The Real Deal on Obesity, Part 2

 

The Traditional Diet:

You have probably experienced the stress and frustration associated with unsuccessful diets and weight loss programs. The traditional diet is a short sighted food selection program that has an end date. It is not a comprehensive lifelong protocol aimed at long term effects.

You are not a failure, the traditional diet is.

Most methods of weight control are usually ineffective in providing long-term weight loss in the Morbidly Obese patient. The end result of diet attempts is the regaining of the lost weight, and the person experiencing an increase in their pre-diet weight.

A traditional diet in which a person achieves a 10% weight loss is deemed successful. In a morbidly obese person a 10% weight loss will not return them to healthy weight or provide the quality of life that is desired.

Why Surgery?

• Diet & exercise only works for 1 in 20 people who are morbidly obese
• Surgery is safe & effective when the benefits outweigh the continued risks of weight and weight gain.
• Improves co-morbidities
• Provides for a longer and greater quality of life
• Benefits of surgery outweigh the risks for the morbidly obese
• Individuals experience emotional and social benefits with improved health

What about Diabetes?
The International Diabetes Federation (IDF) released a position statement in March 2011 calling for bariatric surgery as an appropriate treatment for people with type 2 diabetes who are obese.

“In addition to behavioral and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalizing blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.”

The IDF puts the lifetime cost of diabetes in the United States at $172,000 for a person diagnosed at age 50 years and $305,000 at age 30 years. More than 60% of this amount is incurred in the first 10 years after diagnosis. Futhermore…

The American Diabetes Associated has stated:
“Bariatric surgery should be considered for adults with BMI >35 kg/m² and type 2 diabetes, especially if the diabetes or associated co-morbidities are difficult to control with lifestyle and pharmacologic therapy.”
Standards of Medical Care in Diabetes: 2010

Diabetes Care January 2010 vol. 33 no. Supplement 1 S11-S61

History of Bariatric Surgery
The most popular procedure in the United States is the gastric bypass surgery. This procedure grew out of results of operations for cancer or severe ulcers in which large portions of the stomach or small intestine were removed. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass. This operation, first used 50+ years ago, produced weight loss by causing malabsorption.

The side effect of this surgery was that it caused a loss of essential nutrients and its effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used. Over the years several different procedures have been developed that are either restrictive or malabsorptive in nature.

Restrictive Procedures
A restrictive procedure is one that limits the amount of food intake but does not impact the way the food is absorbed or digested. Restrictive procedures focus on the stomach alone and not the intestines. The laparoscopic adjustable gastric bands (LAP-BAND® or Realize® Band) and the sleeve gastrectomy are examples of restrictive procedures.

The gastric band cinches the upper portion of the stomach, slowing the passage of food through the lower esophagus and upper stomach. The slower passage in turn creates a sense of satiety or fullness with less food than would otherwise be consumed.

The sleeve gastrectomy is also a purely restrictive procedure creating a smaller stomach or “sleeve”. The residual stomach is removed therefore making this procedure non-reversible. The curvature as well as the size of the “sleeve” slow the passage of food and limit the amount consumed at any one time. Patients who choose purely restrictive operations typically lose weight more gradually and at a slower rate than gastric bypass, duodenal switch or other procedures that involve the intestine. Restrictive procedures rely on patients’ compliance with dietary recommendations, exercise and general lifestyle changes.

Restrictive/Malabsorptive Procedures
Restrictive/Malabsorptive operations produce quicker weight loss than restrictive operations, and can be more effective in reversing certain health problems associated with severe obesity such as diabetes. These types of procedures combine restriction of food by reducing the size of the stomach as well as bypassing parts of the intestinal tract which causes some nutrients to not be absorbed. Because some nutrients are being “malabsorbed” these procedures also carry greater risk for nutritional deficiencies.

Malabsorptive/restrictive operations include Roux en Y Gastric Bypass, Biliopancreatic Diversion, and Duodenal Switch. The gastric bypass procedure bypasses about only 1/3 of the intestine whereas the Duodenal Switch procedure typically bypasses roughly 2/3 or more of the intestine making this a truly malabsorptive procedure.

To learn more about Weight Loss Surgery and see if it is right for you, sign up to attend our FREE informational seminar that is taught by one of our Bariatric Surgeons. He will go over all of the Risks and Benefits of each procedure and answer any questions or concerns you might have. To sign up, click HERE or go to www.RMAP.com or call (801) 268-3800.

 

For The Real Deal on Obesity, Part 1, go HERE.

For more information on Adjustable Gastric Band, go here.
For more information on Sleeve Gastrectomy, go here.
For more information on Roux-en-Y Gastric Bypass, go here.
For more information on Biliopancreatic Diversion with Duodenal Switch (DS), go here.

Find more answers to Frequently Answered Questions here.

 

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124