LCHM Spring 2017 - 9

L C M E D S O C .O R G

"Morbid obesity" is a subset of obese patients and is defined as being 100 pounds or
100% over ideal weight. This also corresponds
to a BMI of 40. BMI (Body Mass Index) is
a measure which compares the weight and
height of an individual. It is called "morbid"
obesity because at that weight, a wide variety
of medical problems may arise. These can
include but are not limited to diabetes
mellitus, hypertension, obstructive sleep
apnea, coronary artery disease, cardiovascular
accident, gastroesophageal reflux disease,
osteoarthritis, depression, and more, all of
which affect a patient's health and longevity.
While diet and exercise is a viable and
oftimes successful approach to treating
obesity, morbid obesity is resistant to these
approaches. Fewer than 1% of morbidly
obese patients are able to achieve long-term
weight loss with diet and exercise.
Fortunately, bariatric surgery has given
hope to patients seeking a solution for this
condition which was once considered a
matter of self-control. The National Institutes
of Health (NIH) has recognized bariatric
surgery as the only permanent and long-term
treatment for morbid and severe obesity.

The Centers for Disease Control
(CDC) estimated that from 2011 to 2014,
* The Laparoscopic Roux en Y Gastric
Bypass (LRYGB) makes the stomach
smaller and allows food to bypass part of
the small intestine, making patients feel
full quickly and causing fewer calories
to be absorbed.
* The Laparoscopic Adjustable Gastric
Band (Lap Band) is an inflatable band
placed around the stomach which restricts
food to a small stomach section. While
this procedure was extremely popular
when first introduced, poor results and
complications have caused most patients
and surgeons to abandon it.

In 2015, laparoscopic gastric sleeves
The laparoscopic or minimally invasive accounted for 53.4% of bariatric procedures
approach has made bariatric surgery a and gastric bypasses for 32.1%, with only
more practical option for morbid obesity, 5.7% of patients selecting the lap band,
providing for less risk and easier recovery. a number which goes down each year.
The advent of laparoscopic bariatric surgery Long-term results for the gastric bypass
has contributed to a rapid expansion in the are slightly better than the sleeve because
number of bariatric procedures performed of the malabsorption factor, but both are
in the United States, approaching a record highly effective when coupled with lifestyle
200,000 in 2015.
changes, continued support and follow up.
There are currently three popular bariatric
procedures, although one, the gastric band,
has fallen out of favor due to high complication rates and low long-term success.
* The Laparoscopic Sleeve Gastrectomy
(LSG) removes about 85% of the stomach, leaving the remainder shaped like
a tube or "sleeve" and making patients
feel fuller sooner.

Although individual results vary widely,
most patients who undergo weight loss
surgery will lose 60-80% of their excess
weight. While some will regain some weight
after hitting their "low point," 90% will
keep off at least 50% of their excess weight
in the long term. Even more important are
the effects of weight loss on the patients'
health. One study found an 89% reduction
in overall mortality. Others found a 90%
reduction in death from diabetes and 50%
reduction in death from heart disease. 85%

of diabetes patients show improvement
with remission in 78%. Improvements in
patient mobility and reductions in anxiety
and depression also contribute to a better
quality of life post-bariatric surgery.
Of course, surgery isn't the end game.
It's the beginning of a lifelong journey to
a healthier lifestyle, a tool to help patients
help themselves. Patients must embrace a
whole new way of eating and taking care
of themselves, incorporating high protein
diets and regular physical activity into their
lives to maintain long-term results. There's
no going back to "eating normally" after
bariatric surgery. Sure, it's possible to "beat"
the surgery - but then, what's the point of
having it in the first place?
Although the number of patients helped
by bariatric surgery increases each year, far
more patients could benefit from bariatric
surgery. Far too many insurance companies
don't cover it - including Pennsylvania's state
employee health insurance program and half
of the plans offered through the Affordable
Care Act. This is extremely shortsighted.
Covering bariatric surgery costs far less
than covering obesity-related chronic health
conditions over a patient's lifetime AND the
patient will live a happier and more productive life. Patients and physicians alike should
lobby insurers and government entities to
cover these life-changing procedures.
Additional information about bariatric
surgery is available from a variety of
sources, including Bariatric Surgery Source
Continued on page 11
SPRING 2017 | Lehigh County Health & Medicine 9


Table of Contents for the Digital Edition of LCHM Spring 2017

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