Dorothy Brush "Random Thoughts" Published Nov. 2, 2005

Bariatric surgery may be the answer

Bariatric surgery may be a new term to you as it was to me, but one Boston surgeon calls it "one of the hottest fields in surgery." The Blue Cross/Blue Shield fall newsletter devoted a page to this weight-loss operation. They describe it as the last resort for truly obese patients who have not had success with other methods. A woman eighty pounds or more overweight or a man about a hundred pounds overweight fall in this category.

They warn this is a major gastrointestinal surgery and should not be considered as mere cosmetic surgery or be taken lightly. These people are already at risk, because of their weight, for complications and even death.

Insurance companies are just beginning to pay for bariatric surgery. In spite of its long history, it was not a particularly well-respected field within medical circles and the insurance people had to be convinced that the surgery worked. As obesity became a national problem, insurance companies were finding their medical costs climbing because of the condition. In 2003 Michigan spent more than $2.9 billion on obesity-related medical costs. Nationwide the average annual cost of treating obese patients in 2002 was $1,244 more than treating a person of healthy weight.

Boston Magazine featured an informative story on the subject in the October issue. Their research found that according to the American Society for Bariatric Surgery, the number of weight-loss surgeries in the past five years has increased nearly 500 percent. In Massachusetts alone the number jumped from 630 such surgeries in 1999 to 33,036 in 2004. This increase came in spite of a study done by the University of Washington which looked at gastric-bypass survival beyond hospitalization. The study found that 1.9 percent of patients die within 30 days of the procedure, 20 percent have complications and some require second operations which are even more risky.

My nephew's wife had this surgery two years ago so I called Ohio to learn more. She was not there when I called but my nephew had some interesting observations. She has lost 135 pounds in the two years since surgery. One of his most insightful comments was getting used to a "different normal." He said foods she really enjoyed such as ice cream now bring revulsion but she craves healthy foods she never touched before.

This couple is very active in their church and my nephew said about 12 women there have had the surgery. He said they all say they would do it again. Because of the physical and mental changes the patient undergoes, it is not unusual that there have been several divorces in this group. This is true across the nation. Divorce rates are very high among patients who have had a great weight loss.

Patients considering the surgery are warned about the chance of complications and my niece did have to undergo a second operation for a hernia, but my nephew said there is one unpleasant problem doctors seldom mention. Conventional gastric-bypass surgery results in about a week of the incision dripping copious amounts of fluid. He added this was not just one case because after their surgery other women started calling to ask if this was normal. Since he was the one changing dressings, he was able to assure them it was.

Bariatric surgery is not only a hot field for surgeons but a number of struggling hospitals have been saved by changing their focus to weight-loss surgery. One was the Durham Regional Hospital in North Carolina. Between 1999 and 2002, they had a financial loss of more than $26 million. After adding a weight-loss surgery program, they had a net operating income of $8 million in 2004.

The president of the American Society of Bariatric Surgery, Dr. Harvey J. Sugerman, advises those considering the surgery to seek out a surgeon with specific experience and training in the operation. He suggests a surgeon who has done 40 to 100 cases and to ask about their outcomes and mortality rates.

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Dorothy Copus Brush is a Fairfield Glade resident and Crossville Chronicle staffwriter whose column is published each Wednesday. She may be reached at ebrush@frontiernet.net