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Is Bariatric Surgery For You?
By Kevin Brown

Hiram A. Gonzalez-OrtizMaking resolutions is a New Year’s tradition and, for many people, that means making a commitment to lose weight by going on a diet and starting an exercise program. For those with a serious weight problem, however, diet and exercise alone may not be enough.

Monongahela Valley Hospital (MVH) offers a “Weight Control and Wellness Program” for patients who need help in gaining control of their weight. Started two years ago, the program offers a structured diet and exercise program and, if needed, bariatric surgery.

Hiram A. Gonzalez-Ortiz, M.D., a general/gastrointestinal surgeon on staff at MVH, is director of the program. A fellowship-trained bariatric surgeon, Dr. Gonzalez-Ortiz has extensive experience with weight management programs.

“The problem with obesity is that it not only decreases your time alive, but it significantly decreases your quality of life,” he says.

Obesity or the abnormal or excessive accumulation of body fat, according to the World Health Organization, is measured by Body Mass Index (BMI).

“The calculation for BMI is the person's weight in kilograms divided by the square of his or her height in meters. There are now online calculators and graphs that can help you calculate BMI. A BMI of 25 or more is considered overweight. A BMI of 30 or more is considered obese,” says Dr. Gonzalez-Ortiz.

According to Dr. Gonzalez-Ortiz, the incidence of obesity is increasing.

“Approximately 35 percent of all adults in the United States are obese. At the current rate by the year 2030, 44 percent of all adults will be obese. The causes for obesity are multiple and include increased food intake (portions), unhealthy food (calories and food choices), physical inactivity, and urbanization,” he says.

Dr. Gonzalez-Ortiz notes that obesity is associated with “heart disease, hypertension, diabetes, high cholesterol, obstructive sleep apnea, arthritis, and psychiatric disorders (depression, eating disorders).”

When a patient who is overweight or obese is referred to the MVH Weight Control and Wellness Program, physicians and clinicians evaluate the patient based on lifestyle, diet, culture, physical activity, age and gender, as well as certain environmental, psychological, and genetic factors that contribute to obesity. They also review other illnesses or conditions that may be a result of, or made worse by, the obesity.

The team of physicians, dieticians, physical therapists and exercise physiologists design a personalized weight management program for the patient that includes, among other activities, nutritional counseling, a medically-supervised weight loss plan, and physical activity. These services are offered either at MVH or at the MVH HealthPlex in Belle Vernon.

For patients who are not successful in managing their weight in the personalized weight management program, bariatric surgery may be indicated.

“Bariatric surgery is a discipline within surgery that specializes in patients struggling with obesity,” says Dr. Gonzalez-Ortiz.

“Bariatric surgery is recommended for patients with a BMI of 35 and a medical disease associated with obesity, or a BMI of 40 without a medical condition associated with obesity.  An ideal candidate for bariatric surgery is a patient in the age range of 18 to 65, a BMI between 35 and 70, and at least one medical condition associated with obesity. Patients outside this range could be candidates for bariatric surgery at some specialized centers,” he notes.

Dr. Gonzalez-Ortiz explains that there are different types of operations for obesity.

“The three most common types of bariatric surgery in order of popularity are the sleeve gastrectomy (sleeve), Roux-En-Y (RNY) gastric bypass (bypass), and the adjustable gastric band (band). There are others out there that are less popular due to the risk/benefit ratio or are experimental.”

Bariatric surgery is not without risks, particularly considering that obese patients may have other health complications.

“Just like other surgeries, there are risks of bleeding, infection, heart/lung complications or blood clots. Specific to bariatric surgery is a risk of leakage of gastric content or, in some specific surgeries, the non-healing of new connections in the gastrointestinal tract made during surgery,” Dr. Gonzalez-Ortiz says.

“Nutritional deficiencies are also possible after bariatric surgery. Since this operation is now done mostly laparoscopically (a camera and small incisions), the risk of complications is less than five percent in most cases,” he adds.

As a minimally-invasive surgery, recovery time from bariatric surgery is usually less than traditional surgery.

“The recovery time varies between patients. The majority of the patients are discharged from the hospital within two days after surgery. The average recovery time is two to four weeks, specifically for any lifting,” says Dr. Gonzalez-Ortiz.

Bariatric surgery does not eliminate the necessary lifestyle changes that patients need to make in order to lose pounds and maintain a healthy weight.

“There are some lifestyles changes to follow after bariatric surgery. Bariatric surgery is only a tool for the patient to get where they need to be. It helps them feel full with less food. Initially, they need to concentrate on a high protein/low fat diet. They have to drink plenty of water (64 ounces per day) and they have to increase their level of activity (60 minutes per day). The patient then creates a series of routines that helps them maintain the weight loss,” explains Dr. Gonzalez-Ortiz.

How successful are patients in achieving their weight loss goals following bariatric surgery?

“The weight loss expectations depend on the type of surgery performed and the patient’s adherence to the rules after surgery. They range from 50 to 75 percent of the excess weight at two years after surgery. More than 80 percent of patients can maintain the weight loss after surgery as long as they maintain their routines and a healthy lifestyle. If they don't adhere to the lifestyle after bariatric surgery, they could start to regain weight within two years after surgery,” he says.

Is bariatric surgery covered by health insurance? According to Dr. Gonzalez-Ortiz, bariatric surgery is covered by almost all insurances.

“It is the responsibility of the patient to make sure the specific policy they have includes bariatric coverage. Most insurance plans have requirements prior to authorizing bariatric surgery. Some of them include age, BMI requirements, co-morbid conditions, a psychiatric evaluation, and failure of medical weight loss (usually six months). In order to approve bariatric surgery, most insurance plans require documentation of failure of other alternatives for weight loss,” explains Dr. Gonzalez-Ortiz.

If your New Year’s resolutions include losing weight, or if you think bariatric surgery might be for you, attend one of the upcoming free informational sessions on weight control and bariatric surgery at MVH. Call (724) 258-1333 or visit www.monvalleyhospital.com/bariatric-surgery.asp for more information and a list of dates.

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