Bypassing Obesity

ObesitySliderThere’s no question that losing weight can be difficult. But what do you do when you have a lot of weight to lose? What if you need to lose it quickly? Most importantly, what if, despite all your best efforts to exercise and eat right your body still refuses to do what you wish?

Rebecca Rich had been heavy her whole life. None of the diets she tried worked and having four kids didn’t help much either. Two years ago, she was the biggest she’d ever been. It hurt her to walk. Her self-confidence was nil. Then her birthday came, and as she blew out the candles, she swore to herself that she wouldn’t have another one being that heavy ever again. A couple years earlier, Martha Post had arrived at the same conclusion. She’d tried all kinds of diets, but none of them worked for her either. She was uncomfortable, her blood pressure was high and her legs were always swollen, making it difficult to perform her duties as a restaurant manager.

That’s when both ladies chose gastric bypass surgery.

If sheer willpower, a proper diet and exercise aren’t doing the trick, that’s where more extreme measures come in. A variety of bariatric surgeries exist to give you a choice about just how extreme you really need to go. The most common bariatric procedure is a gastric bypass, which facilitates weight loss by reducing the size of the stomach and rerouting the digestive system. Both Post and Rich knew people who had had it done, so were aware going in of the risks as well as the benefits. When he was first introduced to it 14 years ago, Dr. Dat Tien Nguyen was not entirely convinced of the positive effects of weight loss surgery… but then he saw the results for himself. He was amazed to see that, alongside the dramatic loss of weight, related health issues were also resolved. High blood pressure, diabetes, joint issues, sleep apnea – all of these things eased significantly, or even disappeared entirely, along with the pounds.

17591707_lToday, as a practicing weight loss surgeon in Pleasanton and Manteca (Doctor’s Hospital), Dr. Nguyen laments our current obesity epidemic and the need for surgery to help people lose weight. He wishes there were some less invasive means to solve the problem. But until there is, he cannot deny the advantages that gastric bypass surgery affords people today. “Right now there is no magic pill,” he says. “But until there is, weight loss surgery is the closest thing.” Under the general category of gastric bypass are the more specific procedures of Adjustable Gastric Banding (AGB) and Roux-en-Y. AGB, better known under the LAP-BAND label, is a restrictive surgery by which a silicone ring is fastened around a patient’s stomach near the esophagus. A port in the ring allows it to be inflated or deflated as needed to control the amount of food to be passed into the digestive system.

O1According to Dr. Nguyen, the main benefits to AGB are its adjustability and reversibility. However, weight loss may not be as quick as with other weight loss surgeries. And rare but well-publicized instances of mechanical failures (the band breaking, access port problems, stomach perforation, etc.) have greatly reduced the number of requests for AGB. Roux-en-Y is what people envision when you say gastric bypass (and is the procedure that both Rich and Post had done). By reducing stomach size and bypassing other parts of the stomach and intestine during digestion, the Roux-en-Y procedure is both restrictive and malabsorptive. The surgery involves stapling the stomach into a small upper section and larger lower section. The upper stomach, or “pouch,” is where food will go. It then is connected to the small intestine via a new shorter route, or “Roux limb.” The larger lower portion of the stomach is bypassed completely. Whatever specific procedure a patient decides to go with, improving technologies make gastric bypass surgery in general continually safer and more effective. As much as possible, Dr. Nguyen employs laparoscopic techniques for gastric bypass procedures. This requires single incisions about one-inch wide, just big enough to accommodate surgical instruments and the camera that allows him to see what he’s doing. Not only does this technique hasten recovery time, it also results in minimal scarring.
Even then, these are major surgeries, and should not be gone into lightly. In fact, before they get to the operating table, there is a fairly thorough screening process that patients must go through to prove that 1) they are eligible for the surgery, and 2) they are prepared both mentally and physically for their new body and digestive system. Gastric bypass is not a viable option for someone simply because they’re overweight. The National Institute of Health Sciences (NIHS) eligibility guidelines dictate a body mass index of 40 or more (80 pounds overweight for women, 100 pounds overweight for men), or 35 or more if the surgery will also address a further-reaching medical condition like heart disease or diabetes. Such figures would classify someone as clinically obese. Once physical requirements are met, a candidate has to show a history of continual attempts to lose weight, which exemplifies their determination and willingness to follow through. Over a period of several months there are appointments with nutritionists and psychiatrists, orientations and information sessions, so the patient knows exactly what will happen and what will be required of them. Then after getting through all that, they have to adhere to a pre-surgery diet to get their body prepared and minimize any operative complications.

All of this screening and preparation is designed to inform a patient that, while initial results after surgery are often swift and dramatic, a gastric bypass is not the quick fix some perceive it to be. Rather, it’s just the first step in a complete lifestyle change. “It’s just a tool,” Post says. “It’s up to you to make it successful.” With a functional stomach a fraction of the size it used to be and a new, shortened digestive tract that doesn’t absorb as many nutrients, ongoing maintenance and specialized nutrition is required for the rest of the patient’s life. You have to limit your intake of food, make what you do eat as nutritionally beneficial as possible and take a variety of vitamins. After surgery, a liquid diet segues into soft solids and then finally regular food. Meals are very small, with a focus on high protein, low calories and avoiding sugar and fats as much as possible. No alcohol or carbonated beverages, and any drinks you do have should be consumed between meals, not with them (since they can give you a full feeling). In order to get a full balance of nutrients, you also need to take a multi-vitamin, B12 and calcium supplement every day.

Not following these rules can result in pain, illness and, in the case of overeating, actually reversing the procedure by stretching the stomach back out. But those who are able to adapt to their new lifestyle find the benefits far outweigh any inconveniences. And if they do ever feel like they’re slipping, ongoing support groups are usually available to help gastric bypass patients overcome their fears and hurdles.

“It was hard at the beginning,” Rich recalls. “But then the weight starts coming off. You still have to work for it, but it gets easier.”

O2A little over one year after her surgery at Doctors Hospital of Manteca, Rich has gone from 242 pounds all the way down to 146. As the weight has gone away, so has her pain, both physical and emotional. Feeling better about herself, she’s started socializing more and actually enjoys buying new clothes. Best of all, she is the first in her family to get a college degree. Being able to finish something is an example she’s excited to set for her children. And since having her gastric bypass in December of 2010 at Sutter Memorial Hospital in Sacramento, Post has lost 127 pounds, reaching her goal weight and going from a size 26 down to a size 14/16. She had the loose skin around her stomach removed by one of the Best tummy tuck plastic surgeons in Phoenix. Her blood pressure went down, as did the swelling in her legs, which also allowed her to remove varicose veins. And she’s found that having to watch what she eats has actually helped influence the people she works with as well as her family. Being able to teach others how to make good nutritional decisions is just another unexpected and wonderful side effect that came from her gastric bypass surgery.

For more information contact: If you’re curious to find out if gastric bypass is for you, Doctors Hospital in Manteca offers free monthly informational seminars. For more information, call (800) 470-7229 or go the weight loss surgery page at Sutter Memorial Medical Center in Modesto also offers free informational seminars. Call (888) 547-0935 to register, or go to