Obesity: Treatment Options for this Worldwide Epidemic

If you suffer from obesity, you are not alone. Obesity rates have skyrocketed in recent years, to the point at which healthcare experts now classify the disease as an epidemic. “The prevalence is rising dramatically, not just in the United States but worldwide,” says Dr. John Olsofka, a general and bariatric surgeon in Louisville, Ky.

Currently, more than 300 million people worldwide are considered obese. In the United States, one in four adults, or more than 50 million people, are obese. That means their body mass index (BMI) is between 30 and 34.99. Twenty percent of these people, or about 8 million Americans, are considered morbidly obese, meaning their BMI is 40 or higher.

Obesity is a chronic disease with serious consequences. It has been linked to more than 2.5 million deaths annually. And it is the cause of multiple diseases, referred to by doctors as co-morbidities. Some, like hypertension, gastroesophageal reflux disease, joint pain and sleep apnea, are directly related to obesity. Certain cancers, depression and dermatological problems have also been associated with it.

Losing excess weight makes a big difference in reducing co-morbidities. In many cases, existing diseases will improve or the risk of developing a disease will be reduced when the obesity is reversed. Diabetes is also a major concern among obese patients, which is why Olsofka says that “we tell our patients that with successful weight loss, long term, the majority will have improvement in their diabetes and a significant portion will get off medication.”

Losing the Weight

The best approach to weight loss is a program that includes healthy eating, exercise, behavioral modification and if necessary, drug therapy. But these programs have not proven successful for everybody. “It’s amazing when patients give us a history of what they have tried,” says Olsofka. “Often they have made extensive and multiple attempts throughout their lives.”

Weight-loss surgery is a proven, effective way to help people not only lose the weight, but maintain the weight loss for the long term. Doctors and patients are recognizing the benefits, and the introduction of safer, less-invasive procedures explain why the number of weight-loss surgeries performed in the United States grew by 450 percent from 1998 to 2002.

Surgical Options

There are different types of weight-loss operations, but the two most common are adjustable gastric banding and gastric bypass.

During the gastric banding procedure, which can be performed laparoscopically as an overnight, out-patient procedure, the band is placed around the top part of the stomach to create a small pouch. The pouch fills with food during meals, making the patient feel full. The band can be adjusted in a simple, 5-minute procedure to regulate the rate at which the pouch empties. It is meant to be a permanent procedure, but the band can be removed if medically necessary so patients can revert to their normal anatomy.

Like any surgical procedure, this surgery is not without risks. Complications may include a port infection and slippage of the band, meaning a portion of the stomach slips up under the band, creating a larger pouch. Band erosion, where the band irritates the stomach and erodes into it is also possible. These complications are very uncommon. There are minimal physical restrictions, and recovery takes about 2 weeks.

During the gastric bypass procedure, the surgeon cuts, sutures and staples the stomach to create a small pouch. This causes a restriction in the amount of calories taken in. In addition, a portion of the small bowel is bypassed. As a result, the surgery prevents a portion of every meal eaten from being absorbed. However, because it is more invasive, it generally requires a 2- to 5-day hospital stay, and there are more complications. These include wound infections, leaks, and strictures from cutting and stapling the small intestine. Gastric ulcers, hernias, and bowel obstructions are also a concern. And, because a portion of the digestive tract is bypassed, there is a reduction in the absorption of essential nutrients. Recovery can take anywhere from 2 to 6 weeks.

Weight loss rates depend on the procedure and the individual. Typically, bypass patients have a more rapid initial weight loss, but commonly regain up to 20 pounds from the initial weight loss. Patients who undergo the adjustable gastric band can expect to lose 1 to 3 pounds per week on a continual basis. The weight loss progresses over a 2- to 3-year period and then stabilizes. Five-year studies show the amount of weight loss from gastric bypass equals that of the adjustable gastric band.

Choosing a Weight-Loss Surgeon

When choosing a surgeon, Olsofka says it’s important to look for one who is experienced with the procedure the patient is considering. “Ask about the surgeon’s field of expertise,” he says. Find out if he is a bypass surgeon or a band surgeon. It’s an important distinction.

The next step is to look at the surgeon’s overall program. The surgeon should be working in a clinical, multidisciplinary setting with all aspects of management and assessment.

The American Society for Metabolic and Bariatric Surgery at www.asbs.org is a good place to start. It’s also smart to get recommendations from other patients.

Life After Surgery

Life after weight-loss surgery will never be the same, stresses Olsofka, and not just because patients eat less. “This is an overall, complete change in your lifestyle,” he says. Not only are patients physically healthier, they also report experiencing the positive psychological aspects of losing weight and maintaining that weight loss.

Still, some things will require a period of adjustment. Lifetime follow-up is recommended, with at least three follow-up visits during the first year. Adjustable gastric banding patients require more frequent visits, especially during the first year for band adjustments.

Most doctors stress the importance of adopting a healthy lifestyle, which includes a new nutrition plan. Regular exercise is also recommended for maintaining health and improving muscle tone.

Reconstructive surgery may be necessary for some patients after weight loss stabilizes, but this is more likely to be associated with rapid weight loss due to gastric bypass, says Olsofka. Adjustable gastric band patients lose weight at a constant pace, and when that is coupled with a comprehensive weight loss program, plastic surgery is less likely to be required because the skin maintains its ability to retract over time.