A bump in bariatric surgeries
More women than men undergo weight-loss procedures, physician saysOctober 12th, 2017
Nearly six years ago, Melani Schorr, a 44-year-old radiology information systems administrator at Deaconess Hospital, in Spokane, had gastric bypass surgery, a decision she says has changed her life.
“I’d been overweight my whole life—diets, exercise, nothing worked,” she says. “I was tired and frustrated, but I decided to go for it and it’s really been a life-altering experience.”
After experiencing joint pain so severe she could barely walk, Schorr says she had what’s called a Roux-en-Y gastric bypass surgery, after which she lost close to 91 pounds.
“I was at a point where I couldn’t tie my shoes, and crossing my legs was difficult,” she says. “And even though I was big, I felt almost invisible in a lot of social interactions.”
Health care professionals say bariatric weight loss surgery like Schorr’s is becoming a more popular option for obese and morbidly obese patients who haven’t been able to lose weight through diet and exercise or medications.
According to the U.S. Department of Health and Human Services, just over one-third of American adults are considered to be obese, with more than 6 percent being morbidly obese.
In addition to joint issues, obesity is known to increase an individual’s risk of developing other related health conditions, such as heart disease, stroke, and type 2 diabetes.
While the DHHS considers the prevalence of obesity to be similar for both men and women, Dr. Mathew C. Rawlins, one of three bariatric surgeons with Rockwood Clinic, says 87 percent of his patients are women.
“We do see more women than men getting these procedures,” he says. “But it’s not because more women than men are overweight. I believe it has much more to do with personal outlook and societal factors.”
Last year, Rawlins, along with Rockwood Clinic’s other two bariatric surgeons, Drs. R. Andrew Bright and Jonathan D. Spitz, completed 471 bariatric procedures here.
“We’ve completed 354 surgeries already this year,” says Rawlins. “We usually complete between 450 and 500 annually.”
Rawlins says that number has been increasing over the years as studies have proven the efficacy of each procedure, and insurance coverage has improved.
“These procedures have become more medically acceptable and even encouraged,” he says.
Rawlins claims more women than men choose bariatric surgery because women are more proactive in seeking treatment for obesity-related health issues.
“Most patients are driven to bariatric surgery because of the need to resolve related conditions like diabetes,” he says. “Women tend to recognize these medical issues are caused by obesity, whereas men are less likely or perhaps less willing to see the correlation.”
Rawlins says most of his female patients, like Schorr, have been overweight all their lives, perhaps seeing their weight issues worsen following pregnancy.
“Most don’t have unreasonably bad diets; they just haven’t been able to lose weight through other means,” he says. “Some are worried that even surgery won’t work.”
Rawlins says surgeons at Rockwood’s bariatric surgical department perform three types of weight loss surgery: the Roux-en-Y gastric bypass, gastric banding, and vertical sleeve gastrectomy.
All three operations are performed using laparoscopy, which involves small incisions that are less invasive than conventional surgery.
In a Roux-en-Y gastric bypass, surgeons staple a patient’s stomach, creating a new, smaller pouch roughly the size of an egg. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine and reducing the amount of food a patient can eat.
In gastric sleeve surgery, more than half of a patient’s stomach is removed, leaving a thin vertical sleeve about the size of a banana, which limits the amount of food that can be eaten in a sitting to about one-half cup.
With gastric band surgery, a surgeon uses laparoscopy to place an adjustable silicone band around the upper part of the stomach. After banding, the stomach can hold only about an ounce of food.
Rawlins says most patients are excited for the surgery because they understand it could improve their overall health.
“These aren’t women who are looking to lose weight for a wedding or swimsuit season,” he says. “Some might be a bit surprised to discover it takes months of education and preoperative visits to get started, but they’re motivated to do that work to get their health back.”
Rockwood is recognized as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery, Rawlins says.
“The ASMBS determines the criteria for bariatric centers of excellence to help patients choose facilities with proven excellent care,” he says. “We’ve been certified as a center of excellence since 2007, and with Deaconess, we have a combined team of over 100 people working in bariatrics.”
Rawlins says candidates for bariatric surgery include those with a body mass index, or BMI, of 40 or higher, or those with a BMI of 35 or more who have a serious medical condition that might improve with weight loss.
BMI is a measure of body fat percentage based on a person’s height and weight; a BMI score between 18.5 and 25 is considered average. Individuals with a BMI score higher than 25 but less than 30 are considered overweight, those who score of 30 or higher are considered obese, and those with scores above 40 are considered to be morbidly obese.
Generally, Rawlins says, gastric bypass patients will lose around 70 percent of their excess weight, sleeve gastrectomy patients will lose around 60 percent, and gastric banding patients will lose around 50 percent.
“Weight loss starts quickly at first and gradually slows down,” he says. “But most patients will see that amount of excess weight lost over the course of a year to a year and a half.”
Rawlins says patients who undergo gastric bypass or gastric sleeve surgeries tend to have better outcomes not only for weight loss but also for resolving related health issues. As a result, those two surgeries are more commonly performed than gastric banding.
“Each surgery has its risks and benefits, but they’re on the same magnitude,” he says. “We’re careful to explain to patients that it took a long time to get here, so it’s going to take a while to prepare your mind for diet and lifestyle changes, as well as retrain your body.”
Rawlins says it’s rare for patients to regain the excess weight lost after surgery, because the procedures are designed to make eating a healthy diet easy.
“The vast majority of patients will only gain back 10 percent of excess weight lost,” he says. “It’s rare to regain much more, because you’re eating healthy solid food that fills you up quickly. Patients who regain more tend to be those who’re eating the wrong things, or filling up on sugary liquids.”
Rawlins says in the past, some patients would regain weight as their stomach pouches began to stretch out again over time.
“In the past 10 years, bariatric surgeons have perfected our techniques,” he asserts. “Now, when we create that smaller pouch, we no longer use those stretchy tissues, so the stomach doesn’t regain any size.”
Rawlins says it generally takes at least six months to prepare a patient prior to surgery, starting with a two-hour information session that covers patient criteria, details on surgery choices, and follow-up care information.
Rawlins says Rockwood hosts two or three sessions each month in Spokane, and attendance usually includes up to 40 potential patients plus guests.
He says of the groups that come in, perhaps only 20 percent decide not to follow up, and another 20 percent are eliminated further in the process for lack of insurance coverage or other reasons.
After the information session, Rawlins says the next step is making an appointment with a surgeon to go over medical and surgical history and discuss details of the patient’s current diet and weight loss attempts.
“Once we’ve determined which procedure is the best fit, we start working with dieticians to get the patient’s diet into shape,” he says. “In some cases, that can take several months.”
He says some of the last steps on the way to surgery include a pre-operation checkup, a psychological evaluation, and making sure the procedure meets the patient’s insurance guidelines.
“Depending on the procedure, self-pay patients are looking at a cost of between $15,000 and $20,000 for bariatric surgery,” says Rawlins.
In the two to four weeks leading up to surgery, Rawlins says patients are put on a liquid-only diet, which usually helps them to lose about 20 pounds prior to surgery.
After surgery, patients stay in the hospital for three days of recovery, remaining on a full liquid diet for two weeks and a puree diet for two more weeks, before finally starting on soft solids.
Rawlins says it takes most patients a month and a half to get back to eating regular food, and most are able to walk and begin light exercise one week after surgery.
Although she was nervous prior to her surgery, Schorr says she was also excited.
“It’s difficult because you have to relearn what to eat, when, and how much you can tolerate,” she says. “At the same time, people see you differently so you have to adjust to that. I just tried to stay excited about each new step in the process, because I knew it was changing my life.”
Rawlins says the clinic checks in with patients for follow-up care two weeks after surgery, three months later, and again one year later.
He says the clinic keeps an active dialogue with patients, advising them on diet and exercise regimens, and in some cases helping to wean them off medications that are no longer needed.
He says some patients also are interested in referrals to plastic surgeons for the removal of excess skin following weight loss.
“I’d say perhaps less than 10 percent of our patients go in for excess skin removal following weight loss surgery,” he says. “Some women find that it’s helpful to tighten areas like under their arms so motion is easier.”
Following surgery, Schorr says she did decide to remove some excess skin from her stomach and back. Overall she says her only regret is not having had her gastric bypass sooner.
“My experience was just so positive and supportive. I really wish I’d done it a long time ago,” she says.