Morbid obesity is defined as having a Body Mass Index (BMI) of 40 or more, which is equivalent to 100 pounds or more over ideal body weight. The disease of morbid obesity interferes with basic physical tasks such as breathing, walking, and completing every day tasks. Long term effects of the disease include shorter life expectancy, serious health consequences in the form of weight-related health problems (co-morbid conditions) such as type 2 diabetes and heart disease, and a lower quality of life.
The causes of morbid obesity are multiple and complex. Research has shown that in many cases, significant, underlying causes of morbid obesity are genetic, environmental, and social. Studies have also demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
Bariatric surgery is a procedure designed to reduce the amount of food the stomach can tolerate so the patient feels satisfied with less food. Alternatively, a procedure may rely on malabsorption to limit the amount of nutrients the body can assimilate. It is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other weight loss therapies such as diet, exercise, medications, etc. A person with a Body Mass Index (BMI) of 35 or greater and one or more comorbid condition may also may qualify for bariatric surgery.
BMI is a measure used to index a person’s height and weight. BMI allows healthcare professionals and patients to better understand health issues associated with a specific weight classification (classifications such as obesity and morbid obesity).
Patients who qualify for bariatric surgery should have: 100 pounds or more of excess weight; a BMI of 40 or greater or a BMI of 35 or greater with one or more co-morbid conditions. Other common guidelines include: Understanding the risks of bariatric surgery; Committing to dietary and other lifestyle changes as recommended by the surgeon; Having a history of weight loss treatments that have failed and undergoing a complete examination including medical pre-operative tests.
Talk with Dr. Shillingford about the different surgical treatments, as well as the benefits and risks associated with each.
Bariatric surgery is not cosmetic surgery and will not involve the removal of adipose tissue (fat) by suction or surgical removal. The patient must commit to long-term lifestyle changes, including diet and exercise, which are key to the overall success of bariatric surgery. Problems after surgery are rare, but corrective procedures may be required. Although exercise helps patients reduce excess skin, some may choose to undergo cosmetic procedures based on personal preference.
As with any surgery, there are immediate and long-term complications and risks. Although rate, possible risks can include, but are not limited to: Bleeding Complications due to anesthesia and medications; Deep vein thrombosis; Dehiscence (separation of areas that are stitched or stapled together); Infections; Leaks from staple lines; Marginal ulcers; Pulmonary problems; Spleen injury; Stenosis (narrowing of a passage, such as a valve); Band slippage and Band erosion.
Side effects include: Vomiting, Dumping syndrome, Nutritional deficiencies, Gallstones, Need to avoid pregnancy temporarily, Nausea, Bloating, Diarrhea, Excessive sweating, Increased gas, and Dizziness.
Open surgery involves the surgeon creating a long incision to open the abdomen and operating with “traditional” medical instruments. Laparoscopic, or minimally invasive, surgery is an approach that allows the surgeon to perform the same procedure using several small incisions, a fiber-optic camera, video monitor, and long-handled instruments. The results are faster recovery time, reduced operative risk, and minimal scaring.
Dr Shillingford is fellowship trained in the advanced laparoscopic approach to bariatric surgery.
The decision to perform minimally invasive or open surgery is made by your surgeon before the operation. For some patients, the laparoscopic, or minimally invasive, technique is difficult due to dense scar tissue from prior abdominal surgery. Also, the inability to see organs and/or bleeding during the operation can cause your surgeon to switch from minimally invasive to open surgery during your operation.
Studies show that bariatric surgery is successful in helping a patient achieve extreme weight loss. Furthermore, it can effectively improve and resolve many comorbid conditions. A study of more that 22,000 bariatric surgery patients showed: Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea 61.2% reduction of excess weight.
|TREATMENT||WEIGHT LOSS (% OF PATIENTS)|
|Diet and Exercise*||2% to 5%|
|Bariatric Surgery***||50% to 70%|
* Success measured as a loss of 10 percent of initial body weight ** Weight loss is not maintained once treatment ends *** Success measured as a loss of 50 percent of excess body weight (equivalent to loss of approximately 20 to 25 percent of initial body weight)