Americans are becoming obese at an alarming rate and their associated health costs are rising along with it. In 2008, there was as much as $147 billion in obesity related medical costs.47 Morbid obesity increases risks for serious conditions like Type 2 diabetes, cardiovascular problems and sleep apnea.
Bariatric surgery can help many obese patients restrict calorie intake, lose weight and improve or resolve their serious and expensive related diseases (co-morbidities). And 83% of weight loss surgeries performed are taking advantage of minimally invasive techniques that reduce cost and improve the overall medical experience for the patient.52
Bariatric surgeries, which include gastric bypass, adjustable gastric banding, sleeve gastrectomy and billiary pancreatic diversion can be performed with less invasive laparoscopic technology. Patients receiving a bariatric laparoscopic procedure instead of an "open" one, may benefit from:
How does somebody become a candidate for bariatric surgery? The National Institutes of Health has set the following guidelines:
Bariatric surgery candidates also need to demonstrate that they have attempted diet and exercise for long-term weight loss to no avail. They must be committed to making lifestyle changes after surgery, which include routine medical visits, testing and changes to nutritional habits. Also, because of the dramatic lifestyle changes that the patient will have to undergo before and after surgery as well as the physical change that surgery may bring, patients should be evaluated by a psychiatrist or psychologist before being referred for surgery. It's important that the patient understand all the aspects of the procedure in order to make an informed decision.
Because of the unique technical demands of the surgery, patients should be referred only to surgeons who perform a high volume of these procedures annually. The surgeon should have substantial experience with both minimally invasive weight loss surgery and open bariatric procedures, in case conversion is required.
Many surgeons and facilities have sought to distinguish themselves by seeking certification as a Center of Excellence (COE) designation in bariatric surgery. These medical teams represent the highest caliber of care. Several organizations have established bariatric surgery COE certification programs, including the American Society for Metabolic and Bariatric Surgery, the American College of Surgeons, the Blue Cross Blue Shield Association, and commercial health plans like Aetna, CIGNA, Humana and United HealthCare.
For this procedure, a band is placed around the uppermost part of the stomach, dividing it into two parts—a small upper pouch and a lower stomach. The small upper pouch can only now hold about ½ cup of food, so the patient will eat less, feel full sooner and stay satisfied for longer. Ideally, a patient will lose weight at a gradual rate of 1 to 2 pounds per week.
In the United States, the Roux-en-Y Gastric Bypass is one of the most frequently performed procedures for morbid obesity.21 It restricts food intake, utilizing restrictive and malabsorptive surgery techniques, which prevents the body from absorbing calories and nutrients. Aside from creating a smaller stomach pouch, the overall digestive process of the body is changed so that food will bypass the large part of the stomach and most of the small intestine. Studies show that an average of 61.6% of excess weight is lost after the surgery, with noted improvement in obstructive sleep apnea, Type 2 diabetes, high blood pressure, and depression.22
This restrictive surgical weight loss procedure limits the amount of food patients can eat and makes them feel full quicker. During the procedure, a thin, vertical, banana-sized sleeve of stomach is created and the rest of the stomach is removed. Patients with this procedure may experience significant health improvements and one study showed excess weight loss at an average of 55% of their original weight.40
All three of these bariatric procedures can be performed laparoscopically using minimally invasive techniques. Laparoscopic surgery is performed using small incisions, which usually results in shorter hospital stays, faster recovery, smaller scars, and less pain than open surgical procedures.
