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Obesity: A chance to cut, a chance to cure?

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist

We Coloradans, who like to brag about being the trimmest state in the union, are losing ground and gaining weight. Americans, who have enjoyed progressively longer life spans are seeing the trend reversed. Our grandkids may not live as long as we do. We are getting fatter and all the diets, exercise and weight loss pills are having little effect. Enter bariatric surgery. It has been around for decades, but has made a resurgence in the last 10 years.

WHAT IS IT?

The simplest bariatric procedures are called restrictive. The surgeon decreases the size of the stomach, limiting the amount of food that can be eaten at any one time. In the more invasive bypass procedures, the surgeon re-routes a portion of the upper digestive tract to decrease absorption of foodstuffs.

WHO ARE THE CANDIDATES?

Persons with a BMI of > 40 or those with a BMI > 35 with other significant illnesses, like diabetes are candidates. Persons should have failed diet and lifestyle changes. (BMI = Body Mass Index) Google it, to calculate your own or ask your physician.

WHAT ARE THE BENEFITS?

Those patients undergoing restrictive procedures sustain an average weight loss of 13%-16% of their initial weight over 10 years. Those with bypass operations sustain a 25% weight loss of their initial weight over 10 years. The surgery is effective in treating obesity associated conditions like diabetes, hypertension and sleep apnea. Many bariatric surgery patients claim improvement in the quality of their lives. (SOURCE: Cochrane Reviews 2012, 2013)

WHAT ARE THE DOWNSIDES?

Clots in legs and lungs, wound and lung infections, bleeding and breakdown of surgical sites are the common serious complications (10% of all patients). Three percent of patients will need immediate repeat surgery after the procedure. Ten to 20% of patients will require further surgery at a later date. One-half to 1% of patients will die as a complication of the surgery. Death is more common in the elderly and in the severely obese. (SOURCE: Cochrane Reviews 2012, 2013)

If you are considering bariatric surgery, here are some questions you should ask yourself:

Have I really done everything I can with diet and exercise?

Am I willing to make the necessary dietary changes to make the surgery successful?

Will I be able to deal with the changes in my body, my self-image?

Here are some questions to ask your surgeon:

Which procedure would you recommend for me? Why?

How many of the recommended procedures have you done? How many have been done at your hospital?

What percentage of your patients have had to be re-admitted to the hospital? What percentage had to have a second operation to “fix” the first operation? What percentage of your patients have kept weight off after five years? 10 years?

Shop around. Both Community and St. Mary’s hospitals have active bariatric surgery programs. What does the procedure cost? Will your health insurance cover the procedure?

(The opinions in this column are my own and do not necessarily reflect those of Rocky Mountain Health Plans or Primary Care Partners.)

Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at pjmohler@ bresnan.net.


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