Monday, January 22, 2018
Health

Gov. Christie's surgery highlights surgical weight-loss options

Weight-loss surgery such as the type that New Jersey Gov. Chris Christie underwent may not improve just people's waistlines, but also their health.

Obesity causes or worsens myriad health problems, from diabetes to heart disease, severe sleep apnea to arthritic knees.

"He's doing the right thing," said Dr. Jaime Ponce, president of the American Society for Metabolic and Bariatric Surgery. "He's at the age he really needs to address his problem, to live longer, in a better way, with a better quality of life."

Specialists perform about 160,000 weight-loss operations a year in the United States, according to a recent analysis by the surgeons' group. Surgery isn't a panacea, it isn't for everyone — and some forms work better than others.

What is the most common form of weight-loss surgery?

In the United States, it's gastric bypass, sometimes called stomach-stapling. It generally results in the most weight loss. Doctors wall off a small pouch in the stomach, so that it can hold only a small amount of food. Then, they reroute that food past part of the intestine so the body also absorbs fewer calories.

How is stomach banding different?

It's a less invasive operation, and unlike gastric bypass, it's reversible — the band can be removed if necessary. Best known by the brand name Lap-Band, an adjustable band is placed around the stomach to restrict how much food someone can eat at one time. As initial weight is lost, the band can be tightened. Typically, patients don't lose as much as with gastric bypass.

Are those the only options?

The third major approach is called a gastric sleeve, which removes a large chunk of the stomach and thus cuts production of one of the body's hunger-stimulating hormones. Other, less used options including a complex operation called a duodenal switch that also involves rerouting food.

How well do these operations work?

Over a year or two, weight-loss surgery can lead to loss of 50 percent to even 80 percent of the person's excess weight — if they stick with a healthy diet and exercise. More important, research shows weight-loss surgeries can reverse Type 2 diabetes in patients who lose enough weight and keep it off. Gastric bypass causes the fastest weight loss, and stomach banding a more gradual loss.

But patients don't always benefit enough to justify surgery. The Agency for Healthcare Research and Quality cited reports that within five years, up to a third of stomach banding patients aren't maintaining their weight loss.

"You don't want somebody to always drink milkshakes because they're going to defeat the surgery over time," Ponce said.

Is surgery safe?

Most are done laparoscopically — through small incisions — and Ponce's group says the risk of death is lower than for operations to remove a gall bladder or replace a hip. However, patients may suffer infection, blood clots, and broken or leaking stitches or staples.

After surgery, side effects can include vitamin deficiencies as food is digested differently, and vomiting as people learn to eat less and chew well. Gastric bypass patients also may suffer a complication that causes cramping and diarrhea, especially after eating sweets. The gastric band may slip out of place.

Who's a candidate?

Generally, someone who is about 100 pounds overweight and has failed at other attempts to lose. Doctors evaluate body mass index, a measure of weight for height. Candidates have a BMI of at least 40, or a BMI of 35 along with a weight-related health problem. For example, someone who is 5-foot-10 and weighs 279 pounds has a BMI of 40.

In 2011, the Food and Drug Administration relaxed the rules for stomach banding, allowing it for patients with a BMI as low as 30 who have a weight-related medical condition.

Weight-loss surgery can cost anywhere from $14,000 to $20,000; insurance tends to cover it for people who are sicker and more obese.

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