By: Dr. Armour R. Forse
DHR Health Bariatric and Metabolic Institute
Obesity is not a simple eating problem but a medical disease. It is a global epidemic which is affecting millions and millions of people. Obesity is associated with medical complications, a very difficult and uncomfortable lifestyle, and an increased risk of dying. Obesity is a serious medical condition with increased risk of other diseases, such as contracting and dying from COVID. There are many treatments for obesity, from life style changes to diets to psychotherapy to medications. One form of treatment for obesity is surgery (called bariatric or metabolic surgery), which was developed in the 1960s. There are currently two bariatric surgery operations that are commonly done: the sleeve gastrectomy and the gastric bypass. The risk profile associated with bariatric surgery today indicates that the operations are relatively safe, with the surgical risks similar to those undergoing surgery for hernias or gallbladder disease. Surgery is not for everyone and is recommended for patients with the degree of obesity that is considered morbidly obese or for obese patients with life-threatening medical conditions, such as diabetes, cardiovascular disease, and severe respiratory problems like sleep apnea.
The clinical way of deciding on the degree of obesity is to calculate your Body Mass Index (BMI), your weight in kilograms (kg) or pounds (lbs.) divided by your height in meters or feet squared (https://www.nhlbi.nih.gov ). Obese patients with a BMI above 35 and life-threatening conditions and morbidly obese patients with a BMI of 40 or greater should consider surgery as a treatment option. Patients who choose to undergo the surgical treatment should expect a thorough nutritional, medical, and psychological assessment to ensure that they are good candidates for surgery and to reduce their risks. Patients who are well-prepared for this surgery find that their perioperative course is much easier to complete.
Patients who undergo bariatric surgery can expect that they will lose weight over a year to year and a half. Most of the weight comes off within nine months. The success of the surgery is not only the surgery but the commitment and the ability of the patient to make the lifestyle changes with their surgery. This is why the surgery should be part of a complete and comprehensive program which, through regular follow-ups, provides the nutritional, exercise, medical, and psychological support needed to make the transition successful.
Can the bariatric surgery successfully treat weight-related comorbidities? The answer is a resounding yes and is seen in patients with medical conditions such as diabetes, hypertension, cardiac conditions, gastric acid reflux, fatty liver disease, and sleep apnea. Patients can have a dramatic improvement in their medical conditions.
There are a number of studies that have investigated the use of bariatric surgery as compared to the medical or conservative treatment for these weight-related conditions. Surgery has proven to be more effective, often resulting in patients not requiring any further medical treatment for their medical conditions. Patients with sleep apnea have stopped needing a device to sleep, and patients with diabetes and those with hypertension have stopped needing medications to treat their diseases. Patients with severe arthritis of their joints and back have had relief of their symptoms and are often able to undergo joint and spine surgery once their weight is reduced.
A recent study from the Endocrine Society found that half of the adults with type 2 diabetes had long-term remission of their type 2 diabetes with gastric bypass surgery, even independent of the amount of weight lost. These improvements, particularly with patients with diabetes, have led to studies being carried out using bariatric surgery in patients with diabetes with a BMI between 30 and 35. The results after surgery are very promising and show a lasting improvement in blood sugar control. As a result, patients with diabetes and a BMI between 30 to 35 who are cared for by an endocrinologist and use three medications to control their diabetes may be considered for bariatric surgery. Studies in people without obesity but with other conditions, such as diabetes and fatty liver disease, have shown promising results.
Patients with bariatric surgery have concerns about gaining their weight back. Yes, this can occur if the patient adapts poor habits, and particularly those who do not follow up with their program. The observations are that while some weight can be regained, the weight-related medical conditions often remain in remission.
One question that women ask is, “Can I get pregnant after bariatric surgery?” The answer is yes. In fact, you are more fertile after the bariatric surgery due to reduced estrogens. It is best not to get pregnant right after the surgery, waiting until the post-surgical weight loss has stabilized. The current information is that pregnancy after weight loss (following surgery) is better tolerated, and the children are at lower risk of developing obesity and diabetes.
Is bariatric surgery an option for you? Visiting a bariatric surgical center and attending their information sessions– either in person or on-line–are a great start.
If you or a loved one would like more information about bariatric surgery or would like to sign up for an informational session at DHR Health Bariatric and Metabolic Institute, please call (956) 362-5673. Our experts are ready to answer any questions you may have.
