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Surgical Solution? 

Bariatric surgery is no quick fix; it requires dedication and major life changes

Among the many offerings in primetime television are two reality TV programs that indeed show a very realistic slice of American life: obesity. NBC’s The Biggest Loser and ABC’s Extreme Makeover Weight Loss Edition may differ slightly in format, but at their core is the same idea — that people who are dangerously overweight can take corrective action through a regimen of diet, exercise and personal training to lose large amounts of weight.

But for many of the one-third of U.S. adults who are obese (a Body Mass Index score of 30 or more), an intense, personalized diet and exercise weight-loss program hasn’t proven to be a viable solution. For them, bariatric surgery may offer the last hope of finally achieving weight loss.

PROCEDURES

People with a Body Mass Index of 40 or more are the best candidates for bariatric surgery. Of the four bariatric procedures, these three are performed in Spokane.

Gastric Banding
PROCEDURE: A physical band around the stomach reduces the amount of food the stomach can hold.
TIME: 45-60 minutes. Outpatient.
CONSIDERATIONS: Lowest risk of serious complications but requires most frequent follow up and requires excellent compliance with diet over time.

Sleeve Gastrectomy
PROCEDURE: Remove a majority of the stomach and leave a thin tube or “sleeve” that fills more quickly with less food.
TIME: 60-75 minutes. Normally one night in hospital.
CONSIDERATIONS: Actually removing a portion of the stomach, and in a sense it is not reversible. “There is no going back from it,” says Dr. Jonathan Spitz.

Gastric Bypass
PROCEDURE: The stomach pouch is made smaller and “rerouted” to bypass the duodenum, meaning fewer calories can be absorbed.
TIME: Two hours. Normally two nights in hospital.
CONSIDERATIONS: Of the three, usually results in most amount of weight loss. But it’s a longer surgery with more recovery time and could increase chance of gallstones.

— Sources: Dr. Jonathan Spitz and the National Institutes of Health/MedlinePlus

NO EASY WAY OUT
Bariatric surgery is a catch-all for several procedures that have one overarching goal: limiting the body’s ability to take in or absorb large quantities of food. Four major types of surgery are available: gastric bypass, gastric banding, sleeve gastrectomy and — get ready for a mouthful — biliopancreatic diversion with duodenal switch.

Of the four, only the first three are performed in Spokane by surgeons of the Rockwood Surgical Group. With offices in the Deaconess Health Education Center, the team of three surgeons, and numerous associated personnel — psychologists, case managers, dieticians, nurse practitioners — help patients seeking such surgeries.

Jonathan Spitz, a fellow of the American College of Surgeons, is one of the three bariatric doctors in the Rockwood group. He’s quick to refute the notion that bariatric surgery is “the easy way out” for people who simply don’t want to diet or exercise.

“[Bariatric surgery] indicates a huge commitment on the part of the patient,” Spitz says. “And for patients who do lose weight successfully, they should never feel that it was the easy way out.”

In many ways, the process of bariatric surgery is similar to a long-term weight-loss plan with a personal trainer. Though Spitz says that in the early days of bariatric surgery — the 1970s and ’80s — the process was not comprehensive, things have certainly changed.

Now, when a person indicates she wants the surgery, a very serious review process begins.

Patients coming to the Rockwood practice will receive dietary and psychological screening to determine whether they’re good candidates for surgery. Ideally, this will help determine if a patient may get off track after surgery when it comes time to stick to the diet and exercise plan. The screening also indicates whether a potential patient may suffer from compulsive tendencies or depression.

That process generally takes six to eight weeks before a patient undergoes a procedure, says Spitz. And that’s just the beginning. After surgery what arguably becomes the toughest part begins: following up with a team of health-care providers and sticking to dietary and exercise guidelines — just like a conventional weight loss program on The Biggest Loser.

THE "GOOD" CANDIDATE
Women do make up the majority of patients seen by Spitz and his colleagues, who together perform about nine bariatric procedures per week.

That so many of those getting surgery are women doesn’t surprise Laura Frank, a registered dietician who holds a doctorate in exercise physiology and human performance. As a clinical professor in the Washington State University College of Pharmacy, she researches nutrition issues with bariatric surgery.

Frank has counseled many bariatric patients on nutrition, and she estimates 90 percent were women. Approaching the surgery with caution is key. Frank likens people who aren’t successful at losing weight after surgery — or who lost weight but gain it back over time — to people who think money will solve all of their problems.

“It’s like winning the lottery,” Frank says. “[Patients may think] ‘If I win the lottery, I’ll be so much happier.’ But having a million dollars doesn’t solve it.”

Spitz echoes that, noting surgery is absolutely not a magic pill.

“A good patient is someone who has made a commitment to a diet program, because surgery is not a panacea, it’s not a guarantee to success,” he says. “It’s a tool that, if used correctly, will help people achieve significant and sustained weight loss.”

That tool is only effective if a patient — the operator if you will — knows how to use it correctly. Spitz compares the commitment required of bariatric surgery patients to training for and competing in a true test of physical endurance.

“It’s an ultramarathon,” he says, “because they’re signing up for something that is lifelong.”

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