Last-resort bariatric surgery has the ability to improve lives
By Kellie B. Gormly
Published: Monday, May 13, 2013, 9:00 p.m.
After years of trying to lose weight with dieting and exercising, 345-pound Eric Schmidt turned to his last resort: bariatric surgery.
“I had tried a lot of things,” says Schmidt, 50, a paramedic. “Between my professional and family life, I, frankly, put myself last a lot of times. ... I just felt lousy, and I couldn't do the things I wanted to do.”
Schmidt, of O'Hara, underwent gastric bypass surgery last year, after several prerequisite visits with his primary care doctor over six months, as required by his health insurance. Exactly one year later, Schmidt weighs 227 pounds.
“Not in a long time have I felt better than I do now,” he says. Schmidt and his wife, Beth Ann, have three kids: twins Abbie and Tori, 17, and Deric, 19. “Frankly, I haven't looked back since. ... It's been a transforming thing for me.”
New Jersey Gov. Chris Christie, who recently underwent a stomach-banding operation to lose weight, has plenty of company. Surgeons perform about 160,000 bariatric operations per year, according to figures from the American Society for Metabolic and Bariatric Surgery, based in Gainesville, Fla. The results can be dramatic weight loss — sometimes, like in Schmidt's case, more than 100 pounds in a year.
But bariatric surgery is no quick, easy fix, and it's not for you if you need to lose just a little bit of weight, or even if you need to lose 50 pounds. Surprisingly, the most common patients who initially ask Dr. Andrew Adams, an internist with West Penn Medical Associates, about weight-loss surgery just want to lose 10 to 15 pounds for glamour's sake. Of course, Adams doesn't refer those patients to bariatric surgeons.
“I am very much for the surgery when it's appropriate, but every patient? Absolutely not,” he says. “It's really for the patient who has failed all types of medical intervention.”
However, with an obesity epidemic, severely overweight people can benefit greatly from the surgeries, which can alleviate and even eliminate health conditions like Type 2 diabetes, Adams says.
“I've had patients' lives saved by this operation,” says Adams, who has offices in Bloomfield and Oakmont.
However, weight-loss surgery is a major, serious operation with a mortality risk, he says. It doesn't remove the need to exercise and eat healthfully.
“I think sometimes people do get the idea that you go in and get this done, get your car tuned and go on about your life,” Adams says. “That's not how this operation works.”
Dr. Daniel Gagne, director of bariatric surgery for West Penn Allegheny Bariatric Surgery Center, says a candidate for the operation is generally someone who is at least 100 pounds overweight, and has a body mass index of at least 40, which is considered morbidly obese. Many people do try hard to lose weight through diet and exercise, yet just can't make much progress. By the time these people consult with a bariatric surgeon, they usually have failed many times with their own weight-loss efforts, says Gagne, who has performed more than 2,300 bariatric surgeries over 14 years.
The most common bariatric surgery is gastric bypass, also called stomach stapling, where doctors wall off a small pouch in the stomach and reroute food past part of the intestine. This reduces the amount of food a stomach can hold, and reduces the body's absorption of calories. In stomach banding, an easier and less invasive operation, doctors put an adjustable band around the stomach to restrict space for food. The band, though, has become less popular because it usually doesn't produce the same results as gastric bypass. Only about 1 out of 10 people will do well with a banding, Gagne says. Surgeons also do what's called a sleeve gastroectomy, which removes a large chunk of the stomach and cuts hunger-stimulating hormones.
Depending on the size of the patient, most will lose at least 75 pounds after the surgery; banded patients may only lose 30 to 35 pounds, Gagne says.
Bariatric surgeries should be a last resort, he says. And if the patient doesn't change his lifestyle with diet and exercise, the surgery's positive results will be reversed in time.
“The first year for everyone is the honeymoon, but to keep it off afterwards, most patients have to work at it,” Gagne says.
Although insurance companies differ, they often cover bariatric surgery — which costs anywhere from $14,000 to up to $30,000 — for patients who meet a threshold for obesity and health problems. Patients might endure side effects like cramping and diarrhea, vitamin deficiencies and blood clots.
Dr. Joseph Colella — UPMC director of robotic surgery at St. Margaret Hospital in Aspinwall — estimates that only about 1 percent of the 18 to 20 million Americans who could benefit from bariatric surgery get it.
“That's a source of frustration for those who know better,” says Colella, who does bariatric surgery almost exclusively.
People with a BMI greater than 40 have less than a 5 percent chance of “losing enough weight to matter and keeping it off long enough to matter,” Colella says.
Patients often tell both Colella and Gagne that their only regret is not having the surgery sooner.
“I hear it all the time,” Colella says. “Honestly, it makes my job one of the best on the planet. It's so rewarding to see people whose lives change so dramatically in such a positive way.
“Patients are the ones that do the hard work,” he says. “The operation basically gives them a tool to assist them in doing that hard work.”
Kellie B. Gormly is a staff writer for Trib Total Media. She can be reached at firstname.lastname@example.org or 412-320-7824.
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