| Dr. Maureen Martin is a member of the American Society of Metabolic and Bariatric Surgery. Here the doctor has answered some of the common questions bizymoms visitors have about Bariatric Surgery.
Q. What is depression and how is it affected by bariatric surgery?
A. Depression is very frequently associated with morbid obesity and patients who seek bariatric surgery. In fact, the vast majority of morbidly obese patients have some element of depression in their history. Many patients have suffered from ridicule and criticism for their size. When we look back in the histories of our patients, physical and mental abuse are also quite common and often serve as the stage that is set for the patterns of overeating and weight gains that we see.
It is very important for people contemplating weight loss surgery to have careful evaluation by psychologists who are trained to evaluate people with eating disorders and to rule out any serious underlying psychiatric disorders that would impact the success of bariatric surgeries. Most bariatric surgery programs demand that psychological evaluation and clearance is part of the patient’s pre-operative assessment and preparation for surgery.
Q. How successful is bariatric surgery?
A. Bariatric surgery is emerging as the most successful method that medical providers have today to ensure durable weight loss. When surgery is compared to medical strategies including medications, diet and exercise, there is no doubt that surgery is the most successful. Eighty-five percent of patients who undergo bariatric surgery will sustain rapid and immediate weight loss. Durable long-term weight loss, however, is more dependent on the patient’s ability to change behavior and develop healthy lifestyles to include a healthy diet and exercise to sustain their weight loss. Motivation also plays a critical role in the ultimate success of bariatric surgery. In fact, many patients who demonstrate modest weight loss in preparation for their bariatric surgery will be exceedingly successful following their procedures.
Q. How does the Predominantly Restrictive procedure work?
A. When we think about bariatric surgery there are two important concepts that patients should understand. In general, weight loss operations focus on either reducing the size of the stomach (restrictive) to reduce the volume of food ingested by the patient or bypassing a segment of small intestine to reduce the absorptive surface area for the bowel to absorb calories. (Mal-absorptive)
Common restrictive operations include:
Lap Band – a circular band is placed around the upper portion of the stomach to create a small pouch, no stapling or cutting of the stomach takes place. This band can be adjusted by inflating or deflating a small balloon within the band. Weight loss is slower with this method and patients may need to be adjusted periodically afterwards.
Sleeve gastrectomy - This was originally done as a two-step operation for super obese patients who were not able to tolerate gastric bypass initially, but is now emerging as a purely restrictive option for some patients. A long "sleeve" of stomach is created by stapling along the greatest length of stomach to make it smaller. No bypass of the small bowel is done thus avoiding some of the long-term complications of gastric bypass.
Operations involving both Restriction and Malabsorption include:
Gastric Bypass – This is the most common operation performed in the United States for morbid obesity. In this operation the stomach is stapled to create a small pouch (1 to 2 ounces) and a generous length of small intestine is bypassed to create the malabsorptive route. This operation results in weight loss from dramatic reduction in volume of food that can be eaten while the bypassed segment of small bowel adds a malabsorptive component to reducing the calories ingested. The surgery can be done in an open fashion where a surgical incision is created or in a laparoscopic fashion where minimally invasive surgical techniques are utilized. Both surgeries are equally effective and the end result is the same.
Q. How important is patient attitude towards the success of bariatric surgery?
A. Patient attitude is probably the most important component of success for our patients. Motivated patients who are willing to change lifestyle and assume healthy eating and diet and exercise in addition to undergoing surgery have the most success. Many patients, who failed bariatric surgery, did so because they are not motivated to change their lifestyle and embrace healthy living habits. As time goes on, the pouch stretches and patients can eat more.
Q. Do you do the Panniculectomy procedure for your patients after the surgery?
A. I do not perform Panniculectomy procedures for our patients. However, we have a very close interaction with our plastic surgeons who are available to see and evaluate patients for Panniculectomy and other body contouring procedures.
Q. Do you recommend any alternatives to bariatric surgery?
A. There are a number of alternatives to bariatric surgery that include medication and diet supervision. Diets alone, particularly some of the commercial programs such as Jenny Craig and Weight Watchers are successful. However, strong reliance on the motivation of the patients is required for durable weight loss to be sustained. As difficult as it is, losing weight is quite a simple concept in the sense that weight gain is directly related to ingestion of more calories than the body needs to sustain it’s basic functions.
If patients reduce the amount of calories that they eat regardless of whether it is through diet, medication, exercise or surgery, they will definitely lose weight. Once again, the motivation that drives the patients to seek weight loss treatments will dictate the ultimate success of any procedure surgery included.
Duodenal Switch (DS) – This is the least common of bariatric operations performed. The DS procedure includes a partial gastrectomy, which reduces the stomach but unlike the gastric bypass "pouch" which bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates some of the complications, which can occur after other gastric bypass procedures.
The DS procedure preserves the normal food digestion before being excreted by the pylorus into the small intestine. The malabsorptive component of the DS procedure reroutes the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined; food and digestive juices begin to mix, and limited fat absorption occurs in the common tract as the food continues on its path toward the large intestine.
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