The Doctor's Guide to Weight Loss Surgery: How to Make the Decision That Could Save Your Life [Paperback]

For those individuals who are morbidly obese defined as weighing more than 100 pounds above their ideal body weight or with a body mass index of 40 or higher (35 or higher with other illnesses such as diabetes or heart disease) weight loss, or bariatric, surgery can be a lifesaver. It is not, however, a miracle cure. It requires a skilled surgeon, support staff, and the patient's lifelong adherence to diet, exercise, and vitamin supplementation. Expert bariatric surgeon Flancbaum (St. Luke's-Roosevelt Hosp., New York, and Columbia Univ.) has written an excellent and reassuring guide for those considering the surgery. He clearly outlines the surgical options, explaining each type along with its risks and possible complications, as well as expected outcomes. He also explains what to expect before, during, and after surgery, discussing selection of a surgeon, insurance coverage, the surgery itself, pain control, diet, and (rarely) reoperation. Resources and recipes are appended. For a nurse's perspective on the same subject, see Michelle Boasten's Weight Loss Surgery: Understanding and Overcoming Morbid Obesity (FBE Service Network, 2001). For all health collections. Anne C. Tomlin, Auburn Memorial Hosp. Lib., NY
Copyright 2002 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

Stedman's Medical Dictionary defines obesity as "an abnormal increase in fat" and simple obesity as "resulting when caloric intake exceeds energy expenditure." Flancbaum, a surgeon with considerable experience in weight loss surgery, refers to obesity throughout as a "chronic disease." Erica Manfred, one of his coauthors, had problems with obesity, was operated on by Flancbaum, and became an advocate for this method of treatment. They and their colleagues describe the various types of surgical procedures and counsel the prospective patient in selecting the most helpful one for her or him. They relay what to expect before and after the operation and what complications are possible. They recommend a healthier diet and more exercise after the surgery, and they advise on selecting a good surgeon and getting one's insurance company to pay for the operation. They conclude by listing sources of further information and providing many food recipes. William Beatty
Copyright © American Library Association. All rights reserved --This text refers to an out of print or unavailable edition of this title.

“Takes the mystery out of weight-loss surgery.
Should be read by all severely overweight people.”
—From the Foreword by Richard L. Atkinson, M.D., President, American Obesity Association

Whether you’re already planning to have weight-loss surgery or are still trying to decide, here is what you need to know about the operation that could save your life

If you are considering weight-loss surgery, you are not alone. Obesity is the most common chronic disease in the U.S. today, affecting one out of every four Americans. In this indispensable resource, Dr. Louis Flancbaum, one of the world’s foremost experts on weight-loss surgery, takes you through the entire process, from presurgical evaluation to postop care. You’ll find everything you need to know to get the most out of the latest groundbreaking procedures available that can radically improve your health--and your quality of life.

You’ll discover:

• Why WLS is the safest treatment for patients with clinically severe or morbid obesity
• How to determine if you’re a candidate for WLS
• What to look for when choosing a surgeon
• How to choose the surgical procedure that’s right for you
• What to expect pre-, peri-, and postsurgery
• Common side effects and what they can mean for you
• Diet and nutritional guidelines after WLS

Plus: what to do if your insurance policy excludes obesity treatment, how to determine when you can resume normal activities and return to work, healthful recipes, patient success stories, support groups . . . and much more

Including detailed charts and tables, helpful resources, and websites, this is the only sourcebook on weight-loss surgery you’ll ever need.

Society is scornful of morbidly obese people. They're considered almost sub-human in today's culture. When I see what my patients go through, I feel a strong sense of empathy for them. It gives me tremendous satisfaction to witness the positive transformation that this surgery can make in the lives of patients.

The majority of individuals seeking surgical relief have suffered from obesity for most of their lives. A minority became obese as adults, after childbirth, as a result of an injury that severely limited their physical ability, or in conjunction with an emotionally traumatic event. Virtually all candidates for surgery believe that they have exhausted all available resources before considering surgery. The toll morbid obesity takes on its sufferers is incalculable. In addition to the inevitable health problems that come with severe obesity, those who finally turn to surgery often have heartrending stories of rejection, humiliation and misery. It is a testament to the human spirit that they chose to survive and eventually to thrive after WLS. Unfortunately, obese people are subjected to a unique form of prejudice because our society assumes that we could lose weight if only we tried hard enough.

I wrote this book to help people who are desperate and feel they have nowhere to turn. I want them to know that there is a solution to their problem, there is a way out of the prison of morbid obesity.

-----Louis Flancbaum, M.D. --This text refers to an out of print or unavailable edition of this title.

This is a particularly good time for a book aimed at those who may be considering weight loss surgery. We now understand that obesity is a chronic disease caused by many different factors. Scientists have discovered numerous genes that contribute to weight gain, and at last count, over 200 genes and gene markers have been identified. There clearly are biochemical differences in the bodies of people with obesity compared to non-obese people.

If an obese person loses weight by standard medical therapy, his or her biochemistry does not return to that of a non-obese person. In fact, biochemical changes occur that tend to favor weight gain and fat gain. Although the genetic contribution to obesity is clearly important, it probably causes only about 40 percent of the obesity in the total population. The other 60 percent may be attributed to environmental causes. The presence of an abundance of inexpensive, good tasting, high calorie, high fat, rapidly available food allows the genetic traits present in most of us to come through as an increase in body weight. More ominous, recent research demonstrates that certain viruses produce obesity in animals and there are links for at least some of these viruses to human obesity.

It is not surprising that the prevalence of obesity in the United States and across the world is exploding. In the last 20 years, the percentage of adult Americans with medically significant obesity has increased by 75 percent and more than 55 percent of Americans are overweight. The World Health Organization has declared that there is a "global epidemic" of obesity. The number of people who meet the criteria for weight loss surgery is now almost 5 percent of the population. Nevertheless, there is still great fear and misunderstanding about weight loss surgery. Many patients in my practice refuse even to discuss the option. Many physicians will not consider sending their patients for this surgery. These attitudes are based in the belief that none of the treatments for obesity are effective and that any treatment for obesity other than diet and exercise may be dangerous.

The reality is that there has been a great deal of research on treatment for obesity, and we now understand that weight loss surgery is the single most effective treatment for individuals who have the severest form of the disease of obesity. Long term studies on patients who have undergone weight loss surgery show that extensive weight loss may be attained by the majority of patients. Complications of obesity, such as diabetes, high blood pressure, sleep apnea, arthritis, and gastro-esophageal reflux disease (heartburn) improve markedly or disappear. One study even shows that weight loss surgery decreases the higher death rate associated with obesity.

The Doctor's Guide to Weight Loss Surgery; How to Make The Decision That Could Save Your Life, explains how the severity of obesity is graded and who is a candidate for weight loss surgery. In practical terms, it describes the types of operations used for obesity and the advantages and disadvantages of each. Each operation has a balance of benefits and risks that should be understood by anyone considering weight loss surgery. Patients need long-term follow-up after surgery because some of the complications may not show up immediately.

The book takes the prospective patient through the whole process of weight loss surgery, from the pre-surgical evaluation, to what will occur in the hospital at each step along the way, how long the hospitalization will be, how long before normal activities may be resumed, and what to watch out for in the months and years after surgery. Eating after surgery may need to be different than before, so guidelines are given. Finally, practical advice is given on choosing a surgeon and a follow-up program, as well as steps that can be taken to improve the chances that the insurance company or third party payer will pay for the surgery.

In summary this book takes the mystery out of weight loss surgery and allows patients to make an informed decision about this important step in the treatment of their disease. It is a much-needed guide to the most effective treatment for extreme obesity, and should be read by all severely overweight people who are considering surgery as a treatment option.

Richard L. Atkinson, M.D. President American Obesity Association --This text refers to an out of print or unavailable edition of this title.

“Takes the mystery out of weight-loss surgery.
Should be read by all severely overweight people.”
—From the Foreword by Richard L. Atkinson, M.D., President, American Obesity Association

Louis J. Flancbaum, MD, Chief, Division of Bariatric Surgery at St. Luke's-Roosevelt Hospital Center in New York City, and Associate Professor of Clinical Surgery at the College of Physicians and Surgeons of Columbia University, is a nationally-recognized authority on the surgical treatment of obesity. Dr. Flancbaum has performed nearly 1,000 bariatric surgical procedures. He has operated successfully on patients ranging in age from 15 to 70, weighing as much as 770 pounds. He has made many international presentations and published more than 100 articles in medical journals, and is board certified in General Surgery, Surgical Critical Care and Nutrition Support. His study, with Dr. Patricia Choban, of patient satisfaction after weight loss surgery, received national attention.

Erica Manfred is a freelance writer and medical journalist whose articles on a variety of medical and psychological topics have appeared in "Cosmopolitan," "Ladies Home Journal," "Parenting," "Bottom Line/Personal" and other publications and websites. She had gastric bypass surgery in January of 1998, which substantially improved both her health and quality of life.

Deborah Biskin is an educator and freelance writer who contributes to "Lifestyles," "Modern Bride," and "Olam magazines. She edited Dr. Flancbaum's first book, "And You Shall Live by Them; Contemporary Approaches to Jewish Medical Ethics," and profiled him for "Lifestyles" magazine. --This text refers to an out of print or unavailable edition of this title.

CHAPTER ONE

1

OBESITY: AMERICA'S DISEASE

"I've been fat since I was a baby. My entire family is fat. Who knows if it's our genes or our eating habits or a combination of both. I just know that being fat is a horrible way to have to live."

Sara P., 43, 360 lbs. pre-op; 200 lbs. 2 years post-op

"When I walk around at the mall with my kids, I have to admit that I look at people who are obese. It reminds me of how I looked and felt before the operation. It's amazing how many people there are out there suffering from this when there is something that can be done about it."

Tim W., 50, 400 lbs. pre-op; 230 lbs. 18 months post-op

Disease (noun)-a specific illness or disorder characterized by a recognizable set of signs and symptoms, attributable to heredity, infection, diet, or environment. (Mosby's Medical, Nursing, and Allied Health Dictionary, Fifth Edition)

Contrary to popular opinion, obesity is not a personality disorder

resulting from a lack of individual willpower or self-control. Rather, it is a chronic disease characterized by the accumulation of excess body fat, which can be detrimental to health. Obesity is distinguished from overweight, which does not take body composition into consideration. Many athletes are overweight, but because their excess weight is predominantly comprised of muscle, not fat tissue, they are not obese.

SOME FACTS ABOUT OBESITY

The worldwide incidence of obesity is increasing. In 1998, the World Health Organization published Obesity: Preventing and Managing the Global Epidemic, which classified obesity as a growing epidemic. In the United States, obesity is the most common chronic disease, affecting one-third of all Americans, including children, and its prevalence has been steadily increasing for the past twenty years. In Europe, Australia, New Zealand, the Middle East, and the remaining portions of the Americas, the occurrence of obesity appears to be increasing and is now between 10 and 20 percent. The prevalence of obesity is still fairly low in China, Japan, and many countries in Africa.

During the 1970s, the National Center for Health Statistics found that approximately 45 percent of all adult Americans were overweight and 14 percent were obese. These figures stayed relatively constant for over a decade. Armed with this information at the beginning of the 1990s, the Department of Health and Human Resources published Healthy People 2000, a policy statement outlining our national public-health priorities and goals as we entered the new millennium. The initiatives recommended included: reducing the incidence of overweight and obesity by 20 percent; improving the diagnosis and treatment of several obesity-related conditions, such as diabetes, coronary artery disease (hardening of the arteries), hypertension (high blood pressure), and hyperlipidemia (elevated serum cholesterol and blood lipids); and increasing the amount of regular aerobic exercise engaged in by adults and children.

When the National Center for Health Statistics repeated its survey in the mid-1990s, it found that the prevalence of overweight had increased from 47 percent to 54 percent (57 million people), with the prevalence of obesity increasing from 15 to 22 percent (40 million people). Moreover, the prevalence of severe obesity rose from 4.5 percent to 8 percent of the population (Table 1-1). In 1995, the Institute of Medicine, in its publication Weighing the Options, referred to obesity as an epidemic. It is currently estimated that there are approximately 127 million overweight or obese adults in the United States. Of these, 30 million are obese with a Body Mass Index of 30 to 34, 23 million are severely obese, with a Body Mass Index of 35 to 39, and 10 million suffer from morbid or clinically severe obesity, with a Body Mass Index above 40. (We will discuss the Body Mass Index, or BMI, in Chapter 2.)

Among American youth, the prevalence of obesity has sky-rocketed during the past two decades, from just under 4 percent in children (six to eleven years) and 6 percent in teenagers (twelve

to nineteen years) to 15 percent in children and 15 percent in

adolescents. The prevalence of overweight is also extremely high among youth, being 40 percent in Native Americans, 30 percent in African Americans and Hispanics, 25 percent in whites, and 20 percent in Asian-Americans. As with adults, obesity in youth is associated with a number of medical problems, including type II diabetes, hypertension, asthma, sleep apnea, orthopedic problems, psychological problems, and negative social stigmata.

The exact cause of obesity remains unknown, but multiple factors, genetic and environmental, appear to contribute. Afflicting individuals of all ages, genders, races, and ethnic groups, obesity is associated with numerous medical problems and can have a relatively benign or malignant course. Obesity increases steadily with age in both men and women, and it is more common in women than men. It affects African-American and Mexican-American women more than Caucasians or Asian-Americans. A strong genetic linkage exists among the Pima Indians, who live in the Southwestern United States.

Children born to obese parents are more likely to become obese than children born to thin parents. Studies of adopted children have shown that their tendency toward obesity is more related to the weight of their birth parents than their adoptive parents. Furthermore, in studies of twins who were raised separately, the ultimate weight of each sibling tended to be more similar to each other than to that of their nonbiological, adopted family members. Nevertheless, it is likely that these genetic factors merely predispose individuals to obesity but do not guarantee its development. The disease becomes manifest only in the presence of the proper environmental triggers, which are related to several factors, including culture, diet, and physical activity.

Over the past few centuries, Western industrialized societies have placed a progressively greater value on thinness. Television and magazine advertisements equate beauty with thinness. By contrast, the robust bodies of the women glorified in masterpieces throughout the Middle Ages and Renaissance would be considered obese by our standards. On the other hand, in poorer, underdeveloped cultures, where famine is common, obesity is perceived as a sign of wealth and is therefore associated with greater sexual attractiveness.

Diet and exercise also affect the onset and development of obesity. High-fat diets, which are prevalent in wealthier, Western cultures, increase the prevalence of obesity. Modernization of society and the development of ever more advanced technology have led to a progressive decrease in physical activity. Inventions such as the automobile, elevator, escalator, remote control, and wireless communication all decrease the amount of physical activity we perform daily. Similarly, children reared on television, video games, and computers are more likely to become obese than those who exercise regularly.

Table 1-1: Increase in the Prevalence of Overweight and Obesity

in the United States

Weight                          Number

Category*       1976-1980       1988-1994       1999-2000       Americans

Overweight      32 percent      32 percent      34 percent      64 million

Obese   10 percent      14 percent      16 percent      30 million

Severely Obese  3 percent       5 percent       9 percent       23 million

Morbid Obesity  2 percent       3 percent       5 percent       10 million

Total Population        47 percent      54 percent      64 percent         127 million

* Classification based upon World Health Organization

American Obesity Association: www.aoa.org/subs/fastfacts/obesity_US.shtml

THE HIGH COST OF OBESITY

The economic cost of obesity is enormous. An estimated $70 billion is spent annually in the United States on the treatment of obesity and its related conditions. This sum represents about 8 percent of the total health-care budget, or one out of every twelve dollars spent on health care. In addition, another $33 billion is expended on commercial weight loss programs each year, despite the fact that there is no available evidence suggesting that they are effective in producing long-term weight loss. Annually, the cost of obesity treatment exceeds $100 billion. At any given time, an estimated 40 percent of women and 25 percent of men are trying to lose weight, with an additional 30 percent involved in weight maintenance.

The significance of obesity as a public-health problem is related to its association with a number of complicating (or co-morbid) medical conditions. Obesity alone is a risk factor for premature death, with risk increasing in direct proportion to weight. Furthermore, obesity is causally related to diabetes, hypertension, coronary artery disease, stroke, sleep apnea, venous disease, gallstones, gastroesophageal reflux (heartburn), osteoarthritis, urinary stress incontinence, menstrual irregularity, infertility, depression, and several types of cancer. Many of these health problems improve or completely resolve with weight loss. Iron...