310) 206-7235. For more information visit
www.bariatrics.ucla.edu.
