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The increased girth of Americans coupled with a desire to “shape up” has caused the number of bariatric (weight loss) surgeons and facilities to burgeon.

According to figures from the American Society for Metabolic and Bariatric Surgery (ASMBS), nationwide, 303 hospitals are designated as Bariatric Surgery Centers of Excellence (BSCOE).

Data from the American Obesity Association suggests that about 127 million adults in the United States are overweight, 60 million are obese, and nine million are severely obese. An individual is considered obese if their Body Mass Index (BMI) exceeds 30 and morbidly obese if their BMI is 40 or more.

When dieting and exercise fail to produce desired results, morbidly obese individuals are increasingly resorting to weight loss surgery to help rid them of unwanted pounds.

Surgical options including an adjustable Lap-Band® and gastric bypass are currently available to those who are at least 100 pounds overweight and have a BMI of at least 40. On occasion, individuals who are 75 pounds overweight with a BMI of 35 and afflicted with a combination of co-morbidities such as sleep apnea, hypertension or diabetes are also considered for weight loss surgery.

In order for insurance to consider covering the costs associated with weight loss surgery, a Letter of Medical Necessity and weight-loss history are required. Information in the letter typically includes the patient’s weight and duration of morbid obesity, co-morbidity conditions and previously tried but failed weight loss efforts.

Bariatric surgeons at Palms of Pasadena Hospital in St. Petersburg (POPH) performed 256 weight loss surgeries from Oct. 1 2006 to 2007, according to registered nurse Susan Kay, Lap-Band recipient and director of specialty surgical services at the hospital.

Designated as a BSCOE in 2005, approximately 95 percent of POPH’s bariatric patients opt for the Lap-Band procedure while 5 percent choose a gastric bypass.

Lap-Band Surgery
Approved by the FDA in June 2001, the Lap-Band is an inflatable hollow band that is implanted laparoscopically around the upper third portion of the stomach to create a small stomach pouch.

Attached to the band is a tube that ends with a port connected to abdominal muscles below the ribs. Via the port, the doctor is able to gradually add saline to the band, causing increased restriction to the stomach. Immediately following surgery, the hollow band is left empty for four to six weeks.

Because the nerves that signal satiety are located in the upper area of the stomach, the pouch created by the band results in a longer lasting feeling of fullness. Initially, the pouch can hold 2 ounces of food, and over time allows for 4 to 6 ounces of food.

While advocates of the Lap-Band procedure point to its many advantages including its adjustability, potential surgical candidates are counseled that the surgery is not a quick-fix solution to their problem.

Patients opting for Lap-band or other surgical procedures for weight loss are
counseled that surgery is only a part of the weight loss equation. Exercise and adherence to strict dietary guidelines are also an integral part of the surgical weight loss package.

At POPH, the cost of Lap-Band surgery for self-pay patients is $15,800, which covers office visits to the surgeon for one year as well as adjustments.

Kay, who characterizes herself as a ball of energy, admitted that health issues “were crippling my body.”

“Each day since the Lap-Band surgery is a gift,” she said, “and I would do it over again if I had to.”

Gastric Bypass
Since its development by the University of Iowa’s Dr. Edward E. Mason in 1966, the gastric bypass has undergone refinements over the years.

By making the stomach smaller and allowing food to bypass part of the small intestine, gastric bypass surgery results in a more rapid feeling of satiety. Roux-en-Y gastric bypass (RGB) and biliopancreatic diversion are the most common forms of gastric bypass surgeries performed today.

In the RGB procedure, the surgeon creates a small pouch at the top of the stomach and adds a bypass around a segment of the stomach and small intestine. The small intestine is then cut and part of it is sewn directly onto the pouch.
Thus, when the patient eats, food bypasses the lower part of the stomach and directly enters into the second section of the small intestine. The reduced size of the stomach pouch results in a feeling of fullness after eating only a small portion of food.

Immediately after gastric bypass surgery, patients are maintained on a liquid diet for several days, followed by pureed foods. A transitional diet, including regular table and pureed foods, is initiated approximately one month after surgery.

Generally, six months post-surgery, the patient is eating a maintenance diet of regular table food in small portions.

In a biliopancreatic diversion, part of the stomach is removed and the remaining portion is connected to the lower segment of the small intestine. Because the part of the intestine which most easily absorbs vitamins and minerals is bypassed, patients may become deficient in vitamins and minerals and need to take supplements.

According to an article by RE Brolin published in the American Medical Association’s journal, bilopancreatic diversion surgeries are effective in that most people lose 70 to 80 percent of their excess weight and maintain their new weight.

Regardless of the surgical intervention chosen to effect weight loss, all candidates for weight loss surgery must undergo a comprehensive psychological evaluation designed to assess for mental health problems such as eating disorders, depression and certain personality disorders.



January 2008

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