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Bariatrics

By Helen K. Kelley

According to the Centers for Disease Control and Prevention (CDC), more than one-third (34.9 percent) of all adults in the U.S. are obese, and the rate of adult obesity in the U.S. nearly tripled from 1960 to 2010.

Many individuals who fall into the overweight or morbidly obese categories are desperately searching for a “magic” solution that will take away the pounds permanently. Frustrated with diets and pills that often provide only temporary results, thousands of people are lining up for bariatric procedures, which may provide the closest thing to the permanent solution they seek.

According to the American Society for Metabolic and Bariatric Surgery, bariatric surgery has been shown to be the most effective and durable treatment for morbid obesity, and it helps prevent, improve or resolve more than 40 obesity-related diseases or conditions, including type 2 diabetes, heart disease, obstructive sleep apnea and some cancers.

Atlanta Medicine recently spoke with two Atlanta-area bariatric physicians, who shared their knowledge of how the bariatric landscape has changed over the past several years.

Surgical and Non-Surgical Options Improve Patients’ Weight Loss Success

Jean-Pierre Fritz

Jean-Pierre Fritz, M.D

According to Fritz Jean-Pierre, M.D., a bariatric surgeon with WellStar Health System, improvements in both surgical and nonsurgical options over the past 10 years have resulted in both giving patients better weight loss and giving physicians the ability to better predict that weight loss.

He says the most notable change has been an increase in the selection of a more invasive surgery, the gastric sleeve, over the once-popular lap band and other procedures. The gastric sleeve (sleeve gastrectomy) actually removes approximately 80 percent of the stomach, leaving a tubular pouch that resembles a banana. This procedure, which is less complicated than many other types of bariatric surgery, now comprises over 60 percent of all weight loss surgery procedures performed in the U.S.

“There has been a huge switch in choice of surgeries today. We’ve seen a large increase in patients selecting the sleeve gastrectomy in the past five years,” says Dr. Jean-Pierre. “In addition, we are better able to evaluate our patients’ metabolic conditions today, which helps us in making recommendations for the most appropriate weight loss option.”

Dr. Jean-Pierre adds that non-surgical options can also be very good solutions for some patients who desire to lose weight, especially children and adolescents.

“One of the partners in our practice is an obesity specialist who helps patients determine the weight-loss options available to them and which of those options is best suited. Sometimes, diet and exercise are a better approach,” he says. “For young patients, this is often the first and best choice rather than a surgical intervention, which causes lifelong changes.”

For the patient with a very high Body Mass Index (BMI) and/or various comorbidities like diabetes and high blood pressure, Dr. Jean-Pierre says the more aggressive gastric bypass (Roux-en-Y Gastric Bypass) may be the best option.

Christopher J. Hart

Christopher J. Hart, M.D.

“The gastric bypass is still considered the ‘gold standard’ of weight loss surgeries,” he says. “While it’s more invasive, it has a high rate of success for significant long-term weight loss.”

Lifestyle Change is Key Part of Solution

Christopher J. Hart, M.D., chief of staff and medical director of the Atlanta Bariatric Center at Emory Johns Creek Hospital, says that long-term weight loss success depends on the patient’s commitment to making permanent lifestyle changes to ensure that success after surgery.

“Once a person’s BMI rises above the 30-35 percent range, long-term weight loss with just diet and exercise becomes much harder; it becomes about deprivation,” he says. “So the nice thing about bariatric surgery is that it results in the patient being able to eat less and still feel satisfied.”

However, to obtain lasting results, the patient still has to make lifestyle changes after surgery.

“I tell my patients, ‘I can do a technically perfect surgery, but you will still not lose the weight and get healthy unless you hold up your end of the deal – which means good nutrition and exercise,” he says.

Dr. Hart adds that data compiled over the years for different bariatric procedures is an important tool in developing treatments that can help patients achieve permanent weight loss.

“For example, in the early days of the lap band procedure, there was some experimentation – after a patient reached his or her goal weight, the band was removed. The hope was that the patient had made lifestyle changes that would keep the weight off and would no longer need the band for continued support. The data showed that patients regained the weight because their hunger drive returned,” he says. “It’s important to follow our patients throughout the course of their lives so that we can monitor their progress and success as well as compile data that will be helpful in the future. We can use that data to determine success rates and complications, as well as see how we compare against national statistics.”

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