Options for Weight Loss Surgery
Michael Lasalandra Beth Israel Deaconess Medical Center correspondent
JANUARY 01, 2015
Ryan Whitaker, a travel agent who lives in Cambridge, MA, had been heavy ever since his teenage years. By the time he hit age 30, he was topping out at 387 pounds.
Over the years, he had tried everything to lose weight, from Weight Watchers to fad diets.
“Nothing really worked,” says Whitaker, now 33.
Once, he lost 40 pounds, but gained 20 of it back.
His primary care doctor had been urging him to consider weight loss surgery. His obesity had not yet caused him to develop type 2 diabetes or hypertension, but his doctor told him it was just a matter of time.
Finally, in April 2013, Whitaker underwent a sleeve gastrectomy, a type of restrictive bariatric surgery in which the surgeon removes 75 percent of the stomach. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines.
Whitaker came through the operation at Beth Israel Deaconess Medical Center with flying colors and began losing weight immediately. He had lost 100 pounds by the end of the first year.
Today, he is down to 213 pounds — a loss of 174 pounds. Whitaker, who stands about 5’ 11”, is shooting for a weight of 199.
He runs four days a week and eats small meals, ingesting about 1,100 calories a day. “I just ran a half marathon,” he says.
Having the operation, he says, “was the best decision of my life.”
Whitaker says he chose the sleeve operation over the other options available at BIDMC — gastric bypass and laparoscopic adjustable gastric band — because it was less invasive than the bypass and he had concerns about banding.
Bariatric, or weight loss, surgery is designed for those with a Body Mass Index (BMI) of 35 or higher if the person is having related health problems, or for those with a BMI of 40 or higher if no other health problems have yet developed, says Dr. Daniel Jones, a bariatric surgeon and Director of the Weight Loss Surgery Center at BIDMC.
Whitaker, who weighed 367 at the time of his surgery, had a BMI of 51.2. (A BMI of 30 or above is considered obese). Today, his BMI is 29.7 — just under being considered overweight.
The oldest of the bariatric surgery techniques is gastric bypass, which has been done in a minimally invasive fashion since about 1998. Gastric bypass is the most common form of weight loss surgery and combines two approaches: limiting the amount of food you can take in and affecting how you digest food and absorb nutrients.
In the operation, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach to the lower section of the small intestine.
This creates a shortcut for food, bypassing part of the stomach and the small intestine. Skipping these areas of the digestive tract means the body absorbs fewer calories.
This operation is seen as the one in which the most weight can be lost. But it is also the most radical of the three, says Jones.
For every 100 pounds overweight, the patient having bypass surgery can be expected to lose 70 to 80 pounds, he says.
The sleeve operation, which Whitaker had, is newer and considered a middle ground between bypass and banding. Jones says patients who have it can expect to lose 60 pounds for every 100 pounds overweight they are.
The laparoscopic adjustable gastric band is the least radical of the three procedures performed at BIDMC. The surgeon uses an inflatable band to squeeze the stomach into two sections — a smaller upper pouch and a larger lower area. The two are still connected by a small channel, which slows the emptying of the upper section. Usually, people can eat only a cup of food before feeling full. The food also needs to be soft or chewed well.
Banding is an easier operation to do and tends to carry less risk than the others. The band can also be loosened or tightened, and the procedure is also reversible. However, weight loss is usually less than with other procedures, with those having it able to lose about 50 pounds of every 100 pounds they are overweight.
Dr. Jones says none of the operations are performed lightly and stresses that candidates must go through a lengthy educational program first.
“We have to make sure your head is in the game,” he says. Patients meet with a bariatrician, nutritionist and social worker. “They learn all about the risks and benefits.”
While there are risks associated with any operation, he says bariatric surgery is much safer now than it was in its infancy.
“It is no longer a rare event,” he says. “There are about 200,000 of them done each year in the United States.”