FAQ
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Morbid Obesity and Treatment Options
Qualifying for Bariatric Surgery
Co-morbid Conditions
There are two definitions for a co-morbid condition: the presence of one or more disorder or disease in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient.
Type 2 diabetes is a long-term metabolic disorder where the body produces insulin, but resists it. Insulin is necessary for the body to utilize sugar.
- 83.8% of patients who had gastric bypass surgery experienced complete resolution of type 2 diabetes.4
- 47.8% of patients who had gastric banding surgery experienced complete resolution of type 2 diabetes.4
- Patients who had bariatric surgery had lower insulin resistance, and their risk for metabolic syndrome, high blood pressure, and high amount of fats in the blood also decreased.29
Excess body weight is associated with an increased risk of heart disease, elevated cholesterol, and high blood pressure. These conditions can lead to heart attacks, strokes, and heart and kidney damage. Bariatric surgery reduces excess body weight over time, which decreases strain on the heart.
- 75.4% of patients who had gastric bypass surgery experienced complete resolution of high blood pressure.4
- 38.4% of patients who had gastric banding surgery experienced complete resolution of high blood prssure.4
- Changes in diet and exercise after surgery can lead to significant improvement of cardiovascular problems.4
High cholesterol is a disorder of lipids—the fat-like substances in the blood. A common form of dyslipidemia is hyperlipidemia (or high cholesterol), the condition that exists when someone has too much of certain lipids in the blood. As these lipids build up inside the artery walls, harmful scar tissue and other debris begin thickening and hardening the walls. Long-term, this can lead to heart disease and high blood pressure.
- 95% of patients who had gastric bypass surgery experienced improved cholesterol health.4
- 78.3% of patients who had gastric banding surgery experienced improved cholesterol health.4
Obstructive sleep apnea is when breathing suddenly stops because soft tissue in the back of the throat collapses and closes during sleep. Morbid obesity can cause sleep apnea and other respiratory problems that may result in chronic fatigue.
- 86.6% of patients who had gastric bypass surgery experienced complete resolution of sleep apnea.4
- 94.6% of patients who had gastric banding surgery experienced complete resolution of sleep apnea.4
Acid reflux, also known as gastroesophageal reflux disease, is injury to the esophagus caused by chronic exposure to stomach acid. It is a serious disease that can cause esophagitis, Barrett’s esophagus, and esophageal cancer (adenocarcinoma).8
- 98% of patients who had gastric bypass surgery experienced complete resolution of acid reflux/GERD.4
- 32.3% of patients who had gastric banding surgery experienced complete resolution of acid reflux/GERD.4
Morbid obesity may put you at a higher risk for several types of cancer, such as colon, breast, and kidney cancer. In 2003, an article in the New England Journal of Medicine estimated that obesity could account for:15
- 14% of all deaths from cancer in men
- 20% of all deaths from cancer in women
Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats, sleeps, thinks, and feels. There are many reasons people with morbid obesity experience depression. Emotional health goes hand in hand with physical health. Lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health.
- 47% of patients who had gastric bypass surgery experienced improvement of depression symptoms.2
Osteoarthritis is one of the most common forms of arthritis. Known as the wear-and-tear kind of arthritis, osteoarthritis is a chronic condition in which there is a breakdown of joint cartilage. For anyone who is living with morbid obesity, the excess body weight placed on joints, particularly knees and hips, results in rapid wear and tear, and pain caused by inflammation. Bariatric surgery can reduce much of this weight over a long period of time and can be very effective in treating osteoarthritis.
- 41% of patients who had gastric bypass surgery experienced complete resolution of osteoarthritis.2
Among women, morbid obesity is a risk factor for stress urinary incontinence, or uncontrollable urine loss. A large, heavy abdomen and relaxation of the pelvic muscles due to morbid obesity may cause the valve on the urinary bladder to weaken, leading to leakage of urine with coughing, sneezing, or laughing. Bariatric surgery has been found to improve stress urinary incontinence. Less weight is placed on the bladder, and other physical changes take place to improve this condition.
- 44% of patients who had gastric bypass surgery experienced complete resolution of stress urinary incontinence.2
Reproductive health can be a concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities may occur due to morbid obesity. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS). Additionally, women living with morbid obesity are more likely to have children with certain birth defects.30 A recent study of women following gastric bypass surgery showed improvement of multiple clinical problems related to infertility and PCOS.19,20
- 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS.19,20
- 79% of patients who had gastric bypass surgery experienced complete resolution of excess hair due to PCOS.19,20
- Patients who had gastric bypass surgery experienced restored ovulation and fertility.19,20
Coping with Concerns
The fear of surgery is not irrational or abnormal; in fact, it’s very common. Bariatric surgery creates a smaller stomach pouch and, depending on the procedure, may shorten the digestive tract—all while the patient is under general anesthesia. If you have concerns, consider the following:
- Share your concerns and fears with your surgeon.
- Attend a support group and speak with patients who likely share the same fears.
- Understand the complication rates and mortality rates of surgery.
- Listen to bariatric surgery patients share their own fears and concerns.
And remember, you’ll have a team of healthcare professionals dedicated to your best possible care.
For people who have spent years living with morbid obesity, bariatric surgery can transform their lives. However, it’s important to be prepared for all aspects of the treatment. Surgery changes your body by creating a smaller stomach pouch. Learn more about the different types of bariatric procedures.
For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Even without insurance, many people feel that the surgery is worth the investment in their health and seek out alternative financing options.
- Generally, the out-of-pocket costs for gastric bypass are between $20,000 and $30,000.
- Generally, the out-of-pocket costs for gastric banding are between $14,000 and $18,000.
There are several ways to pay for surgery, including:
- Health insurance coverage for bariatric surgery
- Alternative financing options such as medical loans or home equity loans
Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance coverage for bariatric surgery, there are alternative financing options available, such as medical loans.
It varies from person to person. Generally, the hospital stay (including the day of surgery) can be one to two days for a gastric band, two to three days for a laparoscopic gastric bypass, and five to seven days for an open gastric bypass.
A typical comprehensive bariatric program will consist of a combination of the following healthcare professionals: a program coordinator, psychologist, dietician, exercise physiologist, and other healthcare professionals. Each expert is dedicated to providing support for bariatric patients both before and after surgery. Check with your program to find out about support groups that can be helpful in adjusting to new daily habits.
Most doctors recommend that women wait at least one year after the surgery before a pregnancy. Approximately one year postoperatively, your body should be fairly stable (from a weight and nutrition standpoint), and you should be able to carry a normally nourished fetus. Consult your surgeon as you plan for pregnancy.
Many people think bariatric surgery will be followed by a long and painful recovery period. However, most patients report experiencing only discomfort and soreness rather than pain. Recovery does, however, vary from patient to patient. Click here for more information about recovering from bariatric surgery.
As with any major surgery, there will be a recovery period. Remember that this is a necessary step, and the better care you take during recovery, the more quickly you’ll return to normal activity.Recovery time varies from patient to patient.
- One study found laparoscopic gastric bypass patients spent an average of two days in the hospital and were able to return to work after 21 days.2
For people suffering from morbid obesity, bariatric surgery can be a powerful tool. For the surgery to be effective long term, it must be used properly. Through lifestyle changes, such as regular exercise and a healthy food plan, many patients are able to make a long-term change for better health.
Results of Five-Year Follow-up28
| TREATMENT | WEIGHT LOSS (% OF PATIENTS) |
|---|---|
| Diet and Exercise* | 2% to 5%28 |
| Medication** | 0%28 |
| Bariatric Surgery*** | 50% to 70%28 |
* Success measured as a loss of 10% of initial body weight.
** Weight loss is not maintained once treatment ends.
*** Success measured as a loss of 50% of excess body weight (equivalent to loss of approximately 20% to 25% of initial body weight).
Life After Surgery
Bariatric surgery is not a quick fix. It’s an ongoing journey toward transforming your health through lifestyle changes. After surgery, you will feel satisfied and fuller with less food. Positive changes in your body, your weight, and your health will occur, if you maintain the diet and exercise routines recommended by your bariatric program.
After the initial recovery period, most patients are instructed to eat 1/4 cup, or 2 ounces, of food per meal. As time goes on, you can eat more (as instructed by your medical team). Most people can eat approximately 1 cup of food per meal (with 4 ounces of protein) a year or more post surgery.
Your ability to resume pre surgery levels of activity depends on your physical condition, the nature of the activity, and the type of bariatric surgery you had. Many patients return to normal levels of activity within three to six weeks of surgery.
Exercise is an important part of success after surgery. You may be encouraged to begin exercising, limited only by discomfort, about two weeks after surgery. The type of exercise depends on your overall condition, but the long-term goal is to get 30 minutes of exercise three or more days each week.
Most pills or capsules are small enough to pass through the new stomach pouch. At first, your doctor may suggest that medications be taken in crushed or liquid form. As a general rule, ask your surgeon before taking any medication.
Eating simple sugars (such as sugar, honey, and corn syrup) or high-fat foods can cause dumping syndrome in patients who have had gastric bypass surgery. This occurs when these products, which have a small particle size, are “dumped” from the stomach into the intestine at a rapid rate. Water is pulled into the intestine from the bloodstream to dilute the sugar load. This flush of water causes symptoms that can include diarrhea, rapid heart rate, hot flashes or sweating and clammy skin, and dizziness.
Band patients need to work with their surgeons to have their band adjusted several times during the first 12 to 18 months after surgery. Bypass patients typically see their surgeons for three to five follow-up appointments the first year, then once per year thereafter. Over time, gastric bypass patients will need regular checks for anemia (low red blood cell count) and vitamin B12, folate, and iron levels.
Support groups give patients an excellent opportunity to talk about personal issues. Most patients learn, for example, that bariatric surgery will not resolve personal relationship issues. Most bariatric surgeons who frequently perform bariatric surgery will tell you that ongoing support after surgery helps to achieve the greatest level of success for their patients. Patients help keep each other motivated, celebrate small victories together, and provide perspective on the everyday successes and challenges that patients generally experience.
Studies show that bariatric surgery can effectively improve and resolve many weight-related health conditions. A review of more that 22,000 bariatric surgery patients showed:• Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea4
• 61.2% reduction of excess weight4Results of Five-Year Follow-up28
| TREATMENT | WEIGHT LOSS (% OF PATIENTS) |
|---|---|
| Diet and Exercise* | 2% to 5%28 |
| Medication** | 0%28 |
| Bariatric Surgery*** | 50% to 70%28 |
* Success measured as a loss of 10% of initial body weight.
** Weight loss is not maintained once treatment ends.
*** Success measured as a loss of 50% of excess body weight (equivalent to loss of approximately 20% to 25% of initial body weight).
The Surgeons’ Group, P.C.
Dr. John L. Mathews
D.M.D., M.D., F.A.C.S.
Diplomate, American Board of Surgery