Most of us know that a healthy diet and regular exercise can decrease our risk of developing obesity-related conditions like heart disease, stroke and Type 2 diabetes, but for a select group of people, bariatric surgery is the only way they feel they can combat their extreme obesity. And while some may view these procedures as "the easy way out," most clinicians agree that bariatric surgery is anything but simple. It is major abdominal surgery, and its success depends on a complete lifestyle change and a commitment for life.
Your Surgical Options - Learn the Differences
"Bariatric surgery is a blanket statement for many different operations," explains Dr. Kevin McGill, a bariatric surgeon with Buckhead Bariatrics. "Now there are several operations that we do – some make the stomach smaller, and some change the way your body absorbs food."
The most common bariatric procedure is gastric bypass because it generally poses fewer complications than other weight loss surgeries. This involves the creation of a small stomach pouch through a process called "stomach stapling." The new, smaller stomach pouch is then disconnected from the first part of the small intestine and reconnected to a lower part of the intestine. As a result, food passes directly from the stomach to the lower part of the intestine, bypassing the small intestine, so fewer calories are absorbed.
Other common types of weight loss surgery include adjustable gastric banding, or "Lap-Banding." For this procedure, the surgeon places a silicone ring around the upper stomach, and the ring's tightness can be adjusted by injecting saline to fill up the band or removing saline to loosen it. Another procedure, called sleeve gastrectomy, reduces the stomach to about 25 percent of its original size, leaving a "sleeve," or tube-shaped stomach.
As with any procedure, it's important to discuss with your surgeon which option is right for you. "For Type 2 diabetics, gastric bypass is generally the best option because you get significant control of diabetes," says Dr. Scott Steinberg, bariatric medical director at DeKalb Medical Center. "The second choice is usually sleeve gastrectomy. The Lap-Band was popular for a while, but it's fallen out of favor because of long-term side effects like reflux, and it drives maladaptive eating behavior – patients tend to favor starches, sweets and soft foods that go down easily. We see much better long-term results with gastric bypass and sleeve."
The average cost for a gastric bypass procedure can range from $18,000 to $35,000, while the average cost for adjustable gastric banding ranges from $17,000 to $30,000. Health insurance providers including Medicare and, in some states, Medicaid, are beginning to cover some or all of the costs of surgery if medical necessity is established by your doctor and if you meet the National Institutes of Health requirements.
Who Does Bariatric Surgery Benefit?
"Bariatric surgery benefits a very select group of people," Dr. McGill says. "We're taking care of people who are at least 100 pounds overweight. All of my patients are professional dieters. The problem is they gain it back, and the likelihood that they keep off more than 10 percent of their weight is miniscule."
According to Dr. Michael Williams, president of the Laparoscopic & Endoscopic Surgery Institute in Alpharetta, there are very strict guidelines for bariatric surgery candidates, and patients go through a multidisciplinary assessment prior to any procedure. "People who have a body mass index of 35 with associated illness, or body mass index of 40 without any associated illness may be good candidates," he says. "People with severe medical problems which place them at a high risk of death from general anesthesia and individuals with severe cognitive limitations or psychiatric conditions that limit their ability to follow a post-operative program should not have the procedure."
What To Expect
"There is no way to sugarcoat this," Dr. McGill says. "This is major abdominal surgery." Dr. Steinberg says that patients are on a liquid diet for the first two weeks after the procedure, and then they move on to soft food. In addition to a challenging post-op period, like any surgical procedure, this one has associated risks. Nearly 10 percent of patients have complications such as wound infections and bleeding after surgery, though according to Dr. Steinberg, the most common side effects post-op are nausea, bloating and constipation.
Northside Hospital bariatric specialist and nurse Debbi Spamer points out, "Since most of the surgeries are done laparoscopically, the recovery period is short." For most people, any post-surgical pain is minimal. "Most patients are walking within a few hours of surgery." Patients may even be back to work in as little as one to six weeks, though she cautions, "It usually takes about three months before the patient learns to deal with a smaller stomach and what they can and cannot eat."
Regular check-ups are also required for every patient. "Each patient who commits to this operation is committing to a lifetime of follow-up with us," Dr. McGill says. "We see them every three months for the first two years, then annually for the rest of their lives."
The Best Possible Outcome
The best outcome with bariatric surgery begins with finding the right surgeon. "The hospital should be a Center of Excellence in bariatric surgery and have all the necessary equipment," Dr. Steinberg says. "We've been using the da Vinci Robot because it has enhanced control – in the right hands, it's a very effective tool." Dr. McGill also recommends finding a surgeon who has been fellowship trained and is a member of the American Society for Metabolic and Bariatric Surgery.
Barring any complications, most bariatric procedures today are done in two hours or less with just five small incisions, but the real work begins once the patient leaves the hospital. "Over 90 percent of patients keep the excess weight off," Dr. Steinberg says. "Ten to 15 percent will gain weight after surgery due to diet non-compliance. But for most patients, this is a highly effective treatment. Your body's normal function is to perceive hunger, but the surgery alters your hunger cycle, so it's much more effective."
The majority of a patient's weight loss typically occurs in the first 10 months post-surgery, and often their obesity-related health issues disappear too. "Many co-morbidities such as hypertension, diabetes and sleep apnea either go away or improve," Spamer says. "This is not about looking better – it is about improving one's health." Dr. McGill agrees. "What gets me excited is taking care of diabetic patients and seeing their diabetes go away," he says. "Physically they are transformed, but you watch their health problems go away too – they are living a very different, healthy life."
Kevin McGill, MD -
Buckhead Bariatrics, www.buckheadbariatrics.com
Debbie Spamer, RN - Northside Hospital, www.northside.com
Scott Steinberg, MD - DeKalb Medical Center, www.dekalbmedical.org
Michael Williams, MD - Laparoscopic & Endoscopic Surgery Institute, www.bariatricsmd.com
Atlantans do the work and drop the pounds
Decatur resident Tina Tait, 43, considers herself a "fat-thlete." She's always been active, running in marathons and 5Ks, but has never managed to keep off the weight until now. Since she had bariatric surgery in January 2013, she's lost over 112 pounds. "I had a vertical sleeve gastrectomy, which is a relatively new procedure where 85 percent of my stomach was removed," she explains. "Unlike gastric bypass, the sleeve leaves the intestines intact. It was done laparoscopically, and I had five tiny incisions that were visible."
Tait's surgery was performed by Dr. Charlie Procter at Piedmont Atlanta Hospital, and she was fortunate to have no complications during her recovery. "I have only 13 pounds to my doctor's goal weight for me of 125 pounds, which puts me at a normal BMI," she says. "Because I have a much higher activity level than most, Dr. Procter thinks I might even get to my ideal body weight, which is 110. (I'm only 5 feet tall)."
To keep herself in check, Tait tracks everything she eats in My Fitness Pal. "I eat around 800 calories a day – sometimes as much as 1,000 – mostly protein and then vegetables or carbs if I have room," she says. "I drink most of my vegetables in a green smoothie, which is the easiest way for me to get them in. I weigh and measure everything, even though my stomach tells me when it's time to stop."
Today she says her life no longer revolves around food, and she's become the athlete she's wanted to be her whole life. "I'm no longer carrying an extra person with me, and it's opened up a whole new world," she says. "I train[ed] for the Atlanta Thanksgiving Day half marathon, and I even joined the Atlanta Track Club!"
Sylvie Hamel was overweight from the time she was 13, but it was witnessing her mother's struggle with weight and subsequent loss of mobility that motivated her to make a change in her own life. "I knew I would be in that position in 15 years if I didn't act soon," she says. "I hadn't developed diabetes yet, but I was on cholesterol and high blood pressure medicine. I weighed 283 pounds before surgery."
After meeting Dr. Kevin McGill, Hamel knew she was in good hands with him and the staff at Piedmont Hospital for her gastric bypass surgery in May 2010. "My surgery was performed five weeks prior to my retirement from UPS," she says. "The first day of my retirement was the first day I could exercise, and after that I was in the pool every day for six weeks. I gave my metabolism and weight loss a boost, not only because I was losing fat, but because I was exercising at the same time. I lost 120 pounds over 12 months. I've since regained about 12, so I'm working with a nutritionist now to get back on track. But I'm nowhere near as morbidly obese as I was before."
Since her surgery, Hamel says her life has undergone a complete reinvention. "I take salsa lessons, I shop for clothes (and enjoy it!) and I date, which I didn't do for a long time," she says. "A lot of people see the surgery as the easy way out, but it's not. You've got to do the work. It's a tool, but it's not a miracle. With work and dedication, it's the only way I could have achieved this. It saved my life."
At 267 pounds, Diana Oates was a self-proclaimed food addict. "Food and the couch were my best friends," she says. "My body began to break down. My husband began to shake me throughout the night, saying I stopped breathing in my sleep." During a visit to her primary care physician, Oates was referred to a sleep study. "I stopped breathing many times," she says. "After returning to my primary care physician for the full results of the test, his words were very clear: You need to do something about your health."
In February of 2009, Oates elected to have adjustable gastric band surgery with Dr. Scott Steinberg at DeKalb Medical. "When I entered his office, I saw two life-size [before and after] posters on the wall," she says. "On that day, I set one of the biggest goals of my life. I said I wanted to be on his wall."
Since her surgery, Oates weighs in at 133 pounds. "I went from not exercising at all to now having a love for it," she says. "I now exercise six days a week, and I'm also a certified personal trainer. I love working with others and showing them the road of this journey. So many people have no idea what weight loss surgery can do. I am the face of weight loss surgery. I took back my life, and I can enjoy all that life has to give."
Harold L. Harris, Sr.
For the last eight years of his 21-year run in the Air Force, Harold Harris was on the weight management program. He was spending as many as four hours a day in the gym but could not lose the necessary weight. Then in 1993, he had the first of three heart attacks. "My doctor told me that my weight was a problem," he says. "I was put on weight loss medication with no success, so I started discussing surgery with my doctors."
The final straw came in 2012 when his car broke down and two of his grandsons were walking him home. "After only a few feet up the hill, I fell back down, hurting only my pride in the process," Harris says. "I knew then if I wanted to spend some quality time with my grandchildren, I would have to do something to improve my health."
Harris was 276 pounds when he was admitted to Atlanta Medical Center for gastric bypass surgery with Dr. Miguel del Mazo in June of 2012. "Today my weight is consistently between 170 and 178, dependent on my exercise program, which has started to level out at four times a week," he says. "Medically, the improvements are beyond my every expectation. My [Type 2] diabetes is now being controlled by diet and exercise and has been that way from the time I woke up in the hospital. My blood pressure medications have been cut twice since the surgery, as well as my cholesterol medication being cut in half. I no longer suffer from sleep apnea or acid reflux. My heart has shown vast improvement." Harris even jokes that at his last stress test, his physical stamina was so high that his doctor simply stopped the test, which shows just how far he has come.
Center for Weight Management at Gwinnett Medical Center - Duluth
With a 12,000-square-foot facility and a board-certified, Harvard-trained surgeon, the Center for Weight Management offers bariatric patients support before and after surgery. They are an American College of Surgeons Level 1 Accredited Bariatric Center committed to helping their patients achieve long-term success. See ad p. 42