September 2004
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Obesity surgery: When nothing else works
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For Adasha Knight, the decision to have surgery for obesity was not a choice, but a last resort.
A working mother, Knight developed new health problems after the births of her three children: low thyroid, fibromyalgia (painful muscles, joints, and bones), diabetes, and eventually, high blood pressure.
"It hurt to move, and I was becoming sedentary," says Knight. "I had been on various diets that were monitored by my physician, but nothing was helping me lose weight."
At 247 pounds, frustrated and losing hope, she began to research bariatric surgery. When she consulted her doctor about the surgery, he agreed that it was the best option.
"It was to the point where I would have to start insulin and high blood pressure medication, or have the surgery and try to eliminate the problems altogether," says Knight.
A growing epidemic
Adasha Knight is not alone. Obesity is a growing epidemic in the United
States that contributes to life-threatening and disabling disorders including
diabetes, high blood pressure, abnormally high levels of fat in the blood,
heart disease, stroke, arthritis, and sleep problems including the cessation
of breathing.
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"When diet and exercise alone do not improve obesity-related health
problems, or sustain healthy body weight, surgery can be an effective
treatment," says John Sweeney, MD, associate professor of surgery,
in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine.
Sweeney and William Fisher, MD, BCM associate professor of surgery, direct the department's Bariatric Surgery Program.
Surgical treatments for obesity can limit both food intake and the amount of calories and nutrients the body absorbs, or only restrict food intake. The most common bariatric surgery -- Roux-en-Y gastric bypass - both restricts food intake and limits absorption of nutrients. It is the only obesity surgery performed by Sweeney and Fisher.
"From looking at historical literature and our own experiences, we think Roux-en-Y is the best operation for long-term weight loss with the least risks," says Sweeney.
Laparoscope procedure
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Unless the patient has had previous operations on the abdomen, Sweeney and Fisher perform all such surgeries laparoscopically. The operation involves making six small incisions, each less than one inch in length. Using cameras and long instruments, they create a small pouch at the top of the stomach to restrict food intake. Next, about three feet of the small intestine is bypassed and attached to the lower part of the stomach and first part of the small intestine. Rerouting the intestine prevents the absorption of complex sugars that cause weight gain, says Sweeney.
Because a majority of the surgeries are done laparoscopically, hospital stay and post-operative recovery is shortened. Knight was back at work in 10 days.
Following surgery, patients are expected to make considerable lifestyle and behavioral changes. For example, patients must see their surgeon indefinitely for annual checkups. Because the surgery prevents the body from absorbing essential nutrients, dietary supplements must also be taken daily. Due to the small stomach pouch created in surgery, only small amounts of food (about one-half cup or less) can be consumed at each meal. High fat and sugary foods must be avoided to prevent complications. Sweeney and Fisher also encourage their patients to exercise regularly.
Emotional repercussions
Some patients have a hard time adjusting to these new behaviors, and often
struggle with bouts of depression after surgery. Knight felt these emotional
repercussions shortly after returning from the hospital when the television
advertised foods she used to enjoy, but could no longer eat.
"It was difficult, because even though my stomach had been altered,
my brain had not," says Knight. "I had to confront my inner
food demons and think about why I wanted to eat that food so badly."
BCM's Bariatric Surgery Program offers monthly support group meetings to help patients during this transitional period, and additional counseling can be arranged if needed.
Candidates for surgery |
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Success
Knight reached her goal weight eight months after surgery - she lost 103
pounds. Although heavier individuals tend to lose weight fairly quickly,
Sweeney says the rate of weight loss varies. As patients lose weight,
their health problems improve drastically. By her six-week follow up appointment,
Knight's blood pressure was back to normal, and she felt better than ever.
"I can now take the stairs at work, mow the grass, and be active
with my kids," says Knight. "Before surgery, I couldn't even
walk a short distance without getting out of breath."
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