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BARIATRIC SURGERY PROGRAM: Providing Multidisciplinary Treatment of Morbid Obesity
Stony Brook's multidisplinary bariatric surgery program, under the direction of
Dr. Collin E.M. Brathwaite, provides treatment of morbid obesity. An active general surgeon, Dr. Brathwaite has considerable experience in nutrition and currently chairs University Hospital's nutrition
committee.
Among our patients, the average weight loss at 2 weeks is 20 pounds, at 3 months 50 pounds, at 6 months 90 pounds, and at 1 year 120 pounds. By 1½ to 2 years, most of our patients lose about 70% of their excess body weight.
Morbid obesity is that state where body weight exceeds ideal body weight by 100 pounds or more. Obesity of this degree is truly morbid since individuals with it face increased complications from their obesity or may be expected to die earlier than predicted on the basis of life-expectancy tables.
Recognizing that a multidisciplinary approach to the treatment of obesity is necessary, a special support group facilitated by the program's nurse practitioner supplements the surgical therapy. This group provides patients with psychological support to help ensure successful outcomes. It provides information and an opportunity to network with other patients considering or having had the surgery. The group meets on the first Tuesday of every month, from 5:15 PM to 6:30 PM, at the Baldwin Center at 37 Research Way in East Setauket. The group is open to the public. Individuals interested in attending must call 631-444-1045 to confirm their attendance: please leave voice message, plus name and phone number.
To contribute to efforts to further advance obesity surgery,
the program is enrolled in the International Bariatric Surgery
Registry (formerly known as the National Bariatric Surgery
Registry). One of its goals is to enable surgeons to evaluate and
improve their expertise in obesity surgery, and benefit from the
combined experience of all participants. Obesity is a national health problem of significant
proportion. It is estimated that approximately 97 million adults
in the United States are overweight or obese. The figures would
be even higher if we considered overweight children. The importance of this national health problem has been
underscored by National Institutes of Health (NIH) consensus
conferences. These conferences looked at two issues in the
management of obesity: the role of surgery in the treatment of
obesity and the role of conventional treatments, such as dieting,
in the management of the overweight. The reason why obesity is a health problem relates to the
illnesses associated with, or caused by, obesity. Among these
illnesses are diabetes, heart disease, high blood pressure,
gallbladder disease, and cancer. This list is by no means
complete, but does include some of the major medical problems
that are associated with obesity. Although they are not caused
exclusively by being overweight, they may be exacerbated by it,
or they may be accelerated in their development. The estimated cost to the American health care system for
these problems is $70 billion per year. Thus, the impact of
obesity becomes clearer, not only in terms of health and well-being, but also in economic terms. The causes of obesity are not fully known or understood at the
present time. Obesity is most likely a multi-causal problem, with
contributions from several areas. There is certainly a genetic
factor, since we know that obesity is frequently familial. Certain endocrine diseases may also be associated with
obesity. In our program, patients are screened for them as part
of their work-up. Extensive research is ongoing to discover the underlying cause
of obesity beyond what is already known. Much of this research is
looking at what controls satiety—the sensation of being "full"
or satisfied. Some chemicals naturally produced by the body are
among the prime candidates in these investigations. The treatment of obesity is, like the cause, multi-modal. The
major forms of treatment include dieting and behavioral
modification. The greatest success in non-operative therapy is
achieved by combination therapy which combines elements of
behavior therapy (e.g., reinforcement, changes in attitudes about
foods and eating), dieting, and exercise. Through these means, patients decrease their intake of
calories and increase the rate at which calories are used.
Perhaps the most significant finding of the 1991 NIH Conference
on Non-Operative Treatment of Obesity was the general lack of
success of dieting alone. In fact, the use of dieting with its
yo-yoing weight loss followed by weight regain may in fact be
more harmful to the body than a small amount of obesity. Commercial programs take advantage of the fact that, for the
overweight individual, there very often is an initial gratifying
weight loss by adherence to any single program. However, there
tends to be a plateau in this rapid weight loss during which time
many individuals drop out of the programs because they do not
achieve the continuous ongoing weight loss that they find
desirable. Once commercial dieting programs have been abandoned, the
weight that was initially lost then reaccumulates or sometimes
accumulates to a degree that is even greater than the weight at
the start of the program. This again leads to the yo-yoing up-and-down weight that has harmful effects on the body because of
the frequent alterations in normal body maintenance, or
homeostasis. Thus, exercise must be introduced and maintained on a regular
basis, and unhealthy foods or eating habits must for the most
part be given up and totally abandoned. It is probably the
inability to incorporate these necessary changes into one's life
and lifestyle that prevent the usual means for the management of
obesity from being as successful as they might otherwise be. Surgery has been a treatment option since the early 1950s.
Because surgical intervention is so invasive and, in a sense,
radical, it is only indicated after other methods of weight loss have failed. Obesity has
degrees, and the patients who are candidates for surgery are
those who are classified as morbidly obese. The most effective procedures for weight loss utilize the
principle of gastric restriction. If the stomach pouch is made
smaller, this reduction will limit the amount an individual can
eat and weight loss will result. The operations used include
Roux-en-Y gastric bypass (popularly known just as gastric bypass) and vertical banded gastroplasty. Most of our patients need to stay in the hospital for only 3 days or less than that. Our bariatric surgeons perform both Roux-en-Y gastric bypass and
vertical banded gastroplasty—the two operations most commonly used today for
treating obesity, both of which have been endorsed by medical experts
assembled by the NIH. These experts concluded that surgery for obesity,
with its high rate of success, is an option that should be
considered after non-surgical weight-control measures have
failed. Our surgeons also perform other operations for weight loss, which may be recommended on an individual basis.
Our bariatric surgeons perform both Roux-en-Y gastric bypass and vertical banded gastroplasty—the two operations most commonly used today for
treating obesity, both of which have been endorsed by medical experts
assembled by the National Institutes of Health. These experts concluded that surgery for obesity,
with its high rate of success, is an option that should be
considered after non-surgical weight-control measures have
failed. Our surgeons also perform other operations for weight loss, which may be recommended on an individual basis.
The following criteria must usually be met before a patient can be accepted for weight loss surgery at Stony Brook: 1. You must be at least 100 pounds overweight with a body mass index greater than 40. 2. If your body mass index is between 35 and 40, then you must have at least one associated medical problem (such as high blood pressure or diabetes). 3. You must be a non-smoker. Smoking disqualifies patients from surgery, because it not only interferes with wound healing and causes respiratory complications, but counteracts all the medical benefits of weight loss. 4. You must have a sincere motivation to lose weight, including a willingness to make necessary changes in habits, to cooperate fully with instructions, and to keep appointments for follow-up visits. 5. You must be between 15 and 60 years of age, though this requirement may vary in individual cases. 6. You must weigh less than 500 pounds.
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The extra step of draining food from the upper pouch directly into the small intestine gives this operation an extra mechanism for weight loss because not all of the foods are as effectively absorbed (malabsorption). The average weight loss with this procedure is about 70% of excess body weight.
Vertical banded gastroplasty also creates a small upper pouch in
the stomach and then uses a vertical band of synthetic material
to restrict the opening between this upper pouch and the lower
stomach. Food then leaves the stomach in the normal fashion after
passing out of the upper pouch. Weight losses of 50% to 60% of
excess weight can be expected after this surgery.
Both of these operations do require that patients change their eating habits. Because of the small size of the stomach pouches which are created surgically, large meals cannot be tolerated. Eating too much may result in regurgitation or vomiting.
In this fashion, behavior modification is enforced upon the patient. Patients are also advised to exercise to enhance their weight loss. For some patients this is a new experience since their preceding obesity may have made exercise impossible to do, but they are helped to succeed.
| What our patients have said about the outcomes of their bariatric surgery: n I am becoming a new person; I should have done this years ago. n I was a type 2 diabetic with high blood pressure and high cholesterol; now all of that is gone and I no longer take any medication. n It's like being reborn, but this time I like myself. n I haven't been this healthy in 20 years. n This is a long-time prayer answered for me. n I feel so good. n I have no regrets. n I would never trade how I look now for being able to eat the way I did before. |
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Dr. Brathwaite comments: "It is important to emphasize that surgery is not for everybody. Patients should come to the decision for surgery on their own and not be forced into it, since surgical therapy does require a number of changes in their lifestyle to be most effective. Support by the patient's family is crucial."
"However," he adds, "once patients do undergo the surgery, their future may be significantly changed, not only with respect to their health but also because of improved body image and psychosocial well-being."
Perhaps the most important things to recognize about obesity
are the enormity of the problem and its associated risks.
Whatever method of weight management is used is not as important
as the pressing fact that obesity needs to be controlled.
