by Mark Miranda
 

They have tried diet, exercise, behavior modification and drugs, but only a few, less than five percent, have been successful in losing a significant amount of weight. They are the obese - people who are at least 100 pounds overweight and whose health and lifestyle are at risk because of their weight problems.
The term “morbid obesity” is used, explains Sharon Rosetti, RN, Administrator at Kessler Memorial Hospital, because their weight causes serious health problems to develop or worsen. These conditions include diabetes mellitus, atherosclerosis, asthma, sleep apnea, degenerative arthritis, high cholesterol and triglycerides, venous disease and various metabolic and gastrointestinal disorders. Patients with clinically severe obesity, with its related conditions, have less than a one in 10 chance of living a normal life span, says Rosetti.
However, with the development of bariatric surgery, the cure rate has improved dramatically, especially for patients with adult onset diabetes associated with their obesity. Early attempts at surgical management of obesity with intestinal bypass and various manipulations of the small bowel achieved results but were associated with complications related to poor absorption of essential nutrients and severe diarrhea.
Popular in the late 1960s and 1970s, these operations are no longer performed today. Later, gastric banding and partitioning procedures became popular, however, Rosetti explains, they were also ineffective and likely to fail. Initial results with a procedure which placed a balloon in the stomach to stimulate a full stomach and provide a sense of fullness were promising, but complications of gastric perforation ended this method of treatment.
Today, according to Rosetti, the most common operation performed for the treatment of morbid obesity is gastric bypass with Roux-en-y reconstruction. This surgery has been proven over the long term to be effective with most patients losing 85 percent of excess body weight and keeping it off for five years.
Gastric bypass, which creates a small gastric pouch to which the small intestine is attached, has become the standard of care for treatment of the morbidly obese. A connection is made between the small intestine carrying bile and pancreatic juices to the small intestine which is downstream from the gastric connection. This configuration limits the amount of food the patient can eat at one time and gives the sensation of being sated or full because the gastric pouches dilate with small amounts of food.
Rosetti explains that weight loss is usually rapid and predictable if patients follow the dietary directions. As a patient loses weight and becomes more active, exercise becomes an important part of the weight control program. Other important parts of the program are behavior modification and attendance in support group meetings. Patients are urged to alter their reasons for eating from the mind set “living to eat” to “eating to live”.
Most weight loss occurs within the first 18-24 months following surgery, with patients experiencing immediate improvements in their co-morbid conditions including diabetes, sleep apnea and high cholesterol.
Sharon Rosetti explains that the evaluation process for gastric bypass surgery takes into account the patient’s overall medical condition, including co-morbid conditions, the presence of heart or lung disease, gall bladder disease, venous disease and a history of previous abdominal surgery.
Follow up care of those who have gastric bypass surgery is extremely important in achieving the best possible outcome. A carefully constructed diet plan and follow up visits are recommended. In addition, psychological screening should be completed before and after surgery. Support group membership is also encouraged.
Kessler Hospital is successfully performing this surgery on a regular basis. To find a surgeon who performs this surgery at Kessler, please call the Physician Referral line at 561-6700 ext. 5385.