A bariatric surgeon separates fact from fiction
With obesity at epidemic levels, many people consider bariatric surgery. Yet, misconceptions about sleeve gastrectomy, Lap-Band and gastric bypass surgeries keep many people from pursuing these procedures — all of which are effective ways to treat this disease.
And yes: Obesity is a disease, according to the American Medical Association (AMA). The AMA defines obesity as a body mass index (BMI) of 30 or above. BMI is calculated using a person’s height and weight, and the normal range is between 18.5 and 25.
Obesity often is linked to serious health issues, including diabetes, cardiovascular problems and premature death.
Those with a BMI of 35 — about 60 pounds overweight for your height — or above meet the National Institute of Health's (NIH) criteria for bariatric surgery.
To help clear up some of those misconceptions, we asked Alfonso Torquati, MD, the director of bariatric surgery at Rush University Medical Center, to weigh in on these life-saving procedures.
1. Misconception: It doesn't matter which type of surgery you have.
Fact: Just as no two people are alike, "every operation we do is very different, and each is tailored specifically to that person," Torquati says.
Someone with diabetes would likely need gastric bypass surgery, which reduces the size of the stomach and bypass some of the small intestine.
For patients with BMIs up to 50, sleeve gastrectomy — which removes all but a banana-sized portion of the stomach — often is the best option.
Once popular, gastric banding — when a band restricts the amount of food your stomach will hold — now is performed on less than 5 percent of patients. The best candidates are those who already maintain a strict diet and exercise regime, avoid high-carbohydrate calories, and are willing and able to have multiple band adjustments.
2. Misconception: Surgery is a "cop out." Willpower plus good diet and exercise regimens work just as well.
Fact: Most patients who see a bariatric surgeon have already tried diet, exercise and medications to control their weight for years, even decades.
"When someone is 20 or 30 pounds overweight, diet and exercise are prescribed and can work," Torquati says. "But once you cross the threshold of being 50 or 60 pounds overweight, the failure rates for controlling weight with exercise and diet are close to 90 percent."
The reason: Losing and keeping off 50 pounds or more requires an intense commitment to diet and exercise that very few people can maintain. Bariatric surgery helps make extreme weight loss more achievable by eliminating the food cravings that can derail your diet.
That said, good diet and exercise regimens are crucial for shedding pounds after surgery — not to mention for weight maintenance. "Surgery is a tool; it's not a magic bullet," Torquati says. "At Rush, it's just part of the patient's weight loss journey."
Torquati and the team at the Rush Center for Weight Loss & Bariatric Surgery build a vital support system for the patient, including their surgeon, primary care doctor, nutritionist and psychologist.
Patients must also attend classes before and after surgery to help them make the lifestyle changes — such as eating right and starting an exercise program — that improve the chances of long-term success.
3. Misconception: Surgery is a waste because you just regain the weight.
Fact: Research has shown that not only do patients who have bariatric surgery lose more weight than those who only diet and exercise, they keep it off.
A long-term Swedish study compared obese people who had surgery with those who controlled weight by diet and exercise alone. After 20 years, those who had surgery had lost more weight and were better able to maintain their weight loss.
Study participants who had surgery also experienced lower incidences of diabetes and cardiovascular disease — and lived longer.
Surgery is a tool; it's not a magic bullet. At Rush, it's just part of the patient's weight loss journey.
4. Misconception: Bariatric surgery is cosmetic, so it’s not covered by insurance.
Fact: Although extreme weight loss will transform your appearance, the most important benefits are not cosmetic.
"Yes, you will look better," Torquati says. "But our goal in performing the surgery is to help you feel better, live longer and lead a more active, healthy life."
That's why most insurance companies follow the NIH guidelines for bariatric surgery to determine coverage. Having other conditions aggravated by obesity — such as blood pressure and diabetes — can increase the likelihood that your procedure will be covered.
5. Misconception: You will need plastic surgery after bariatric surgery.
Fact: "Today, 99.9 percent of weight loss surgery is done through laparoscopy," Torquati says. "So there is no big scar that will require plastic surgery."
In addition, not everyone ends up with large amounts of excess skin after losing weight following bariatric surgery. Torquati finds less than 50 percent of his patients have skin removal surgery.
6. Misconception: You can be too heavy for bariatric surgery.
Fact: It's true that for patients over 500 pounds, surgery can be challenging.
"High BMI patients usually have several comorbidities — two or more diseases that exist at the same time within the body — that make the operation much riskier," Torquati says. "The most significant risks are cardiovascular disease and lung disease."
But surgery often is still possible. "The key,” says Torquati, "is to find a surgeon who has a lot of experience treating larger patients."
7. Misconception: Bariatric surgery isn't safe for older adults.
Fact: As with weight, age can be a risk factor — especially if you also have other serious health issues that make any surgery riskier. But it doesn't automatically exclude you.
"I have seen a lot of success for people in their 60s and early 70s," Torquati says. "So even if you're older, don't hesitate to talk to your doctor about whether you're a good candidate."
One caveat: Bariatric surgery for people in their 80s is rare, according to Torquati. "There is not enough research to support using or not using it," he says,
8. Misconception: You still need to take insulin and blood pressure medication after surgery.
Fact: There's a good chance you'll be able to ditch those meds. Along with reducing your weight, bariatric surgery helps change your body chemistry.
"After bypass surgery, 80 percent of patients with diabetes and 60 percent of patients with high blood pressure go into remission — and that means no more medication," Torquati says.
In addition, 70 percent of those with sleep apnea no longer need their CPAP machines at night after weight loss surgery.
9. Misconception: Surgery is risky and has a long recovery time.
Fact: For most people, the risk for bariatric surgery is low, comparable to having your gall bladder removed. In fact, it may be riskier to not have the surgery.
"If you stay morbidly obese," Torquati says, "you are much more likely to die from heart disease, diabetes, stroke and even some types of cancer."
As for recovery: It's typically brief. After surgery, most patients stay a night or two in the hospital and can move back to solid foods after two weeks of a liquid diet.
10. Misconception: You can't get pregnant if you have this surgery.
Fact: "We advise that patients wait at least a year to try to get pregnant since it could interfere with weight loss," Torquati says. "But the surgery won't affect your ability to conceive, carry a baby or give birth."
In fact, losing weight is an important step toward having a baby, since obesity can contribute to infertility in both women and men.
If you plan to have children, be sure to work with an ob/gyn who has expertise in this area, and have your vitamin D levels monitored regularly.
New lease on life
The bottom line: Bariatric surgery changes not only your body — reducing your risks of many serious diseases — but your quality of life.
"It's a big deal to not need an extra seat on an airplane. Or to be able to go on the rides at Disneyland with your children. Or even something simple like going for a long walk," Torquati says. "Bariatric surgery doesn't just help you live longer. It helps you live better."