Feature Archive

Bariatric Surgery

A Radical Obesity Fix

WebMD Feature

Dec. 18, 2000 -- Two years ago, Rhonda Bailey was fat and miserable. The 38-year-old bore 245 pounds on her 5-foot-1 frame. Squeezing into a restaurant booth, airplane seat, or amusement park ride was unimaginable. Walking made her joints stiff and sore. She leaned heavily on a cane to get from the handicapped parking space to her desk at work.

Today, Bailey is literally half the woman she used to be. Over the past 18 months, she has shed 50% of her body weight. Her waist shrunk from a size 26 to a size six. Now, at 125 pounds, the Southern California resident jogs daily, bicycles with her stepdaughter, and rejoices in her ability to do life's little things -- like tying her shoes -- without asking her husband for help.

Bailey's secret isn't the latest fad diet or radical weight loss drug. She owes her slimmed-down body to gastric-bypass surgery. The procedure is just one of several weight loss operations that fall under the heading of bariatric surgery.

As obesity rates creep skyward, so do the number of Americans turning to surgery as a weight loss tool. Although today's bariatric surgery is safer and more effective than earlier versions, the procedure is not an instant cure. Reserved only for the severely obese (those who tip the scales at 100 pounds or more over their normal body weight), bariatric surgery is a drastic step with a high rate of complications. Patients must make radical, lifelong dietary changes, and permanent weight loss is not guaranteed. Still, a growing number of doctors are recommending bariatric surgery for severely obese patients who find themselves at wits' end about weight loss.

The increasing demand for bariatric surgery reflects the country's obesity epidemic. In the United States, 55% of adults are overweight. Four million Americans are severely obese. Of that group, 80% are women of childbearing age.

The average bariatric surgery patient is a woman in her late 30s who weighs approximately 300 pounds, says Robert Brolin, MD, president of the American Society for Bariatric Surgery. Brolin estimates the number of bariatric surgeries performed this year will reach 40,000 -- double that of five years ago. He attributes the procedure's popularity to the rise in obesity rates and the willingness of insurance companies to cover the operation's $25,000 and up price tag.

How It Works

During bariatric surgery, the stomach is closed off, leaving only a small pouch about the size of a thumb for food. As a result, patients feel full on fewer calories. However, the most common procedure -- gastric-bypass surgery -- goes one step further. Surgeons not only shrink the stomach but also reroute the small intestine to thwart the digestive process, thereby decreasing the number of calories absorbed.

This is achieved by making a direct connection between the stomach and a lower section of the small intestine. The first segment, the duodenum, is skipped entirely. The duodenum's chief responsibility is igniting the digestive process and absorbing iron and calcium from food. So in the end, patients eat less and absorb fewer calories. Sound too good to be true? Consider the price.

Serious Side Effects

As with any major operation, bariatric surgery is far from foolproof. The death rate nears 1%, meaning up to 400 people may die from the procedure this year alone. As many as 20% of patients need additional surgery to mend complications, such as abdominal hernias. Due to malabsorption in the shortened digestive tract, roughly 30% of patients develop nutritional deficiencies, such as anemia and osteoporosis, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Then there are the lifestyle changes. People who once ate freely and copiously must become hyperattentive to their diets. The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. Eating too much or indulging in rich, sugary, or fried foods can overload the sensitive pouch and cause dumping -- a term used to describe the sweats, chills, and nausea that result from food filling the pouch and overflowing straight into the small intestine.

Bailey knows the dangers of the surgery firsthand. Two days after her bariatric procedure, she was rushed back to the operating room with life-threatening complications. What began as relatively routine surgery with a three-day hospital stay suddenly became a fight for her life and, ultimately, an agonizing three-month stint in the intensive care unit. But Bailey doesn't have any regrets. "I would do it again in a heartbeat. Life is wonderful today. I feel like Cinderella," she tells WebMD.

It's the small things that mean the most to her now, like relaxing into a movie seat, scooting past people in a crowded room with grace, and enjoying flirtatious looks from men. "For the first time in my life, men take a second look at me," Bailey says. "At first I thought my husband might be jealous, but instead he just beams. I've turned into a beautiful woman."

Slimming Results

Bailey's success story is a common one. In 75% of cases, bariatric surgery succeeds where other methods fail. Dramatic weight loss begins immediately after the procedure and levels off in 18 to 24 months. The average patient loses between 50% and 75% of his/her excess weight and keeps it off -- a feat no diet or drug has yet to match.

It's clear that nonoperative treatment doesn't work for the severely obese, Brolin says. "In this group, the failure rate of dieting approaches 100%."

Other weight-loss experts concur. Compare bariatric surgery to dieting and it's no contest, says John Foreyt, a psychologist at Baylor College of Medicine in Houston, who works extensively with bariatric surgery patients. The average dieter loses 10% of his body weight. For someone who is severely obese, that can be a mere 30 or 35 pounds, says Foreyt.

Using behavior modification, such as diet and exercise, the most weight a person can hope to shed is one to two pounds per week, says Randall Flanery, a psychologist at the St. Louis Behavioral Medicine Institute in St. Louis. At that rate, a person who needs to drop 150 to 200 pounds may die of an obesity-related illness before getting the weight off, he says.

Surgery Isn't a Cure

Still, Flanery and Foreyt agree that every other weight loss option should be exhausted before considering something as drastic as surgery. "Bariatric surgery is not a first, second, or even third alternative," Flanery says. "Surgery is not a magic bullet for obesity."

"The biggest misconception about bariatric surgery is that it's going to solve the problem," Foreyt says. "It's part of the answer, but it's not the whole answer. It's critical that people eat well and exercise after surgery."

Indeed, up to 25% of bariatric surgeries fail. These patients either never reach their target weight or regain pounds by slowly and deliberately ingesting high-calorie foods and, over time, stretching the pouch far beyond its original size. "There's a patient out there who can beat any operation designed," Brolin says.

Obesity's Health Risks

For Bailey, the risk of failure seemed minuscule compared to the status quo. Years of unsuccessful yo-yo dieting and weight loss gimmicks had left her depressed and bigger than ever. It wasn't until she saw her mother suffer a stroke that Bailey began considering surgery. Looking at her mother was like peering into a mirror and seeing her future stare back. Both women share a love of food and a lifelong struggle with the scale. According to research, Bailey's fears about the future were not unfounded.

Obesity opens the door for a procession of serious health problems including hypertension, diabetes, sleep apnea, arthritis, narrowing of the arteries, and an increased risk of death from some cancers. Each year, obesity and inactivity combined lead to 300,000 premature deaths, according to the CDC.

In its clinical guidelines for obesity treatment, the National Institutes of Health supports the use of bariatric surgery in the severely obese, citing studies that show the procedure often alleviates or eliminates many obesity-related conditions.

In the 18 months since her surgery, Bailey tossed aside her cane and disabled parking placard, traded in her sensible shoes for high heels, and stopped swallowing megadoses of ibuprofen to sooth her aching joints. But her rewards weren't just physical.

A slim physique gave Bailey the confidence she needed to apply for a promotion at work. She'd eyed the job for years but was afraid to go for it because of her size. "I would never put myself forward because of the stigma that fat people are lazy, that they have no control," she says. "That's simply not true." She attributes her new attitude to self-pride, something she never had before.

"I wish I could go up to every single person who's trapped in an obese body and say, 'There's help out there. Just reach out and grab that brass ring. You don't have to live like that anymore.'"

Catherine Guthrie is a freelance writer based in San Francisco. Her work has appeared in Health magazine.

 

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Last Editorial Review: 1/30/2005 11:30:54 PM



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