Weight-loss surgery has been in the news a lot lately, and not just because musician and reality TV star Carnie Wilson just had her second round of the procedure. In two recent studies, obese people with Type 2 diabetes who underwent bariatric surgery showed dramatic improvements, some experiencing a reversal of the disease several months after the procedure.
We spoke with Dr. Scott A. Cunneen, director of bariatric surgery at Cedars-Sinai Medical Center in Los Angeles and author of WEIGHTY ISSUES: Getting the Skinny on Weight-Loss Surgery, about the good, the bad, and the reality of these procedures.
Spry: Who is a candidate for weight-loss surgery?
Dr. Scott Cunnen: Most weight-loss surgery patients have made several failed attempts at losing weight and keeping it off and are feeling the ill effects of decades of carrying around all those extra pounds. Currently, Body Mass Index (BMI), which takes into consideration a patient’s height and weight, is used by insurance companies to determine eligibility for coverage. A BMI of 35 and above is considered appropriate for bariatric surgery, or 30 and above, if co-morbidities (illnesses associated with obesity) exist. The average age of my patients is about 40, though there’s been great success with those into their 70s.
Spry: Why is it being touted as good for people with Type 2 diabetes caused by obesity?
SC: Studies have shown that bariatric (weight-loss) surgery is the most effective and durable “treatment” for Type 2 diabetes. Diabetic numbers go down almost immediately and there is a reduced risk of heart attack, stroke and kidney failure associated with out-of-control diabetes, which can translate into years of increased life expectancy.Rather than a cure, most endocrinologists refer to it as remission since it’s not yet known if these after-effects will last 10 years or a lifetime. What we do know is: having an improvement over an extended period of time will result in less damage to organs and halt the progression of disease.
Spry: What are other benefits of weight-loss surgery?
SC: The majority of patients do significantly improve their health in a very short period of time. Losing weight also lightens the load on the joints, helping them to exercise—perhaps for the first time in their life—which, of course, promotes heart health and increases lean muscle mass that helps burn calories.
Spry: What are the best weight-loss surgery options?
SC: A wide spectrum of surgeries exists in the weight-loss arena, but most surgeons opt for restrictive surgeries. This is where they transform an area of your stomach into a smaller, golf ball-sized stomach and food travels from there to your normal stomach to get digested. The restrictive operations that have proven to have the best risk-benefit ratio are gastric band (or lap band) and the Roux-en-Y gastric bypass (named for a 19th century pioneer in surgery and the configuration the surgery accomplishes). A third choice added relatively recently to the mix is the sleeve gastrectomy, whichis basically the removal of about 90 percent of the stomach, meaning you wind up with a long tube that connects the esophagus to your small intestine. Lastly,gastric plicationinvolves not cutting the stomach, but folding it in on itself. Some people are doing it as a stand-alone procedure and some are adding it to the band to get even greater weight loss.
Spry: How do you decide which surgery you need?
SC: In general, you want to find the simplest way to get the results you need, so it depends on the extent of obesity-related health issues you are battling and how much time you can afford to take to recuperate, in addition to your own preference and the recommendation of your surgeon. The lap band is a very safe procedure that will often result in the necessary weight loss to resolve health problems and it’s a fast recovery. Gastric bypass is generally recommended for extremely large patients but has a longer recovery time and the sleeve gastrectomy falls somewhere in between the two in terms of weight loss.
Spry: What are the risks of weight-loss surgery?
SC: All of these surgeries are currently done laparoscopically, that is, using instruments through very small incisions, so recovery time and risk has been significantly reduced. The risk factors of a sleeve and bypass are about the same—when you cut away the majority of the stomach, you have a long staple line in the stomach, and if that doesn’t heal well, leaks and potentially an infection can occur. After band surgery, there are cases where the port (where the doctor accesses the band in order to adjust its tightness) can get loosened and requires changing the cord or fixing the tubing. Additionally, a band may slip, especially if the patient regularly tries to push too much food down a very small opening. In rare cases, severe pain could indicate a leak in the surgical connections, a bowel obstruction (due to twisting intestines) or bleeding from an ulcer. If you’re diabetic, older or severely overweight, you may not heal as quickly.
Spry: What can someone who’s undergone weight-loss surgery expect after it?
SC: All patients are on liquid diets for a period of weeks after surgery, followed by pureed foods, soft foods and, eventually, a “normal” diet. There will still be certain foods that may be difficult to get and keep down, like soft bread, sticky rice and red meat. You may need to take daily vitamin supplements as well.
With the bypass operation, the honeymoon period is really the first six months when you have absolutely no hunger, it’s hard to eat a lot of food and lose weight very rapidly and easily. After a year-and-a-half or two, you may not have an adverse reaction to some of those liquid calories or fatty foods, and your motivation to eat healthier food may wane. This is when post-surgery support groups are so important—patients who can relate to each other offer support and keep each other motivated.
Spry: Can it last forever?
SC: Contrary to popular belief, weight-loss surgery isn’t the quick fix—it requires a lot of hard work and a lifetime commitment. The great majority can keep that weight off for the rest of their lives if they are committed and make a huge change in their relationship to food.