The Centers for Disease Control and Prevention reported recently that adult obesity rates were stuck at 36 percent from 2011 to 2014, and Virginia (Jenny) Weaver, MD, says that in the Mid-South we live at "the epicenter of obesity in the United Sates."
Each year, between 700 and 800 patients have procedures at the Center for Surgical Weight Loss at Saint Francis Hospital, according to Weaver, the center's medical director. Though it's an impressive increase from the 45 procedures the clinic performed the year it opened in 2003, Weaver considers the number too small.
"In fact, we really only treat a very small percentage of the number of patients out there who qualify for bariatric surgery and should be referred for bariatric surgery," she said. "Nationally, only 3 percent of people who are obese and would qualify for bariatric surgery actually go on to have the surgery."
A report by London researchers published on the National Institutes of Health Library of Medicine site says of bariatric surgery: "This is the only therapy to have demonstrated the ability to produce a sustained, long-term weight loss and deliver reductions in mortality and morbidity."
Referring to the most common bariatric surgery procedure, the gastric bypass, the researchers note that it alters "the secretion of various gut hormones associated with appetite and satiety as well as energy expenditure." A Cleveland Clinic study called bariatric surgery "the most effective method for achieving major, long-term weight loss, with weight loss ranges of 35 percent to 40 percent lasting as long as 15 years." The authors of that study also link metabolic changes that result from the surgery to changes in the gut hormones.
“When we do the surgery, we are dramatically altering the intestinal hormones; that is what research is showing plays a much greater effect in the success of patients after bariatric surgery," Weaver said.
“Certainly restricting the amount of food you eat is not the primary way the procedure works. It is one of the factors, but the alteration that we do with the gut hormones, which does pertain to metabolism, has a far greater effect on the weight loss than just simply limiting the amount of food you can eat.”
Weaver speculated that potential patients might avoid bariatric surgery because of fear or uncertainty.
“Basically what we tell patients is it carries the same percentage of risks as taking your gallbladder out or, for women, getting a hysterectomy. People think of it for some reason as a very high-risk procedure, but in reality it's not.”
At Columbia University's Center for Metabolic and Weight Loss Surgery, the risks for gastric bypass surgery are described as "the same as the risk for any operation on an obese patient. ... Operative complications such as bleeding or intestinal leakage can occur in less than 2 percent of patients." The Mayo Clinic cites bleeding, infection, leaks in the gastrointestinal system and blood clots among risks associated with the surgery.
“Long-term, people mistakenly think that malnutrition also is a risk, but it's not,” Weaver said, “particularly if you follow guidelines as far as protein and vitamin supplementation.”
Weaver, 45, an All-America swimmer during her undergraduate years at the University of Tennessee, Knoxville, got her medical degree and completed her residency at the University of Tennessee Health Science Center. After a fellowship at the Ohio State University Center for Minimally Invasive Surgery, she returned to Memphis in 2003 to open the Saint Francis clinic.
The Saint Francis clinic has a "robust education process" that includes a mandatory seminar about the surgical process, diet and exercise, Weaver said. "Patients are required either to watch the online seminar or attend a live seminar before they enter the program. The online seminar is 25 to 30 minutes long; the live seminars take a little longer." They're conducted by Weaver or Robert Wegner, MD, who completed a bariatric fellowship at the University of Iowa and joined the clinic in 2010.
The clinic describes surgery candidates as generally 100 pounds or more overweight, with a body mass index of 40 or greater, or those with a BMI of 35 or more and simultaneous conditions such as diabetes.
About 80 percent of bariatric surgery patients are women. "I still don't quite understand why the percentage is the way it is," Weaver said. "A lot more men out there could really benefit from the procedure, who for some reason, don't come see us."
Weaver says insurance companies often require patients to have a comorbid condition to qualify for bariatric surgery. Besides diabetes -- "the results as far as putting diabetes into remission after bariatric surgery are honestly just staggering," she said -- qualifying comorbidities can include hypertension, sleep apnea, elevated lipid levels in the blood, knee or hip pain due to weight, and infertility.
“Some interesting studies show that infertility and obesity are linked, so some of our referrals are women who desire to start families but have been unable to conceive due to obesity," Weaver said. “Other than putting diabetes in remission, another one of the exciting things we see is when people who've been unable to conceive come back a year or two after their surgery, and they're pregnant.”
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