Morbid obesity is a Body Mass Index (BMI) of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight. The disease of morbid obesity interferes with basic physical functions such as breathing or walking. Long-term effects of the disease include shorter life expectancy, serious health consequences in the form of weight-related health problems (co-morbid conditions) such as type 2 diabetes and heart disease, and a lower quality of life with fewer economic and social opportunities.
The causes of morbid obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that, in many cases, significant, underlying causes of morbid obesity are genetic, environmental, and social. Studies have demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
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. The primary disease of morbid obesity can lead to several co-morbid conditions.
Bariatric surgery is a procedure designed to make the stomach smaller so the patient feels satisfied with less food. It is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other weight loss therapies such as diet, exercise, medications, etc. A person with a Body Mass Index (BMI) of 35 or greater and one or more co-morbid condition also may qualify for bariatric surgery.
BMI is a measure used to index a person s height and weight. BMI allows healthcare professionals and patients to better understand health issues associated with a specific weight classification (classifications such as obesity and morbid obesity).
To become eligible for bariatric surgery at Mount Carmel, patients must meet strict selection criteria. Patients may be eligible if they:
- Are over the age of 18
- Are at least 100 pounds overweight AND/OR have a BMI greater than 40,or a BMI between 35 and 40 accompanied by other health-related issues
- A BMI of 35 or greater with one or more co-morbid condition
Other common guidelines include:
- Understanding the risks of bariatric surgery
- Committing to dietary and other lifestyle changes as recommended by the surgeon
- Having a history of weight loss treatments having failed the patient
- Undergoing a complete examination including medical tests
Talk with your surgeon about the different surgical treatments, as well as the benefits and risks
- Bariatric surgery is not cosmetic surgery.
- Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
- The patient must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
- Problems after surgery are rare, but corrective procedures may be required.
As with any surgery, there are immediate and long-term complications and risks. Possible risks can include, but are not limited to:
- Complications due to anesthesia and medications
- Deep vein thrombosis
- Dehiscence (separation of areas that are stitched or stapled together)
- Leaks from staple lines
- Marginal ulcers
- Pulmonary problems
- Spleen injury
- Stenosis (narrowing of a passage, such as a valve)
Side effects include:
- Dumping syndrome
- Nutritional deficiencies
- Need to avoid pregnancy temporarily
- Nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas, and dizziness
Open surgery involves the surgeon creating a long incision to open the abdomen and operating with "traditional medical instruments. Laparoscopic, or minimally invasive, surgery is an approach that allows the surgeon to perform the same procedure using several small incisions, a fiber-optic camera, video monitor, and long-handled instruments
The decision to perform minimally invasive or open surgery is made by your surgeon before the operation. For some patients, the laparoscopic, or minimally invasive, technique cannot be used due to dense scar tissue from prior abdominal surgery. Also, the inability to see organs and/or bleeding during the operation can cause your surgeon to switch from minimally invasive to open surgery during your operation.
Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States. In this procedure, the surgeon creates a small stomach pouch and then constructs a bypass of some of the small intestine. The smaller stomach pouch restricts the amount of food the patient can comfortably eat, and the bypass decreases the number of nutrients and calories absorbed
Gastric banding is a purely restrictive surgical procedure in which a silicone band is placed around the uppermost part of the stomach. The band is adjustable and can be periodically tightened or loosened depending on the patient s needs
The qualification process includes a series of tests with your bariatric surgeon. You also will meet with a nutritionist, psychologist, and other support staff members in sessions leading up to surgery. Each healthcare professional will help you prepare for the changes and challenges that lie ahead.
Because every insurance policy is unique, it's important that you thoroughly understand your Certificate of Coverage to know exactly what is and isn't covered through your plan.
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.
Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, many serious medical conditions may improve or resolve after successful bariatric surgery.
Bariatric surgery is like other major abdominal surgery. You can best prepare by knowing the benefits and risks of surgery, and by closely following your doctor's instructions.
- Understand the surgical process and what to expect afterward.
- Keep in mind that you ll never be able to eat the way you did before, and that you ll have to watch what and how you eat for the rest of your life.
- Talk to people who have had bariatric surgery.
- Write down your reasons for having bariatric surgery and outline your plans to maintain your weight loss after surgery.
- Practice the post-op diet, including the transition from an all-liquid diet, to pureed food, to a normal diet of smaller portions with 4 ounces of protein.
- Start a journal. Record how you feel now, the challenges you face, and the things you hope to be able to do after bariatric surgery.
- Ask your family and friends for their support. Talk to them about why you want to have bariatric surgery. It helps to have people behind you, waiting to help.
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.
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.
Our comprehensive bariatric program will consist of a combination of the following healthcare professionals: a program coordinator, dietician, counselors 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.
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 and type job you may be returning to.
- Roux-en-Y Gastric Bypass Surgery 3 to 6 weeks
- Adjustable Gastric Banding 1 to 4 weeks
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.
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, patients are instructed to eat 1/4 -1/2 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 postsurgery.
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 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 cut down. 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. Call 614-234-LIFE for information.
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 apnea
- 61.2% reduction of excess weight