When Diets Don’t Work

Contributed By Linda Kelly, RN, CGRN, WakeMed Cary Hospital Bariatric Surgery

If you have been on the diet rollercoaster, you know what it feels like. There are high points when that new fad diet seems to work. Then, there are the low points when all the weight comes back.

Many Americans can make and stick to the lifestyle changes that help them maintain a healthy weight and a healthy body. Many cannot, and these individuals often suffer life-threatening side effects of prolonged obesity such as diabetes, high blood pressure and sleep apnea. For these people, bariatric surgery may be a viable option, particularly because, in many cases, bariatric procedures can reduce and even eliminate health issues.

As reported by the American Society for Metabolic & Bariatric Surgery, a study published in the Journal of the American Medical Association revealed that bariatric surgery patients showed improvements in the following conditions:

     •    Type 2 diabetes remission in 76.8 percent of patients; significant improvement in 86 percent.

     •    High blood pressure eliminated in 61.7 percent; significant improvement in 78.5 percent.

     •    High cholesterol reduced in more than 70 percent of patients.

     •    Sleep apnea eliminated in 85.7 percent of patients.

Bariatric procedures began at WakeMed Cary Hospital in April 2009. Since then, Dr. Paul Enochs and Dr. Jon Bruce, general and bariatric surgeons with Bariatric Specialists of North Carolina, and most recently Dr. Brandon Roy, a general and bariatric surgeon with WakeMed Faculty Physicians — General Surgery, have performed more than 270 bariatric procedures at Cary Hospital. Here are some basics about bariatric patients, protocols and procedures.

The Patient
“Our bariatric surgery candidates are typically in their early to mid-40s, and they have tried every diet out there,” said Dr. Roy. While these individuals do have some weight loss success, they gain all the weight back within the year.

The average age of bariatric surgery patients at WakeMed Cary Hospital is 42, and the hospital does not provide bariatric surgical services to patients who are younger than 18.
Bariatric surgery candidates often have co-morbidities, which are health problems that can be attributed to being overweight for many years, age, family history and bad habits. Some of these include type 2 diabetes, arthritis, sleep apnea, high cholesterol and high blood pressure. Losing weight will help them either control or eliminate these often-threatening health issues.

A typical bariatric surgery candidate has an average body mass index of 35 and one or more associated health problems. A normal BMI is between 18.5 and 24.9. A BMI of 30 or greater indicates obesity.

The Procedures
LAP-BAND® System, sleeve gastrectomy and gastric bypass surgeries are the most common procedures performed by surgeons in the WakeMed Cary Hospital Bariatric Surgery program.

LAP-BAND — “This is considered a restrictive bariatric procedure because it restricts the amount you can eat in one sitting,” said Dr. Enochs, who was the first surgeon in North Carolina to perform a single-incision LAP-BAND procedure. “The surgeon wraps a special band around the upper section of the stomach, which reduces the stomach to a small pouch.” This is a reversible procedure that is typically done on an outpatient basis, meaning patients stay in the hospital for less than 24 hours.

Gastric Bypass — Gastric bypass surgery combines the restrictive properties associated with procedures such as LAP-BAND with bypass. The surgeon uses the LAP-BAND system or surgical staples to drastically reduce the size of the stomach. This smaller stomach is then attached to the midsection of the small intestine therefore bypassing the rest of the stomach and the top portion of the small intestine. A gastric bypass procedure limits the amount of food your stomach can hold and the amount of calories and nutrients your body absorbs. This procedure can be performed through a single incision and involves a 48-hour stay in the hospital. It is non-reversible. People who have gastric bypass surgery lose weight at a faster rate than people who have the LAP-BAND procedure.

Sleeve Gastrectomy — In this procedure, the surgeon removes a large portion of the stomach then attaches the open edges to form a sleeve or tube. It can be performed through a single incision and involves a 48-hour stay in the hospital.

The Protocol
“The protocol for bariatric surgery candidates is very intensive for several reasons,” explained Dr. Bruce. “First, we want to have a high level of certainty that the person can maintain the lifestyle changes necessary to ensure the procedure’s long-term efficacy. Second, we want to make sure we choose the procedure that best meets the candidate’s needs.”
People suffering from health issues such as sleep apnea, type 2 diabetes and high blood pressure may benefit more from the rapid weight loss and limited absorption of nutrients and calories associated with gastric bypass and sleeve gastrectomy procedures. People who do not have these health issues and prefer a weight loss solution that is reversible may be better candidates for the LAP-BAND procedure.

Medical tests associated with the bariatric surgery protocol vary from person to person but typically include:

    •    Blood work.

    •    X-rays.

    •    An endoscopy exam of the upper gastrointestinal tract.

    •    Other testing such as sleep studies may also be ordered by the surgeon.

Psychological and nutritional counseling are vital parts of the protocol. Candidates must be able to demonstrate that they have the ability to maintain the new lifestyle changes after their procedure that are just as important as the surgery itself. Some of these include:

    •    Eating very small meals four to six times a day.

    •    Quitting smoking, drinking alcohol and consuming caffeinated beverages.

Candidates are also required to participate in educational sessions to ensure they have a complete understanding of the procedure, potential side effects, risks and new eating patterns.

In addition, the protocol involves a thorough consultation between the surgeon and the patient. The surgeon will explain the different types of procedures available, review the patient’s health history and discuss the patient’s financial obligations. In some cases, insurance companies will cover the cost of procedure; in others they will not. Insurance companies have specific criteria a patient must meet in order to receive partial or full coverage for the procedure.

If you are considering bariatric surgery, the place to start is with your primary care physician. Talk to your doctor about it. Your doctor can then refer you to the bariatric surgeon and program that best meet your needs.

Linda Kelly, RN, CGRN, is the endoscopy supervisor and bariatric surgery coordinator at WakeMed Cary Hospital. For more information, visit wakmed.com.

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