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Bariatric surgery: When do the benefits outweigh the risks?

Patients must make lifestyle changes after surgery or weight will return.

Contributed Jennifer Bloom-Long says she tried many diets before deciding to have weight-loss surgery.

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Contributed photo After Jon Jacobus' weight loss through bariatric surgery, he is now eligible to be kidney transplant.

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Contributed Tracey Elliott is now a size 8 after her bariatric surgery.

Contributed Jennifer Bloom-Long says she has much more energy since her weight-loss surgery.

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By Robin McMacken, Staff Writer Updated 8:00 PM Friday, July 29, 2011

Editor’s note: Today, we continue our weekly series intended to arm you with the tools and information you need to start on the path toward better health and fitness in 2011. Find special health and fitness coverage every week in Life.

When she had to request a seat belt extender during a business-related flight, Tracey Elliott, 38, of Fairborn, knew it was time to consider something she had been researching for three years: bariatric surgery.

“I was so embarrassed I cried,” she recalled.

The seat belt incident reinforced a fact that had haunted Elliott as an adult: diets repeatedly failed. “They would work to a point, but I would gain back the weight I had lost, plus more weight,” she said.

She realized surgery would not be a panacea to the excess weight she had carried since the birth of her first son. Bariatric surgery patients must follow a healthful, regimented diet and exercise plan to keep the weight off.

It is estimated that nearly 93 million Americans are obese, and that number is predicted to climb to 120 million within the next five years.

At 5 foot 6 inches tall, Elliott weighed 301 pounds the day of her surgery in November, 2006, and wore size 26 clothing. Dr. Rita M. Anderson, of BestFit Bariatrics at Kettering Medical Center, performed the bioliopancreatic diversion with duodenal switch, which essentially changes the normal process of digestion by making the stomach smaller and allowing food to bypass part of the small intestine so fewer calories are absorbed.

Elliott is now a size 8 and weighs 150 pounds.

Benefits may outweigh risks

Bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults, according to a recent statement from the American Heart Association.

The AHA found that, when indicated, bariatric surgery leads to significant weight loss and improvements in the health consequences of being overweight, such as diabetes, high cholesterol, liver disease, high blood pressure, sleep apnea, certain types of cancer and cardiovascular dysfunction. The American Society for Metabolic and Bariatric Surgery reports that the risk of living with morbid obesity outweighs the risks of bartiatric surgery, which can improve the life expectancy for patients.

The surgery has indeed been a lifeline for Jon Jacobus, 65, of Deerfield Twp. His obesity had contributed to several medical conditions, including type 1 diabetes and high blood pressure that eventually led to chronic kidney failure. His weight peaked at 313, and on Feb. 15, 2010, Dr. John P. Maguire of Premier Bariatric Associates at Miami Valley Hospital performed a Roux-en-Y gastric bypass, during which the stomach is surgically altered to make food bypass a large part of the small intestine, on Jacobus. At 6 feet tall, he now weighs 207 pounds, qualifying him to be a kidney transplant recipient. A friend from high school has offered to donate a kidney, and the two men are waiting to hear if they are a match.

In the meantime, Jacobus focuses on eating right, exercising and spending time with his wife, Dee, and their children and grandchildren. “I work out three times a week, doing half an hour on the treadmill and then light weight lifting,” he said. He also walks and golfs.

As a surgical resident at Miami Valley Hospital, Kathleen Dominguez, 34, of Englewood, was familiar with bariatric surgery and found her own medical issues due to obesity especially alarming. “As I progressed through medical school (at the University of Northern Colorado in Greeley), I developed health problems, including sleep apnea and high blood pressure.” At 5 foot and one-half inch and 228 pounds, her cholesterol levels also were borderline high.

On March 23, 2010, Dr. Donovan Teel of Premier Bariatric Associates at Miami Valley Hospital performed the gastric sleeve procedure on Dominguez. “I feel 100 percent better, and physically, I can do almost anything,” she said, adding her weight now hovers in the low 120s.

She tries to take the stairs at work, aiming for 15 flights a day, and works out three or four times a week.

For Jennifer Bloom-Long, 41, of Dayton, not being able to bend down and tie her shoelaces was the turning point that led her to bariatric surgery. “I weighed 286.6 pounds, and I was feeling miserable and I had lots of fatigue. I knew I needed to do something different.”

At 5 foot 4 inches tall, Bloom-Long wore size 24 pants and suffered from tachycardia (a faster-than-normal heart rate), high blood cholesterol and triglycerides, and gastroesophageal reflux disease (GERD).

As a nurse practitioner who travels to different nursing homes, Bloom-Long was having difficulty carrying charts and her computer.

Anderson performed gastric bypass surgery on Bloom-Long in July 2010. She has lost 113.6 pounds and now wears size 12 pants.

A lifetime commitment

Both Teel and Anderson stressed the importance of compliance to the lifestyle changes. “The surgery doesn’t work if you don’t do the work,” said Anderson. Eating habits must be modified. For instance, patients need to eat slowly. Nutritional supplements may be mandatory for some patients.

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Types of bariatric surgery

Here are descriptions of the four procedures:

• During gastric banding, a silicone band is placed around the top of the stomach, creating a small pouch that restricts the amount of food that can be eaten. The remaining part of the stomach remains viable, and food passes slowly from the pouch to the lower stomach. Nutrients can be absorbed normally because the small intestine is left intact.The long-term risks with this procedure include the band slipping or becoming eroded, according to Dr. Rita M. Anderson of BestFit Bariatrics at Kettering Medical Center.

• About 75 percent of the stomach is removed during a sleeve gastrectomy. The small stomach that remains is shaped like a vertical sleeve and remains attached to the duodenum at the top of the small intestine. “The sleeve is newer, and it’s very successful,” said Anderson.

• During Roux-en-Y gastric bypass, the upper portion of the stomach is cut off to form a significantly smaller stomach. The small stomach is attached to the small intestine at a lower point, resulting in a decreased ability to absorb nutrients. Anderson added gastric bypass risks include vitamin deficiencies, especially calcium and iron.

• Two-thirds of the stomach is removed during biliopancreatic diversion, and most of the small intestine is bypassed. The remaining stomach is attached to the bottom of the small intestine (the ileum). The amount of digestive enzymes available to break down food is reduced because the small intestine is shortened. Therefore, most nutrients, especially fat and protein, are excreted into the colon. Because the intestine can’t absorb nutrients, the patient will need to be on supplements for the rest of his or her life. “From my perspective, each of the surgeries has its own personality and way it helps patients achieve their goals, and each of them has its set of negative traits,” said Dr. Donovan Teel of Premier Bariatric Associates at Miami Valley Hospital.

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