Weight loss surgery reduces major health risks

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By John Mecenas, MD, Special to the Journal

6:49 p.m. ET Feb. 22, 2017

For adults and adolescents diagnosed with clinically severe obesity, bariatric surgery offers an effective, safe solution for weight loss that also reduces risks for developing diabetes and other illnesses.

Years of research has shown obesity is a complex disease and bariatric surgery, while highly effective, is just one component of a successful treatment plan. The Cayuga Center for Metabolic and Bariatric Surgery at Cayuga Wellness Center has developed a program that links patients to specialists who manage health issues related to obesity as well as diet, nutrition, exercise and lifestyle modification for effective, long-term weight loss. Obesity treatment is undergoing a shift on when surgery is recommended. Earlier surgical care, when combined with other treatments, prevents many patients from developing other obesity-related illnesses.

Who should consider bariatric (weight-loss) surgery? 

Bariatric surgery is considered for people with a body mass index (BMI) of greater than 40. However, you should also consider surgery if your BMI is equal to or greater than 35 and you have other obesity-related illnesses such as diabetes, high blood pressure, elevated cholesterol, heart disease, sleep apnea, debilitating joint problems and some types of cancers.

Why is weight-loss surgery, rather than dieting, recommended for people with clinically severe obesity?

Many studies show patients with extreme obesity are more successful in weight reduction with surgical treatment than with dieting or exercise alone. Numerous medical groups from the American Diabetes Association and the American Heart Association to federal health agencies including the National Institutes of Health and the Centers for Medicare & Medicaid Services recommend bariatric surgery for effective weight loss in cases of severe obesity.

What types of bariatric surgery are available at Cayuga Medical Center?

Three types of minimally invasive, laparoscopic surgeries are used at Cayuga Medical Center.

Sleeve gastrectomy is among the most common bariatric surgeries used locally and nationally. During a sleeve procedure, the surgeon removes a section of the stomach. That creates a stomach shaped like a sleeve, which reduces stomach volume and induces weight loss.

Gastric bypass surgery, also called Roux-en-Y gastric bypass, is still considered the standard bariatric procedure by many surgeons. The surgery includes two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. That procedure makes the stomach smaller, so you eat less to feel full. Next, the intestine is re-routed to bypass the majority of the stomach and part of the small intestine. The bypass reduces the absorption of food.

Both gastric bypass surgery and sleeve gastrectomy produce other physiologic and metabolic changes in the body that can increase weight loss and control obesity associated illnesses.

A third procedure called adjustable gastric banding is less frequently used than the other two bariatric surgeries. In gastric banding, a ring with an inner inflatable band is placed around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. After surgery, the surgeon can adjust the size of the opening from the pouch to the rest of your stomach.

How long do the surgeries take, how many days would I be hospitalized and is the surgery covered by insurance?

Depending on the type of surgery, the procedure takes one to two hours and the hospital stay may be one to two nights, but sometimes not require an over-night stay. The three surgeries offered are covered by Medicare and most private insurance plans.

How does a patient prepare for bariatric surgery?

Discussing your concerns with your primary care provider is always a good first step. Your primary physician can help by referring you to a surgeon. The surgeon will advise you on tests needed prior to surgery and precautions to make in the days preceding the operation. In addition, starting and following a weight loss and exercise program for several months prior to surgery may increase weight loss and improve patient outcomes.

What should a patient look for in a bariatric surgery program?

First, find an experienced, board certified surgeon who has specialized training in laparoscopic bariatric surgery. Patients should look for a program that links various aspects of their care. A team approach is the best way to treat obesity because the causes and consequences of the disease are so varied. Patients should look for a program that links various aspects of their care. The program at the Cayuga Center for Metabolic and Bariatric Surgery works to include a patient’s primary care physician, board certified laparoscopic surgeons and a certified bariatrician, who is a medical doctor specializing in obesity treatment. The program also involves nurses, health educators, dieticians and exercise physiologists. Developing that continuum of care is the goal of the Cayuga Center for Metabolic and Bariatric Surgery and the Cayuga Center for Healthy Living.

Following surgery many patients benefit from joining a weight-loss surgery support group. Regular meetings for bariatric surgery patients are held at Cayuga Medical Center.

Dr. Mecenas is a board certified general surgeon with advanced training in minimally invasive surgery and bariatric surgery. He began the Weight-loss Surgery Program at Cayuga Medical Center in 2002 and is now the director of the Cayuga Center for Metabolic and Bariatric Surgery. For additional information on bariatric surgery, go to cayugamed.org or call the bariatric services line at (607) 252-3555. 

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Weight loss surgery reduces major health risks

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