Lisa Waterman Gray courtesy of The Bariatric Center of Kansas City

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We all know that being overweight is unhealthy, but did you know that extra fat could be the next big killer? According to a March 2006 report from the Centers for Disease Control and Prevention, obesity may become the leading cause of mortality in the United States, with a death toll of 500,000 per year. Measures other than diet and exercise are being used to remove excess weight.

Stan Hoehn, a physician with The Bariatric Center of Kansas City, affiliated with Shawnee Mission Medical Center, completed his first obesity surgery four years ago. By year’s end, he had performed approximately 75 to 100 more procedures. Hoehn completed 300 weight loss procedures during 2005.

Stephen Malley, a physician with Malley Surgical Weight Loss Centers, performed his first open gastric bypass procedure in the late ’90s and his first lap band procedure in February 2004. In professional practice, he now focuses exclusively on and has performed nearly 500 lap band procedures.

“The FDA has approved the lap band only since 2001,” Malley says. “(But) I feel you’ll have as good a result, five years out, without all the complications (of a gastric bypass procedure).”

Qualifications for Surgery
Most obesity patients self-refer and can undergo a lap band procedure or gastric bypass surgery based on personal preference. Approximately 80-85 percent of Hoehn’s and Malley’s obesity surgery patients are female.

A majority have a Body Mass Index of at least 40--or 35, with weight-related medical problems--which typically reflects excessive weight of greater than 100 pounds. On average, patients also have previously failed to lose sufficient weight at least 10 to 20 times when following diets or medical weight loss programs.

Gastric Bypass Surgery
Laparoscopic gastric bypass surgery first became available in the United States a decade ago. Patients usually lose 70 to 75 percent of their excess body weight within 18 months.

During the 45-50 minute procedure, a physician surgically bypasses three feet of the small intestines and creates a small gastric pouch near the top of the stomach, while closing off the remaining stomach with a linear stapler.

“(When you bypass the small intestine) less calories are absorbed and patients have early satisfaction when eating,” Hoehn says. The procedure requires general anesthesia, an overnight hospital stay and two to three weeks of recovery time.

The Lap Band
This procedure has been available in Europe for a dozen years and in the United States for six to seven years. Three years after the procedure, many patients lose approximately 50 to 65 percent of their excess body weight.

“This is perceived as a less-invasive option and easily reversible,” Hoehn says.

The surgeon places a restrictive lap band device around the upper part of the stomach, laparoscopically, through five puncture wounds and under general anesthesia. Patients experience mild discomfort and can return to work within a week.

Most of Hoehn’s patients spend about five hours in prep, surgery and recovery in the hospital, while Malley’s patients stay overnight.

“I still keep people overnight, because I like to do an upper GI the next morning to make sure there are no leaks and the band is not too tight,” he says. “I also have some people who receive surgery on Thursday and return to work on Monday.”

Adjustment of the lap band occurs in   the physician’s office approximately one week after surgery and an additional three to five times during the first year. Most patients follow a liquid diet during the first week, and transition to a regular diet within one month.

Lifestyle Changes
These procedures are by no means a cure-all. There’s also work involved in losing and keeping the weight off.

“Younger patients and those who work out will have less of a problem (losing weight),” Hoehn says. “Patients will have nausea and vomiting if they overeat after either operation, and there is typically a 100 percent failure rate if (the lap band) is removed, because the restriction is removed and the appetite returns.”

Simple sugars and fats aren’t tolerated well among gastric bypass patients, who must pay particular attention to receiving adequate vitamin supplementation. Following either procedure, patients should eat three small meals a day, with no snacking between meals.

“Snacking is so often a downfall for people with weight problems,” Malley says.

 Hydration presents another key issue for these patients. Hoehn tells them to avoid high-calorie liquids, such as soft drinks, and  ingest only minimal alcohol.

“They also should drink minimal liquids within thirty minutes before and after meals,” Hoehn says. Malley suggests that patients avoid fluids during meals and for about an hour after meals, so food is not  liquefied and can more adequately satisfy the appetite.

A Visual Side Effect
Loose muscles, localized fat tissue and large folds of excess skin may result from losing such large amounts of weight. As a result, approximately one quarter of patients later undergo plastic surgery. Although insurance covers approximately 60 to 80 percent of the cost for obesity surgeries, this  cosmetic surgery remains an out-of-pocket expense.

The Well-Informed Patient
Education is an important part of preparing a patient for either procedure. Informational seminars and individual counseling, as needed, are typically available through the surgeon’s office. SMMC also runs education classes that Hoehn requires patients to attend.

“We feel that informed consent is very important,” he says.

Malley agrees. “Patients must attend a two-hour seminar before they ever come to my office, with a video of the procedure,” he says. “They also complete an educational computer program before they come in. In addition, we have our own support  group and we highly recommend it because these are people who have experienced the same things.”