Bariatric Surgery: A Tool For Living Longer, Healthier

Bobby Bhasker-Rao, MD, specializes in the field of bariatric (weight-loss) surgery for one important reason.

“I can kill many birds with one stone,” he says referring to how a single operation can help resolve the comorbidities — the presence of two or more chronic diseases — that invariably occur in someone suffering from obesity.

In fact, he notes, there are nearly 30 obesity-related comorbidities that bariatric surgery can cure, including diabetes, high blood pressure, high cholesterol, sleep apnea, arthritis, depression, non-alcoholic fatty liver disease, and acid reflux disease

“It’s not all about losing weight and looking good — those are fringe benefits,” says Dr. Bhasker-Rao. “It’s about the medical benefits and adding years to your life.”

Patricia Sanford of 29 Palms agrees. She had bariatric surgery in November 2015.

“I was 59 in the spring of that year, and my primary care physician told me my weight was a ticking time bomb,” Sanford relates. “At six feet, I weighed 330 lbs., I’d been on high blood pressure medication for about five years, my cholesterol was going up, and the doctor said diabetes was in my future if I didn’t do something. “I’d tried diets before and was a good loser,” she continues, “but I just couldn’t maintain it.”

“I attended a seminars and was impressed with the thoroughness of that presentation,” she says. “I made an appointment and had a vertical sleeve gastrectomy procedure on November 16, 2015.

A year post-surgery, Sanford was down to a weight of 174 lbs., losing nearly half her body weight, and she’s maintained it. More importantly:

“I feel fantastic, physically and mentally,” she says. “My high blood pressure went away, my cholesterol dropped, and my primary care physician says I have the lab work of a teenager.

“And I’m able to exercise,” she continues. “I walk three miles in the morning, go to the gym three times a week, and I started yoga. Before, I couldn’t even touch my toes. I retired four years ago, which gives me plenty of time to exercise and take care of myself.

“I recently flew to see my brother and sister-in-law in Washington State,” she adds. “Before my surgery, every time I flew, it was a struggle to fasten the seat belt. Now I have plenty of room. I’ve gone from a size XXXL to medium in tops, from size 24 to 10 in pants, and just yesterday bought a pair of jeans with a 31 waist. That’s pretty exciting.”

Sanford notes that she still has to watch her food intake.

“I can’t eat the portion sizes I used to, but it’s still possible to regain weight if you’re not careful,” she says. “Dr. Bobby’s office has a support group that’s a great resource for reinforcing the changes you have to make if you want to be successful.”

“The support group is here to teach patients what they need to do to keep the weight off; some people still attend five to eight years after surgery,” explains Courtney Markey, MSN, RD, a registered dietitian who runs the group. “We encourage people to come before surgery, too, to ask questions from others who’ve had it.”

Patients who undergo surgery also have unlimited access to Markey via phone, email and in-person appointments for an entire year post-surgery. Twice weekly exercise classes led by a personal trainer also are available.

“The hardest work is after surgery,” Markey stresses. “Patients have to track their protein intake, take vitamins at specific times, not eat and drink at the same time, and really plan their day. We’re here to help as much as possible.”

Who Is A Candidate for Bariatric Surgery?
Bariatric surgery is generally covered by insurance if:

• BMI* (body mass index) is greater than 40, or a person is more than 100 pounds overweight
• BMI is greater than 35 and a person has at least two obesity-related comorbidities such as type 2 diabetes, high blood pressure, sleep apnea and other respiratory disorders, osteoarthritis, gastrointestinal disorders or heart disease
• The patient has been unable to achieve a healthy weight loss independently and sustain it for a period of time

*BMI is a measure of body fat based on weight in relation to height

The types of bariatric surgery
There are four options for bariatric surgery today:

• Roux-en-Y gastric bypass — The “gold standard” of bariatric surgery, this procedure creates a small pouch at the top of the stomach that receives food, limiting the amount that can be eaten and drunk at one time. The small intestine is then cut a short distance below the stomach and connected to the new pouch.
• Laparoscopic adjustable gastric banding — An inflatable band is placed around the upper part of the stomach, creating a small pouch with a narrow opening to the rest of the stomach. The band can be inflated or deflated to adjust its size, controlling the amount of food the stomach can hold.
• Sleeve gastrectomy — Part of the stomach is removed, and the remaining section is formed into a tube-like structure that cannot hold as much food. It also produces less of the appetite regulating hormone ghrelin, which may lessen the desire to eat.
• Modified duodenal switch (also known as SIPS) — This surgery begins with the sleeve gastrectomy (see above description). Then, the end of the small intestine is reconnected to the stomach, leaving approximately 250 centimeters of small intestine for absorption.