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Weighing in on bariatric surgery 

Two doctors and a patient discuss the procedure

click to enlarge weight_loss.jpg

In what may be an unwelcome consequence of our distinctive food culture, Louisiana regularly appears on lists of states with the highest rates of obesity. On a 2015 Centers for Disease Control and Prevention map, the state joins just three others with an obesity rate higher than 35 percent, and doctors statewide often warn of related public health implications, including high rates of heart disease and diabetes.

 Bariatric surgery (surgery for weight loss — bariatrics is the study of obesity) is an increasingly common way to reverse significant weight gain. Though the concept isn't new, this treatment method has become more common as insurers have begun writing bariatric coverage into policies and social stigma has faded.

 "[In the past] patients, for whatever reason, didn't want to reveal that they were having weight loss surgery, or they were afraid because of misconceptions about it," Dr. David Treen, director of bariatric surgery at West Jefferson Medical Center, explains. "[Now] pretty much everybody knows somebody who's had weight loss surgery."

 Bariatric surgery can be a good option for patients who have had trouble maintaining a healthy weight over a number of years. At Ochsner Medical Center - North Shore, chief of surgery and bariatric director Dr. Asahel Gridley says it isn't a first step before diet and exercise, but if those efforts repeatedly fail, surgery is worth considering — especially in the presence of other health problems that often are associated with obesity.

 "[For patients with Type 2 diabetes] there is a good chance you could help control your blood sugars altogether, and maybe even get your blood sugars to a much lower number," he says. According to Gridley, bariatric surgery also can help with sleep apnea, high blood pressure and high cholesterol.

 Prospective bariatric patients should set appointments with a primary care physician, a dietitian and a psychiatrist to establish relationships for post-surgery supportive care, and to ensure they don't have an existing health problem that conflicts with the surgery. Some genetic disorders make people ineligible, and patients with severe congestive heart failure should clear bariatric procedures with a cardiologist. People with schizophrenia or any other psychotic disorder generally aren't good candidates, because they can have difficulty following dietary plans. And even before surgery, the doctor wants to see that the patient can stick to a prescribed diet, Gridley says.

 "Just doing the surgery itself will make you lose some weight, because it will restrict how much food you can eat," he says. "But if you don't make the right choices and you continue to eat the wrong sorts of foods ... the weight will eventually catch back up."

 In Louisiana, the most common type of bariatric surgery is called a vertical sleeve gastrectomy (VSG). Unlike the gastric bypass or gastric band, both of which have fallen out of favor with surgeons due to potential complications, the VSG physically removes 80 percent of the stomach. This reduces stomach capacity and removes stomach cells that manufacture the hormone ghrelin, which contributes to hunger.

 Treen says the loss of ghrelin- producing cells helps patients readjust their eating habits after the surgery, encouraging portion control.

 "When the stomach is gone, you don't have this churning feeling in your stomach when it's empty," he says. "You don't have this feedback mechanism of an empty stomach telling the brain 'go get some food and fill me up.'"

 The majority of insurance policies explicitly state whether bariatric surgery is covered and any special requirements. Treen says some insurers only offer coverage if the surgery takes place in an approved "center of excellence." At West Jefferson Medical Center's bariatric clinic, the out-of-pocket cost is about $14,000, which includes coverage for any complications that may occur. (Treen says complications are relatively rare.)

 People who have had VSG surgery can expect to proceed through a protocol that gradually reintroduces normal food. For West Jefferson Medical Center patients, it usually takes about six weeks to move from liquids to soft foods to regular food. As they recover, bariatric patients are encouraged to undertake an exercise regime to build heart health and accelerate their weight loss.

 "As they lose weight, they're able to exercise more, and don't dread it like they [did]," Treen says. "Most importantly, [with the VSG] they don't feel deprived. (With) some of these other procedures, you'd still be hungry after you ate as much as you could eat. ... It's easier to stay on a diet when you're not hungry all the time."

Sounds great, but what is it really like?

A year and a half after her bariatric surgery, Tara Taylor feels good about the results — with a few caveats. Taylor had VSG surgery at a New Iberia clinic after reaching a point of profound unhappiness with her body image and weight, which she'd been struggling to manage since she was a teenager.

 "Either I would be relatively in control on Weight Watchers ... [or] I would fall off, then gain [the weight] back," she says. "It had gotten to the point where I was having trouble sleeping and my knees were ... super-inflamed."

 Since the surgery, she feels healthier and has lost a significant amount of weight. But she's been challenged by psychological aspects of an extreme physical transformation. "I've cried in so many dressing rooms," she says.

 It's also been hard managing the precise balance of carbohydrates, protein and fat her doctor recommended — she worries that the diet exacerbates her complicated feelings about food. She has had some small complications, including digestive problems. She avoids some foods due to her reduced stomach capacity, including carbonated beverages, soup and gumbo, and she's stopped drinking alcohol almost completely.

 Taylor also says people close to her have had to adjust to life after her surgery. During the first months after her procedure, she found it difficult to eat more than a few bites of food at a time. Even though they knew she was following her doctor's advice, family members sometimes were hurt when she declined meals.

 "When you reject someone's food ... people take it personally," she says. "The last time I went home to Lafayette, there were tears."

 Taylor says the surgery has been really effective in terms of her weight loss. But like Treen and Gridley, she encourages prospective bariatric patients to look into aftercare with a doctor or support group, to help deal with any issues that might come up.

 "I genuinely do like the way I look now; I'm proud of this," she says. "But [more important] than the nutrition, is the psychological [care]."

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