For many, bariatric or weight loss surgery isn’t a cosmetic choice but a medical necessity.
“Our culture with so many fast food options and hurried schedules as well as lack of time to cook, feeds into the continuing and rapid rise of overweight Americans,” says General and Bariatric Surgeon, Dr. Paul Stanish, M.D., F.A.C.S., who is the Medical Director for the Healthy 4 Life program at Community Hospital in Munster and St. Mary Medical Center in Hobart.
According to Dr. Larry Brewerton, PhD, a professor of psychology at Indiana University Northwest who also has a part time private clinical practice, though our ancestors ate just enough to survive with a little to keep going in the winter when food was scarcer, now our eating patterns have definitely changed and not for the best.
“Food is too readily available,” he says. “Soda used to be a treat, when I was growing up nobody drank it every day.”
Not so in the era of Big Gulps, all-you-can-eat-buffets and supersized meals – an overload of unhealthy calories that translates into an obesity epidemic. Current estimates indicate that nearly one-third of the adult American population or about 60 million people. Those with clinically severe obesity, generally considered to be 100 pounds above a person’s ideal weight, are at a high risk of developing such life threatening medical conditions as heart disease, high blood pressure and diabetes. Annually, there are more than 300,000 excess deaths in the U.S. due to obesity and the resulting healthcare costs amount to approximately $100 billion.
According to Stanish, several studies show that bariatric surgery can reverse the Type 2 diabetes better than just medication. Other medical pluses, besides significant weight loss, include improvement in cardiovascular risk factors along with a reduction in mortality ranging from 23 percent to 40 percent.
“There are basic criteria that insurance companies look for in determining if a patient is a candidate for bariatric surgery,” says Lori Granich, Bariatric Dietitian at the Midwest Bariatric Institute in Dyer. “The most popular parameters are having a BMI greater than 40 or having a BMI over 35 with two co-morbidities such as hypertension, diabetes or sleep apnea. Patients have typically failed previous attempts at weight loss. Patient’s eligibility will also depend on meetings with the surgeon, nursing staff, psychologist and dietitian.”
Healthy 4 Life’s website features an easy to use tool for measuring body mass index (BMI). Plug in your height and weight (no fibbing please) and the site can calculate your BMI.
The surgery first became available in the 1950s but has vastly improved since then.
“Most bariatric surgeries these days are minimally invasive or laparoscopic and can be categorized into restrictive or malabsorptive procedures,” says Granich RD. “A restrictive procedure, such as the lap-band or sleeve gastrectomy, reduces the size of the stomach to decrease the amount of food it can hold. Malabsorptive procedures, such as the Roux-En-Y Gastric Bypass, restricts food intake while limiting absorption of calories. This results in large amounts of weight loss.”
But it isn’t a free pass to a future of endless desserts and no weight gain (sigh!). Indeed Stanish says that after surgery if big time sweet eaters don’t cut back it significantly, the undigested sugar in their intestines can make them sick and cause something unpleasantly known as dumping syndrome.
“Bariatric surgery should be taken as a last resort,” says Kim Kramer, a wellness dietitian at Ingalls Hospital and the Illinois Dietetic Association’s media spokeswoman. “It is not a quick fix, it’s very hard work. People should try every other option before making this choice whether it’s going on a weight loss plan or adding more exercise to your day.”
Stanish says that when they first started their weight loss program, it was surgical.
“Then we recognized we needed a non-surgical program,” he says. “So now usually when patients come to us we say we’re going to get to the surgery later, let’s work on this first so by the time we get them into surgery the patient is probably 15 to 20 pounds lighter and in much better shape for the surgery. But even with surgery, if patients don’t make the therapeutic changes in their way of life, they will gain some of it back. These changes include healthy eating and an increase in physical activity.”
Besides their pre-surgery program, Healthy 4 Life also provides customized weight loss options with ongoing medical and personal support as patients adjust to their new – and healthy -- life habits. This includes their Weight No More support group designed for on-going participation enabling patients to continue practicing the skills necessary for a lifetime of continued health and weight management.
“Our Therapeutic Lifestyle Changes (TLC) teaches patients about eating the right foods and increasing physical activity," says Stanish, adding that he avoids the dreaded “e” word – exercise.
“Bariatric surgery is a life-changing procedure,” says Granich. “It is imperative that patients are willing to commit to the lifestyle changes needed for post-operative success. Some insurance companies implement a time frame up to six months for medically supervised weight loss before they will approve surgery. The surgeon may require additional testing based on the patients past medical history or age. A medically supervised program will help patients change their eating habits, quit smoking, lose weight and start exercising before surgery. When these changes are made preoperatively, patients adapt better to life after surgery.”
Kramer, who conducts preparatory classes for people considering the surgery as well as weight management programs, says that the life changes include smaller portions, at times not being able to eat solids and fluids together and a commitment to exercise and healthy eating.
“We offer healthy cooking demonstrations and discuss general nutrition,” she says. “We prepare people for what to expect after surgery. A lot of times people take vitamins afterwards based on what surgeries they’re having.”
In order to get ready for surgery, Kramer says people need to start exercising before surgery.
“Bariatric surgery is a huge step,” says Brewerton. “For those who are considering it, they should talk to someone who has had the surgery and find out would they do it again if they had the choice and why or why not.”
Besides the physical component, weight loss surgery also has a psychological aspect too.
“Many people use food when they’re feeling badly, sad, angry or anxious,” says Brewer. “It becomes a way of dealing with their feelings.”
But ultimately, stuffing ourselves harms our health and, if we gain too much weight, our self-esteem, sometimes increasing the feeling we’re trying to stymie through food.
Brewerton suggests learning to express our feelings by talking to a therapist or joining a supportive weight lose group like Weight Watchers is one way to handle negative emotions in a positive way.
“Stress management is also important so that we don’t eat as a stress reliever,” says Kramer. “There’s a lot of emotion in why we eat what we do.”