Rita McMillan, age 41, reports to her place of employment, a large community hospital located in an upscale suburb of a large Midwestern city. She has been employed at the same hospital as an RN house supervisor in the pediatric intensive care unit for the past 12 years, but was recently promoted to a position as unit manager over the PICU and general pediatric floors. She's become accustomed to the plethora of complimentary comments from coworkers that started approximately six months ago: "You look so great!" "You must feel better." "What have you been doing to lose all that extra weight?"
According to the Centers for Disease Control and Prevention (CDC), 69 percent of all Americans were overweight or obese during the year 2012. When broken down further, 35 percent of these overweight adults were also considered clinically obese, which essentially means they had body mass indexes (BMIs) of 30 or greater. An assortment of techniques to produce weight loss are available, including diets that involve reduced caloric consumption, exercise, commercial meal plans, Weight Watchers, and HCG injections, to name a few. However, without permanent lifestyle changes, any significant amount of weight loss is typically regained. In fact, about 80 percent of dieters regain all their lost weight, plus more.
Rita's body weight has cycled up and down wildly since her prepubescent years; this phenomenon is informally known as yo-yo dieting. Her highest adult weight of 267 pounds occurred in her mid-20s during a prolonged bout of depression, whereas her lowest weight of 130 pounds was achieved in her early thirties after exclusively breastfeeding her twin sons for 14 months while training for a half-marathon. 12 months ago, at 40 years of age, she became dispirited and disgusted at the number that flashed on her electronic scale: 220 pounds. That same afternoon she telephoned the clinic of a prominent bariatric surgeon to set up a consultative appointment. Rita had made up her mind: after losing and regaining the same 100+ pounds at least five times during her adult life, she was seriously exploring the option of weight loss surgery.
Bariatric surgery, also known as weight loss surgery, has exploded in popularity over the past three decades. The National Institutes of Health has deemed bariatric surgery the only effectual treatment for severe obesity and long-term weight loss. In addition, the American Society for Metabolic and Bariatric Surgery (2015) agrees that bariatric surgery leads to long-term weight loss success for most patients. Although a wide range of weight loss surgical procedures are available, the four most common ones are laparoscopic adjustable gastric banding (a.k.a. Lap-Band), sleeve gastrectomy (a.k.a. gastric sleeve), gastric bypass, and the biliopancreatic diversion with duodenal switch (a.k.a. duodenal switch).
Laparoscopic Adjustable Gastric Banding
Commonly called a Lap-Band, laparoscopic adjustable gastric banding is a restrictive procedure that entails placement of an inflatable silicone band around the upper portion of the stomach (ASMBS, n.d.). The newly created pouch is intended to induce a feeling of fullness when only a small quantity of food is consumed. The Lap-Band is reversible and typically yields 40 to 50 percent loss of excess body weight. Patients must routinely visit their surgeons' office or clinic to ensure the Lap-Band receives periodic 'fills' and 'unfills' of normal saline that produce enough restriction to maintain weight loss.
Laparoscopic Sleeve Gastrectomy
Informally known as the gastric sleeve, the laparoscopic sleeve gastrectomy entails removal of the stomach's greater curvature. In this procedure, approximately 80 percent of the stomach is removed, and the remaining stomach pouch is stapled into a banana-shaped 'sleeve' that produces fullness after eating only a few ounces of food. The gastric sleeve is irreversible and normally generates 50 to 60 percent loss of excess body weight.
Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass starts with the creation of a golf ball-shaped stomach pouch and ends with the connection to the upper section of the newly divided small intestine to the small intestine further down so that stomach acids and digestive enzymes from the bypassed stomach and upper section of small intestine will eventually mix with the food (ASMBS, n.d.). This procedure typically leads to a loss of up to 80 percent of excess body weight, but also carries the risk of nutritional deficiencies.
Biliopancreatic Diversion with Duodenal Switch
Most commonly referred to as the duodenal switch, this procedure is usually reserved for the most severely obese patients because it leads to greater excess weight loss than all other types of bariatric surgeries. This procedure involves two integral steps: firstly, a small stomach pouch is surgically created, then a large section of the small intestine is bypassed to ensure food doesn't mix with biliary and pancreatic enzymes until far down into the small intestine, resulting in a remarkable decrease in absorption of calories, fats, and other nutrients (ASMBS, n.d.).
At 5'6" and 220 pounds, Rita's BMI of 35.5 placed her into the grade 2 obesity category. However, since she had less than 100 pounds to lose, the bariatric surgeon with whom she consulted was unwilling to perform a Roux-en-Y gastric bypass or duodenal switch. With a goal weight of 135 pounds and a goal BMI of 22, this meant she had about 85 pounds to lose. She opted for the sleeve gastrectomy, reached her goal weight in less than 8 months, and is successfully maintaining through a regimen that involves a high-protein diet combined with three days of strength training per week. Her type 2 diabetes and elevated cholesterol resolved within three months of the surgery.
Is weight loss surgery the easy way out? Some would say "yes," but many of those who have had bariatric surgery would say no. Finally, we must remember that weight loss surgery is merely a tool to a healthier life. It is up to the patient to execute the lifestyle changes that are required to maintain whatever weight has been lost, or else weight regain is a possibility. Celebrities such as Carnie Wilson are anecdotal evidence that a significant quantity of weight can be regained after bariatric surgery if adherence to lifelong changes does not occur.
RESOURCES
Long-term weight loss maintenance
FastStats - Overweight Prevalence
American Society for Metabolic and Bariatric Surgery. (n.d.). Bariatric Surgery Procedures. Retrieved from Bariatric Surgery Procedures – ASMBS | American Society for Metabolic and Bariatric Surgery
American Society for Metabolic and Bariatric Surgery. (n.d.). Benefits of Bariatric Surgery. Retrieved from Benefits of Bariatric Surgery | American Society for Metabolic and Bariatric Surgery
