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Get the facts on obesity and bariatric weight loss

7 min read
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Michael D. Felix, MD, FACS, Metabolic and Bariatric Surgery Director for Washington Health System, Washington Hospital

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Obesity has been called many things- an epidemic, a major public health problem, an urgent chronic condition- but is it a disease?

The American Medical Association (AMA), the largest physician organization in the nation, has decided that it is.

One in three American adults is obese, and the rate of obesity in children has nearly tripled over the past 30 years. Experts have warned that kids today may be the first generation in history to live shorter lives than their parents.

Recognizing obesity as a disease will help change the way the medical community tackles this complex health issue.

Hope Bariatrics is the private practice of Dr. Geoffrey H. Wilcox and Dr. Michael D. Felix, general surgeons with the specialty in bariatric surgery. Hope Bariatrics has performed over 2300 bariatric surgeries since 2003. Both surgeons are board certified and members of the ASMBS (American Society of Metabolic Bariatric Surgery) as well as the FACS.

Hope Bariatrics has been designated the Bariatric Center of Excellence from the ASMBS since 2006. The comprehensive approach to bariatric surgery includes a full time registered dietitian who consults with each and every patient prior to surgery and available to them for life. Dr. Wilcox and Dr. Felix consult with each new patient before surgery discussing their health history including expectations of surgery.

The three metabolic and bariatric operations performed at Hope Bariatrics are Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and the Adjustable Gastric Band, all predominately done laparoscopically.

The gastric bypass is currently the gold standard of weight loss surgery. It is a combination of restrictive and malabsorptive, by making the stomach smaller and bypassing the upper small intestine. Patients are able to achieve an average of 80% excess weight loss and significant resolution of weight related comorbidities.

While the Sleeve Gastrectomy is generally considered a restrictive procedure, the mechanisms of weight loss and improvement in comorbidities seen after the sleeve gastrectomy may also be related to neurohumoral changes related to gastric resection or expedited nutrient transport into the small bowel. The metabolic mechanisms of action of the sleeve gastrectomy continue to be an active area of research.

The adjustable gastric band is purely a restrictive procedure. It is another option for those who are reluctant about choosing the gastric bypass or sleeve gastrectomy. Patients can expect an average of 50% weight loss.

These surgeries are an effective tool for weight loss and resolution of co-morbidities. However, the most successful patient is the one who changes their eating habits by making good choices and following the guidelines recommended by the registered dietitian at Hope Bariatrics and ASMBS.

Metabolic and Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related health conditions.

Surgery for obesity goes beyond weight loss. It results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients.

New research indicates that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss; most likely due to changes in gastrointestinal hormones. Many patients with type 2 diabetes experience normal blood sugar levels within days of surgery, long before significant weight loss.

Above is a table is from a study by Dr. Wittgrove and Dr. Clark of 500 laparoscopic gastric bypass patients who were followed for 5 years. The numbers in the pre-op column represent health problems these patients had before surgery, 1752. Post-operatively, this group of patients reported 71. This is indicative of the kind of resolution of co-morbidities in Hope Bariatric patients.

The following are the criteria for bariatric surgery mandated by the NIH:

• BMI > 40 or

• BMI of 35 to 40 with co-morbidities

• 3, 6 or 7 month visits with PCP (dependent on type of insurance)

• Psychiatric evaluation

• Understand the risks associated with weight loss surgery

• Commitment to the necessary lifestyle change

Family Physicians and play an important role in the pre authorization process for patients, but patients are educated about the importance of their continued relationship with their family doctor AFTER surgery. Close monitoring of their health conditions post surgery is critical as weight loss progresses.

One of the most significant studies conducted on the safety of bariatric surgery was published in the New England Journal of Medicine in July, 2009. The findings of the research reaffirm the safety of bariatric surgery. Key findings included: NIH study found the risks of bariatric surgery have dropped dramatically and now are no greater than gallbladder or hip replacement surgery. Risks are lower than the longer-term risk of dying from heart disease, diabetes, and other health conditions related to excess weight.

Conducted by the LABS (Longitudinal Assessment of Bariatric Surgery), researchers followed 4,776 bariatric patients at 10 US hospitals. Mortality rate among patients at 30 days post-surgery was 0.3%.

Patients interested in weight loss surgery have two options to get started. They can attend an informational seminar held monthly at the Wilfred R. Cameron Wellness Center, the first Wednesday of every month at 11:30 a.m., or view the seminar on-line at www.hopebariatrics.com.

Hope Bariatrics staff guide and educate patients through the insurance process and post-operative guidelines necessary for a successful outcome.

Office hours are held monthly at 88 Wellness Way, Building 3.

For information contact 412-741-8862.

Geoffrey H. Wilcox, MD, FACS

Dr. Wilcox received his medical training at the University of Pittsburgh, School of Medicine. He completed his surgical residency at Mercy Hospital in Pittsburgh. He is certified in general surgery by the American Board of Surgery and is a member of the American Society for Metabolic & Bariatric Surgery, as well as a Fellow of the American College of Surgeons. Dr. Wilcox is the Medical Director of Bariatric Surgery at Heritage Valley Sewickley, and the Co-Director at St. Clair Hospital.

Michael D. Felix, MD, FACS

Dr. Felix received his medical training at Georgetown University School of Medicine and completed his surgical residency at Mercy Hospital, Pittsburgh. He served as a United States Naval Officer, is certified in general surgery by the American Board of Surgery and is a member of the American Society for Metabolic & Bariatric Surgery, as well as a Fellow of the American College of Surgeons. Dr. Felix is the Medical Director of Bariatric Surgery at St. Clair Hospital and the Co-Director at Heritage Valley Sewickley.

1. Ardis D. Hoven, MD, President of American Medical Association; Obeisty as a Disease?, 6-18-13

2. www.ASMBS.org

3. Wittgrove AC, Clark GW; Laparoscopic Gastric Bypass: A five year study of 50 patients. Obesity Surgery 9: 123-143, 1999.

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