Weight-loss surgery helps Toledo fight obesityWritten by Staff Reports | | firstname.lastname@example.org
By Sura Khuder, Toledo Free Press Staff Writer
For three months, Erin Silveous had what seemed like a chronically runny nose. Along with extreme vertigo, dizziness and persistent migraine headaches, the 41-year-old dialysis technician found herself seeking medical advice from countless specialists until a correct diagnosis could be made.
Her condition, doctors later discovered, was called pseudotumor cerebri and what was running out of her nose wasn’t from a sinus infection or a cold, it was cerebral (brain) fluid.
What the Swanton resident first thought would be cured with a head or neck surgery, was in her case treated through bariatric surgery. Silveous had never before considered the weight-loss surgery, but at that point it was her last option. If she didn’t have the surgery, her physician warned her, she would die.
Referrals for bariatric surgery as a viable treatment for obesity and its comorbidities are so common that Dr. Patrick White, Toledo bariatric surgeon and medical director at ProMedica who performed Silveous’ surgery, said half of his patients are from physician referrals.
More than one third of the U.S. population is obese according to the Centers of Disease Control and Prevention. With the recent recognition of obesity as a disease by the American Medical Association (AMA), more patients and physicians are seeking bariatric surgery as a viable treatment for obesity and its related problems, particularly Type 2 diabetes.
“Obesity is a growing epidemic in the United States and there is nothing out there as effective as weight loss surgery. There’s no other treatment even for diabetes out there that works any better than weight-loss surgery,” said Dr. Matthew Fourman, bariatric surgeon at Mercy Weight Management Center.
“It’s not simply that people need to eat less and exercise more. This is truly a disease; there are things going on at a genetic level that we don’t totally understand yet,” he said.
White said the number of gastric bypass surgeries being performed has increased by 300 percent in the past 10 years nationwide.
Dr. Jaime Ponce, current president of the American Society for Metabolic & Bariatric Surgery, said insurance companies have always resisted covering bariatric surgery for patients with severe obesity. He sees the AMA’s recent statement as allowing physicians greater ability to work with insurance agencies to cover the surgery more widely.
The three main surgeries performed nationwide are Roux-en-Y gastric bypass, laproscopic adjustable gastric banding (LAP-BAND), or sleeve gastrectomy.
The gastric bypass is considered a malabsorptive procedure where there is some rerouting of the small intestine to limit the amount of calories absorbed. LAP-BAND and “the sleeve” are considered restrictive surgeries where the size of the stomach is reduced to hold as little as 15 milliliters, or the size of a small shot glass.
Fourman said LAP-BAND surgeries are less popular and sleeve is becoming more popular.
“[It’s] gaining popularity probably because it works really well,” he said. “The weight loss is better than the LAP-BAND and it’s not quite as much surgery as the gastric bypass.”
Eighty percent of the surgeries White performs are gastric bypass and 20 percent are sleeve gastrectomy.
The sleeve procedure is recommended for the youngest and oldest patients, while the bypass is best suited for those with Type 2 diabetes or individuals needing to lose a lot of weight, i.e., a body mass index over 50.
The sleeve can be reversed into a gastric bypass if a patient’s weight-loss is inadequate. However, there are few fallback procedures for patients looking to reverse a procedure that is not satisfactory and a second surgery comes at a greater risk.
“We don’t have very many fallbacks from surgical options,” White said. “There is half a dozen different things described that one can maybe try but not all of them work that well.”
Mortality rates for the surgery are low. LAP-BAND surgery has a mortality rate of 0.06 percent, or three in 5,000 surgeries, and gastric bypass has a rate of at 0.16 percent or four in 2,500.
On the other hand, psychological costs for patients may be high, White said. For example, bariatric surgery patients could face issues such as suicide and addiction, particularly alcoholism, because of the high emotional toll the surgery takes and change in intestinal absorption.
Divorce rates are particularly high for patients, especially for women, White said.
Most insurance companies cover the cost of the surgery only if a patient has a BMI higher than 40, or 35 with comorbidity; this includes Type 2 diabetes, arthritis and sleep apnea, among others.
If a patient does not meet these criteria he may still opt for the surgery, however, he would have to complete a payment plan.
According to Amy Watkins, Mercy Weight Management Center’s director, this ranges between $13,000-$15,000 for private packages.
To qualify for most insurance coverage, patients must prove a long history of weight-loss attempts as well as complete a three-to six-month physician supervised medical weight-loss program she said.
Two months after her diagnosis, Silveous went into surgery in October 2009 weighing 340 lbs. Since her surgery she has lost 198 pounds.
Prior to surgery, Silveous suffered from Type II diabetes, cardiovascular and neurovascular issues, as well as sleep apnea and restless leg syndrome, all of which she no longer has.
Silveous credits her success to following the post-operation regimen very closely. “When I was out of my surgery I was to the letter,” she said. “I knew I had just come very close to dying. And I wanted to use the new tools that they gave me and learn how to moderate, to learn how to eat better and have self-control, all the things I really felt like I did not have before.”
Twice a month, ProMedica offers bariatric seminars for prospective bariatric surgery patients.
That is where Ann Loften Rice found herself four years ago. She is now six years post surgery, going from 460 pounds to 280 pounds within eight months.
Rice was driven to pursue the surgery after trying and failing at several diets. She is the regional director for aquatics at the YMCA of Greater Cincinnati, having worked at locations in Toledo for several years.
“A lot of people think of the Y as a gym or as a swim place, so it’s important to look like you work for the Y,” Rice said. “If I were to get heavier than I was, I don’t think I’d be able to do the things as well as I could and train as well.”
Post-surgery, Silveous and Rice saw major changes in their diets, particularly in the portions they were able to eat.
For these women, foods high in sugar and carbonation aren’t tolerated; neither are rice and tortillas that glutenize in the stomach and are hard to digest.
“You definitely learn when you are full and you can’t ignore that like you can if you hadn’t had the surgery because that ‘one more bite’ is pain or sickness,” Silveous said.
Both women credit their success to following the regimen precisely and having the right intentions heading into the surgery.
Rice said only pursue those completely committed to the diet and lifestyle changes that follow should pursue the surgery.
“If you are doing it just to lose weight or just to find a boyfriend or girlfriend, don’t do it. Because you are going to fail, you are going to be miserable, you’re going to be sick,” she said. “If you are doing it to be healthy and to change your life, those are the reasons why you should.”