Bariatric Surgery -- Is It Right for You? (cont.)

So, the mal-absorption operations allow patients to consume large quantities of calories, but there is a very dramatic decrease in absorption. Most bariatric surgeons do not recommend these operations as a first-line therapy.

I was going to ask why someone would choose that particular therapy given the problems.

"This kind of weight loss is for people who have severe obesity."

Well, it's all a matter of risk-benefits. The mal-absorption operations are much more -- I'd say drastic. They are even more effective than gastric bypass and lap band in terms of weight loss.

In fact, these patients tend to lose 80% of their excess weight or more. So in some very, very large patients, perhaps in the four- or five-hundred-pound category, these operations will enable them to get closer to their ideal body weight. But there's a price to pay for that.

So there may be a role for these operations for some patients, but probably for the majority who are seeking bariatric surgery the gastric bypass or lap band would be the best options.

Who is a good candidate for weight loss surgery?

First and foremost this kind of weight loss is for people who have severe obesity, which is usually defined as more than 100 pounds of excess body weight.

Usually that amount of weight is almost always associated with many other medical conditions, such as diabetes, high blood pressure, sleep apnea, elevated cholesterol, and joint problems with knees, hips, and back. So these operations are for people who have 100 pounds or more of excess weight and medical conditions related to that heavy weight; they're not for patients who want to lose 30 pounds, or people who want to get into a bikini for their vacation.

Do most insurance plans cover this type of surgery?

This is probably our biggest challenge in the field right now. After several years of very good results from medical studies, there is a tremendous demand for bariatric surgery in this country, and we all know that obesity is increasing at an alarming rate.

Unfortunately, some insurance companies have actually withdrawn coverage for bariatric surgery. For example, in the state of Florida there is no insurance coverage for bariatric surgery anymore.

There are many other states where insurance companies are threatening to pull out. Why this is happening is not quite clear. Certainly the operation does cost money and has increased costs for insurance companies in the short term.

However, there's also a payback: the improvement in health often reduces the medical bills for many of these patients so that the operation actually pays for itself after three to five years. Nevertheless, it is a fact insurance companies are pulling out of coverage, making it very difficult for patients to seek the surgery.

Will this kind of procedure help with my type 2 diabetes and with getting pregnant?

Patients with severe obesity often have or will develop type 2 diabetes. Diabetes is one of the most common medical conditions attributed to severe obesity. Bariatric surgery very recently has been shown to be extremely effective at not only improving but in the majority of cases completely curing type 2 diabetes.

When I was at the University of Pittsburgh we published a very large series in 2003 showing that 83% of our patients who had gastric bypass surgery had complete resolution of their diabetes.

There was no other more effective long-term therapy for diabetes than bariatric surgery in patients with obesity. So I'm a strong advocate for bariatric surgery in diabetic patients.

The second part of the question had to do with pregnancy. Both the gastric bypass and lap band operations can certainly be performed in young women who want to get pregnant at some time in their life. With the gastric bypass we strongly encourage that for the year following the operation, they take measures not to become pregnant.

This is primarily because of the very rapid weight loss that occurs in those first few months after surgery. If a woman were to get pregnant during that time, it would make managing the pregnancy quite challenging, for obvious reasons.

But beyond that one year, when the patient's weight has stabilized, becoming pregnant is not a problem. In fact, I've had scores of women who I've operated on, five, eight years ago, who have had children after they had gastric bypass surgery. And both they and the babies have done quite well.

One advantage of the lap band procedure is that it is adjustable, so if a woman were to get pregnant even within a few months after surgery, all the fluid from the band could be removed. She would eat, you know, totally normally as she had before the surgery. And after delivering the baby, the band can be tightened up again. That's one big advantage of the adjustability of the lap band.

My advice is be evaluated for bariatric surgery. Diabetes would probably resolve and there's no reason why you could not become pregnant sometime after the operation.

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