According to the Centers for Disease Control and Prevention (CDC), about 40 percent of American adults are obese or have too much body fat. Excess weight can contribute to a range of serious health problems, such as heart disease, stroke and type 2 diabetes, according to the CDC. You can be overweight and not obese but still be at risk to develop health problems.
Fortunately, losing weight can help reverse these risks. In this video, San Diego Health host Susan Taylor talks with Ken Fujioka, MD, an endocrinologist and director of the nutrition and metabolic center at Scripps Clinic Del Mar, and William Fuller, MD, a bariatric surgeon at Scripps Clinic Del Mar, about the obesity epidemic in the nation and common weight-loss surgery options.
Dr. Fujioka attributes the epidemic of excess weight gain to a “perfect storm” of factors.
“We have a combination of less activity, much more processed food and brains that are hard-wired to keep any weight that we gain,” says Dr. Fujioka. “We recently learned through a study of contestants on The Biggest Loser that the brain’s hypothalamus functions to keep a person’s weight at the highest point they have ever reached, so you’re fighting a biological force that you can’t control.”
Genetics can also influence weight. If just one parent is overweight, half of their children may have weight issues. When both parents are overweight, 90 percent of the children will struggle with excess weight gain.
As excess weight adds up, so do the risks of health issues, especially when someone is more than 30 to 40 pounds overweight. Serious medical consequences associated with being overweight include heart disease, stroke and diabetes. Diabetes, in turn, can lead to kidney disease, peripheral nerve damage, vision loss and other problems. Cancers related to weight, including breast cancer and colon cancer, also are on the rise.
Diet and exercise are still the standard methods for losing weight, but there is no one-size-fits-all plan for successful weight loss. Some people drop weight by cutting calories or avoiding sugar, while others scale way back on carbs or practice intermittent fasting.
Still, despite giving it their all, some people remain severely overweight or obese. In such cases, it may be time to consider bariatric surgery.
“Bariatric surgery includes two types of weight loss procedures: gastric bypass surgery or a sleeve gastrectomy,” explains Dr. Fuller. “Both are designed to help patients control appetite, deal with portion sizes and learn a different and better way to eat.”
Gastric bypass surgery significantly reduces the size of the stomach and reroutes food, so it bypasses part of the intestine. This allows patients to feel full even when they eat less and to absorb fewer calories from food. Gastric sleeve surgery narrows the stomach by wrapping it in a “sleeve” to slow the rate that food passes through it, which helps patients control their portion sizes.
Both types of bariatric surgeries can be performed as minimally invasive procedures, which requires several tiny incisions on the abdomen instead of one large incision. Minimally invasive surgery offers several benefits, including less pain and bleeding, reduced scarring and a faster recovery time.
Weight loss results begin almost immediately. Most patients lose between 60 and 80 percent of their excess body weight, which also improves their health and quality of life. Moreover, the surgery leads to metabolic changes that help keep the weight off.
“Patients who have bariatric surgery have an 80 to 85 percent chance of meaningful weight loss, compared to about 20 percent with diet and exercise,” says Dr. Fujioka. “Sure, you can’t eat as much as you used to, but with bariatric surgery, the hormones move in the right direction to keep your weight down.”
In order to be considered for bariatric surgery, candidates generally should be at least 100 pounds over their ideal clinical weight.
If using Body Mass Index (BMI) to determine eligibility for bariatric surgery, you must:
- Have a BMI of 40 or more
- Have a BMI between 35 and 39.9 and a serious obesity-related health problem, such as Type 2 diabetes, coronary heart disease or severe sleep apnea
In addition, candidates should have exhausted other medically supervised weight loss options; for example, most patients have tried Weight Watchers and other formal weight loss programs.
Also, candidates must be healthy enough to have surgery as well as undergo a psychological evaluation to ensure they are psychologically prepared to make the significant lifestyle changes required for bariatric surgery to be successful. They also meet with a dietitian to learn how to make proper food choices.
Like any surgery, bariatric surgery has risks, including gastrointestinal leakage which can lead to infection. Generally speaking, these risks are very low and happen in less than 1 percent of surgeries.
Side effects of the procedure may include nausea, constipation and indigestion as the body gets used to a new way of eating. Regular check-ins with a physician are necessary to ensure patients stay on the right track.
“Once somebody gets bariatric surgery, they really need to be seen at least yearly by somebody who understands it,” says. Dr Fujioka. “For example, vitamin deficiencies can be common, but we know how to fix them. As long as you’re checked regularly, you do well.”
Both doctors agree that bariatric surgery can be life changing.
“I think what we do is help give patients hope, allow them to recapture aspects of their lives that they aren’t living anymore and give them the chance to live a longer life,” says Dr. Fuller. “I think that’s the ultimate goal of doing bariatric surgery.”