Nicholson Clinic Blog

Are you considering bariatric surgery as a means to lose weight? If so, you are one of many. The number of bariatric surgeries performed in the United States has increased from about 13,000 annually in 1998 to 121,000 in 2004 [1]. This is not surprising when you consider that nearly 8% of some populations in the United States have a Body Mass Index (BMI) of 40 or above, putting them in the category of class 3 obesity. Class 3 obesity is a serious condition and is associated with both premature death and an increased risk of health problems such as diabetes, hypertension, high blood cholesterol, heart disease, osteoarthritis, sleep apnea, and gallbladder disease. Current guidelines from the National Institutes on Health recommend that people who meet the criteria for class 3 obesity or have a BMI of at least 35 along with serious health problems consider undergoing bariatric surgery as a method of weight loss.

Significant weight loss by a person who is morbidly obese has been shown to improve social functioning, quality of life, and health, and bariatric surgery was developed specifically to induce significant weight loss. When compared to other weight loss strategies, bariatric surgery seems to have some advantages for the morbidly obese. Dietary measures designed to induce weight loss tend to result in the loss of less than 15% of initial body weight [2], while medication and behavioral therapy resulting in an average long-term weight loss of 4 to 7 kg; these methods also fail to significantly improve health problems related to obesity. In comparison, the average weight loss after undergoing bariatric surgery is 40 kg, and many obesity-related health problems are resolved or improved [3].

When looking at bariatric surgery as a weight loss option, most people will be choosing between either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding. These two types of weight loss surgery are the ones most commonly performed, with Roux-en-Y gastric bypass the standard procedure in the United States and laparoscopic adjustable gastric banding common in Europe and Australia. In order to compare the effectiveness and complications involved in these common surgeries, Dr. Tice and his colleagues at the University of California conducted a review of the research that has been reported on both procedures [4].

Gastric Bypass or Banding? The Study

Eighty percent of the patients in the studies examined by Dr. Tice and colleagues were female, and the average patient was about 40 years old with an initial BMI of 45 (class 3 obesity). The patients underwent either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding, both primarily restrictive procedures designed to limit food intake. In Roux-en-Y gastric bypass, a small stomach pouch is surgically created, and the route of the small intestine is modified so a portion of the stomach and small intestine is bypassed. In laparoscopic adjustable banding, an inflatable tube is placed just below the junction of the esophagus and stomach. The tube is inflated via a saline solution injected through a subcutaneous port, which allows the size of the outlet to be adjusted.

In general, there have been few high-quality studies performed on the two bariatric surgeries, and sample sizes in the best available studies tend to be low. Randomized clinical trials are the best way to compare the risks and benefits of gastric bypass and gastric banding surgeries, and information from only one such trial was available for analysis. Future studies will hopefully shed even more light on the relative merits of different bariatric surgery treatments.

The Results

The available research data shows both advantages and disadvantages to each type of bariatric surgery. Some of the main issues considered include:

Weight loss

When patients’ weight loss results were compared one year after surgery, a 25% difference was found in the amount of weight lost by the two groups. The difference favored the gastric bypass group, with patients who underwent that procedure consistently having better weight loss outcomes. In the highest quality study – the only randomized clinical trial – only 4% of the gastric bypass patients failed to lose weight, while 35% of the gastric banding group did not lose their excess weight [5].

Resolution of comorbidities

Gastric bypass patients were more likely to experience resolution or improvement of weight-related conditions such as diabetes, hypertension, and sleep apnea [6,7]. One study, consisting of patients with a pre-surgery BMI of 50 or above, found that all diabetic patients treated with gastric bypass surgery were subsequently able to control their blood glucose levels without medication, compared to only 40% of patients who were treated with gastric banding.

Complications & recovery

Gastric banding surgery is generally considered less invasive than gastric bypass as well as potentially reversible, and this is reflected in a shorter operating time (by a median of 68 minutes), fewer short-term complications, and a subsequent hospital stay that was on average 2 days shorter. Mortality rates, although low for both procedures, also appear to be slightly lower for gastric banding. However, long-term complications were more likely to occur in patients who had received gastric banding surgery rather than gastric bypass.

Patient satisfaction

Only one of the studies examined reported information regarding patient satisfaction with their procedure; in that study, patients who received gastric bypass surgery were more satisfied overall than those who underwent gastric banding. While approximately 80% of the gastric bypass group was very satisfied with the procedure, only 46% of the gastric banding group reported being very satisfied. In addition, none of the gastric bypass patients indicated they were unsatisfied with the procedure or regretted having it performed [8].

Depending on your particular situation and concerns, you may find that one type of surgery is better suited to you than another. There are many factors to consider, including your initial BMI, your particular health concerns, your doctor’s recommendation, and the country in which you plan to have the surgery performed. However, the overall results tended to favor Roux-en-Y gastric bypass over laparoscopic adjustable banding. If you are planning to have your surgery performed in the United States, there doesn’t appear to be a compelling reason to deviate from the standard procedure.
References

1. Zhao Y, Encinosa W. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Statistical brief #23. Rockville, MD: Agency for Healthcare Research and Quality; 2007.

2. Bennett W. Dietary treatments of obesity. Ann N Y Acad Sci. 1987; 499:250-263.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

3. Tice et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. The American Journal of Medicine. 2008;121.

4. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127-133.

5. Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534-540.

6. Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. Dec 2004;240:975-983.

Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683-689.

About the Author

Matthew Denos is a medical researcher at Washington University in St. Louis, MO. He has a particular interest in the field of obesity treatment and sympathizes with people who have found that diet and exercise alone are not effective enough to control their weight. Matthew enjoys reading and writing articles related to weight loss and diet programs and enjoys publishing information about the latest research findings on obesity research. His website can be visited at coupon for bistromd diet nutrisystem promo code find coupon codes for medifast.

Gabourey Sidibe is young, confident, up for an Oscar in her first movie role. And despite reportedly weighing a very Hollywood-unfriendly 300 pounds, she is drawing celebrity praise. Ellen DeGeneres says, “You stay exactly who you are! Don’t ever let this town change you. You’re amazing.” The 26-year old star of the film “Precious” has been called beautiful and a role model in the big leagues. Back at home in Dallas, Quinthelyn Leejoy says, “I think she’s pretty.” Josh Jacobs adds, “To find that kind of confidence and success at that young age is pretty amazing.” Jenny Berryhill agrees, “To be confident in herself, that’s really awesome.” Lola Curry sums it up, “She’s beautiful.” But in a nation and state where an estimated 1 in 3 people is obese and it ranks as a leading cause of preventable deaths, some are saying Sidibe’s performance should be praised. But in regards to her weight, Dr. Nick Nicholson with Forest Park Medical Center says, “The problem is 15-20 years from now when she develops diabetes, high blood pressure and all of the factors that go along with obesity.” Dr. Nicholson says obesity is not a lack of willpower. It can be cured. He says, “It is education, awareness. It is starting to understand obesity for what it is. It’s a disease, not a social problem.” Sidibe admits wrestling with her weight, going on her first diet at age 6. The road to being comfortable in her own skin came in her early 20’s. Gabourey Sidibe says, “One day I had to sit down with myself and decide that I loved myself no matter what my body looked like and what other people thought about my body.” , But Jenny Berryhill, a Farmers Branch woman who lost 60 pounds in 2 years, still worries about Sidibe’s health. So does her husband. Johnathan Berryhill says, “Is she going to be on medicine? What’s her quality of life going to be like, you know for her kids sake?”

Copyright © 2010, KDAF-TV Full Story

Surgery to Remove Hanging Skin
Though continued exercise and fat loss will help reduce hanging skin around the abs, inner thighs and underarms, a surgical procedure is likely necessary to remove the loose skin. While weight loss surgery is often covered under medical insurance plans, skin removal is considered cosmetic surgery and is not covered by insurance. Prevention is the ideal way to deal with loose, hanging skin due to weight loss.

Prevent Loose Skin After Weight Loss

•     Exercise regularly to tighten and tone problem areas
•     Follow a healthy diet plan
•     Do resistance training 3 times a week to build new muscle for the skin to adhere to
•     Count calories
•     Don’t follow an extremely restrictive diet
•     Drink a lot of water
•     Lose weight slowly
•     Talk to your doctor about healthy weight loss options

•     Continue to exercise regularly
•     Concentrate on strength training exercises
•     Eat lean poultry and other proteins with each meal
•     Try over-the-counter creams to tighten the loose skin
•     Consider surgical options to remove hanging skin
•     Change your BMI to tighten loose skin

You already know weight loss surgery is not a magic bullet and you know it’s just a tool… There’s something else that is very important that you need to know and even though you believe this to the core of your being, losing all the weight is not getting you to the paved golden streets of happiness.

Pre-ops will tell me I’m crazy and don’t get me wrong, it makes you happier for awhile. (I believed it too) The problem is that when we put our happiness in outside “things” we set ourselves up for disappointment. “When I lose weight, when I get the right job, when I get the right man/woman.” If the thing that makes us happy is always in the future, we can never get there and even if we get it, we wake up one day and realize that the “thing” isn’t as exciting as it was in the beginning. All new things become old. You can’t maintain a high from one thing without consequences. Happiness comes from within.

I had a wonderful friend that said she wanted to go back and be 20 again since all the hot guys were hitting on her now even though she had a wonderful supportive husband. I explained that she already had her knight in shining armor because let’s say you replace him and one day you’ll wake up and see that he snores too and after all the newness has worn off, it will just be the same old thing and you might find out he has more bad habits than the last one.

You may or may not be aware of what “they say” about how someone who emerges from years of alcoholism. They have been numbing their feelings so long that they have to learn to grow up socially because they checked out when the disease took hold of their life. It is much the same for many of the obese. When you and others decide that you are unworthy of taking part in the real world you are often left alone to your own devices and are not exposed to normal life lessons. Not every obese person isolates, but I believe most do because we have condemned ourselves to a self loathing prison.

Many obese people are absolutely sure when they walk in a room that EVERY SINGLE PERSON in the room has seen them and commented about how big they are. Of course this isn’t true, but it comes with the job. I was an expert at isolation at the end of my fat life. I had to go to work and only went to Wal-Mart because I could get food and clothes in one spot. The thought that someone might recognize me and the shame associated with it was too much to bear. With that in mind it meant that I did not take part in the everyday activities that so many people take for granted.

When we start to live in “normal people land” there is so much adjusting involved. Newbies often have a tough time because life changes so quickly and you’re on a massive high. This massive high helps you deal with the fact that you are no longer getting high on food. Your hormones go crazy, you are feeling better than ever and you might make life choices that are not good for you. You might end up drinking too much or you might feel sexy for the first time in a long time….or ever. Oh wow…have I seen some things! Because you are changing so radically you need to have a system to keep you in check.

I’m not kidding because I swear you’ll think something is a really good idea at the time and when you look back on it later, you wonder who on earth was that person and what was I thinking? I believe you should avoid new relationships for at least a year because we don’t even know who we are yet.

If you are already in a relationship, it is so important for both of you to know that the person that got the surgery will be getting attention and they will like it. (That’s normal but tough on the spouse) Spouses you need to be first in line to tell your newly thin significant other how nice they look. Surgery person, you need to realize how much benefit you are getting from the surgery, having the time of your life, and the spouse’s life is changing and has no choice in the matter and might feel scared and resentful. Unfortunately this life changing surgery is still poorly understood. The operation itself is the smallest part of our “recovery”. Someone needs to help you learn to drive this new race car because you haven’t done it before.

Cross addiction is real. One of my favorite definitions of addiction is “continued use despite negative consequences”. That described my obesity perfectly. I knew I was huge but I continued to eat because it was my coping mechanism. I knew I would only have a few moments of pleasure to be followed by a period of guilt and self loathing. We have to figure out how to deal with life without coping mechanisms. The first year it is so important to retrain your lifestyle because it’s the easiest time because you can practically do anything without messing up the plan because you will lose weight. When you get to the end of the honeymoon period, you need to be well trained by then because trying to start the changes after the honeymoon period is very difficult. You need to already be involved in new activities and learn how to handle what triggers your addictive behavior…

Tomorrow we will post the rest of Yvonne’s blog about the life changing effects of weight loss surgery. Stay tuned!

Read Yvonne’s blog, Bariatric Girl and her show WLS Journeys