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

MEMBER QUESTION:
Given that your nutritional intake is reduced with gastric bypass, would this affect breast milk and its value to the baby?

SCHAUER:
Although it is true that the quantity of food intake after gastric bypass is reduced, it still is very adequate to maintain a normal, healthy weight.

Most patients after gastric bypass will consume 1300 to 1500 calories a day and can certainly intake enough protein and nutrients to stay healthy, including breast-feeding. I've had several patients in my practice who have breast-fed relatively normally after gastric bypass surgery.

MODERATOR:
What time frame are we talking about from surgery to seeing a real effect on type 2 diabetes?

SCHAUER:
Almost immediate. In a study that we published in 2003 at the University of Pittsburgh, one-third of our patients had normal blood sugar when they left the hospital. So even before there is dramatic weight loss, gastric bypass operation can have dramatic effect. It's quite amazing.

"Weight loss of 20 or even 30 pounds per month is not rare."

And for the other two-thirds the improvement happens over the ensuing months, such that by within a year after the operation for the gastric bypass, 83% of patients have resolution of their diabetes.

And for the lap band, it's similarly effective. Approximately 65% of patients have resolution of their diabetes within a year after the lap band procedure.

MEMBER QUESTION:
How much does a pouch stretch over time?

SCHAUER:
If the pouch is made relatively small initially, there should be minimal stretching. Most surgeons will make a pouch that's quite small, approximately 15 milliliters, or the size of a walnut. So it has minimal capacity to stretch.

There can be weight gain, though, after any bariatric operation. And over time, if you follow patients 10, 15, 20 years, some will gain back some weight. On average it's usually about 10% or less.

So in other words, if a patient has 100 pounds of excess weight and loses 75 pounds in the first two years, over the next ten years they may gain back ten or 15 pounds. That's a typical scenario.

MODERATOR:
Does the age of the patient when they have the initially surgery effect the percentage they're likely to lose and how much they are likely to regain?

SCHAUER:
There does not appear to be an association between the patient's age and how much weight they lose or the potential for regaining of weight.

I'll add that many elderly patients can qualify for bariatric surgery. Our experience includes patients in their 60s and even in their 70s may qualify for surgery if they are in relatively good health to withstand a major operation.

MEMBER QUESTION:
How can we know when we have lost all that we're going to lose?

SCHAUER:
Within the first few months after gastric bypass there's rapid weight loss. Weight loss on the order of 20 or even 30 pounds per month is not rare. As time goes on, certainly beyond one year after surgery, the weight loss definitely slows down.

Most patients will reach their new baseline weight somewhere between one-and-a-half to two years after surgery. This can also be affected by the activity level of the patient. Most bariatric surgeons strongly advocate patients be involved in an exercise program; regular exercise can dramatically add to the weight loss achieved by the gastric bypass.

Your weight loss will likely decrease over the next several months. But you can certainly impact your weight loss by actively being involved in a regular exercise program as well as being very judicious on what and how you eat.

MEMBER QUESTION:
How does a doctor decide which procedure is the right one for you?

SCHAUER:
The choice of the operation will differ among bariatric surgeons. Both operations, I believe, are effective and relatively safe, but there are differences that may be more or less appealing to individuals. In our program at The Cleveland Clinic, we try to educate our patients and involve them in that decision.

MODERATOR:
What are the risks involved in these surgeries?

SCHAUER:
It is true these operations can have dramatic benefits to patients by decreasing weight, improving their quality of life, and in some cases even improving their life span. However, even though we can usually do these operations with laparoscopic surgery, they are still major operations, so complications can occur. In the hands of an experienced surgeon and an experienced medical center, these complications can usually be kept at a very low rate.

But one must expect that complications are possible when having this surgery, just like any patient who is contemplating heart surgery or other major intestinal surgery or even gallbladder surgery. It's important for the patients to understand that there certainly is a risk, but there's also a significant risk of severe obesity.