• Columns, Health check

    Posted on January 4th, 2011

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    BY DR. EDWARD C. FACUNDUS / CRESTWOOD MEDICAL DIRECTOR

    Many of us have been on some type of diet in our lives. Some of us have spent our entire lives trying the latest fad diet, each time ending up right back where we started. We find that over 90 percent of diets fail in the long run.

    More than 72 million Americans are obese or severely overweight. Each year, obesity causes at least 112,000 deaths in the United States, and it’s associated with numerous health problems: Type 2 diabetes, high cholesterol, hypertension, gallstones, liver disease, sleep apnea, gastroesophageal reflux disease (GERD), heart failure, degenerative joint disease, birth defects, miscarriages, asthma and cancer.

    If you’re more than 100 pounds over your ideal weight, you may benefit from weight-loss surgery. Weight-loss surgery (also known as bariatric surgery) can offer lifesaving health benefits. It’s estimated that in 2008, approximately 220,000 people in the U.S. had weight-loss surgery.

    A 2004 study published in the Journal of the American Medical Association found that bariatric surgery patients lost between 62 and 75 percent of their excess body weight. Beyond simple weight loss, there were significant improvements to chronic health conditions: 76.8 percent of bariatric surgery patients experienced remission of Type 2 diabetes; hypertension was eliminated in more than 61 percent of patients and significantly lowered in 78 percent; more than 70 percent experienced a drop in cholesterol levels; and sleep apnea was eliminated in more than 85 percent of patients.

    There are various types of bariatric surgeries:

    —Roux-en-Y gastric bypass is the most common bariatric surgery performed in the United States, accounting for about 80 percent of all weight-loss surgeries. Surgeons create a small gastric pouch to reduce food intake. They then attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the lower stomach and parts of the intestine to reduce caloric absorption. The procedure is performed with a laparoscope through several small incisions.

    —Adjustable gastric banding (Lap Band and Realize Band) is the second most common bariatric surgery, representing 15 to 20 percent of all weight-loss surgeries. Surgeons place a band around the upper stomach with a laparoscope, limiting food intake to 1 – 3 ounces. The band can be tightened or loosened over time to change the passage’s size. This procedure generally results in less weight loss than a gastric bypass, but is more easily reversible.

    —Duodenal switch with biliopancreatic diversion, similar to the gastric bypass, surgeons reduce stomach capacity and disconnects the upper small intestine, reconnecting it to another part of the small intestine, much lower down than the reconnection site of the gastric bypass procedure. Because even more of the small intestine is bypassed, even fewer calories are absorbed.  This procedure is not reversible.

    —Gastric sleeve or vertical sleeve gastrectomy restricts food intake, by removing most of the stomach. The remaining stomach “sleeve” will hold about one cup of liquid.  This is the first part of the duodenal switch procedure, but has been found to be effective as a solo procedure to achieve long term weight loss.  This procedure is not reversible.

    Basic criteria are reviewed when considering bariatric surgery.   Exceptions and variations to these criteria are considered on a case by case basis.  In general, surgical candidates should:

    —have a body mass index (BMI, the ratio of your weight adjusted for your height) of 40 or more, or be at least 100 pounds overweight

    —have at least one significant associated illnesses, such as diabetes, hypertension, arthritis or sleep apnea, if your BMI is between 35 and 40.

    —have no drug or alcohol dependency, or have at least one year of sobriety.

    —have documented attempts to lose weight medically.

    —be a nonsmoker for at least two months prior to surgery.

    —be committed to improving your health and lifestyle with changes in diet, increasing daily activity and exercise.

    As with any surgical procedure, bariatric surgery may present risk. Talk with your doctor about whether you’re a candidate for weight loss surgery and together, discuss the risks and benefits.

    Remember that you must be committed to maintaining a healthy lifestyle – including adopting very different eating habits and increased exercise, as well as nutritional counseling and lifelong medical follow-up, after surgery.

    Dr. Edward C. Facundus is a board certified surgeon specializing in general surgery, advanced laparoscopic surgery and bariatric surgery. Dr. Facundus’ surgical practice, Alabama Surgical Associates, is located at 250 Chateau Drive on the Crestwood campus. For more information, visit Lapbariatrics.com or contact his office at 256-880-1977.

    This entry was posted on Tuesday, January 4th, 2011 at 10:39 am and is filed under Columns, Health check. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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    5. Rexine Pigg
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      This is an informative article which sparks my desire to look into making the decision to improve my quality of life. I am a 62 year old female with a BMI of 67 weighing in at 418 lbe. with extremely limited mobility (use walker & power chair). I am on medication for hypertension (since the age of 40). suffer with severe lymphedema of the feet and legs, incontinence. depression and find it difficult to socialize due to my large body and restrictions. I am concerned about surgery due to the lymphedema but my heart is healthy and I am basically in fair health. pain comes from arthritis and acute edema. I can only do limited exercise in my lift chair and feel that my metabolism must be very slow due to restrictive movement. I do not have varicose veins or have not had blood clots thankfully but my legs and feet are so swollen I can’t wear regular shoes and socks. My plan of action is to attend the
      april 5 seminar/support group at Crestwood. I notice that Huntsville Hospital has one the same week. I know a recent client of the lapband you treated at Crestwood (Angie Neal) and she gave me a good report on her progress. I have been afraid of bariatric surgery in the past but find myself feeling fatter day by day no matter what I eat. Please help me make these changes. I will do whatever I am told because I am very determined to live to be l00 at least. lol.

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