Catherine LaPointe (Guest): Okay, thank you for having me. Obesity is a chronic disease. A lot of people don’t view it that way, but it is a disease of energy metabolism, and some people’s bodies are better at storing energy then burning energy. People who need to lose weight, who are obese, it means changing the way their body deals with storing and burning energy. Diets have been proven over and over through multiple studies to be less than 95% effective long term. For people who struggle with obesity long term, it can become very difficult to lose weight, through the yo-yo-ing of gaining and losing weight. It sometimes requires a bariatric procedure in order to help the patient get to a place where they can get their weight to a manageable place where the health issues go away and they are able to exercise and feel well. Examples of that would be people who have Type 2 diabetes, hypertension, cholesterol problem, gastroesophageal reflux disease, sleep apnea, stress incontinence, poor cardiac function, osteoarthritis and many more. We know that the incidence of cancer has also increased with obesity. So it’s a real health issue. We know that after bariatric surgery, if enough weight is lost, they can have resolution of most of these health problems that I mentioned up to as much as 95% to 97%. Type 2 diabetes is the only disease that can be helped through gastric bypass surgery and actually put in remission for long periods of time or for a lifetime. That’s another reason with someone who is quite ill to consider bariatric surgery. Gastric bypass is still the gold standard. The first operation was back in 1954, so it’s been around for greater than 60 years. We know that patients, years ago, had complications that were quite significant. We all had memory of that, but since the inception of a laparoscopic procedure, we no longer have to open up the entire abdominal cavity. Instead, there’s just a little puncture or a small incision made, so there’s much less complications such as infections and things that would make people quite sick afterwards.
Melanie: When you’re talking about gastric bypass, for the listeners, Catherine, this kind of malabsorptive sort of surgery, what is actually doing? How is it actually helping them lose weight? Is it making it so that they cannot eat as much food? Is it making it so that the food that they do eat is treated differently? Just give a quick little explanation of what it actually does.
Catherine: Sure. Gastric bypass is the procedure that actually causes the malabsorptive side effect that helps significantly with fairly rapid weight loss within the first 12 to 18 months. What happens is a loop of the jejunum gets brought up to a pouch that restricts the amount of food that can be ingested, but also bypassing the pancreas, and having that malabsorptive [realm], it really helps pull the weights from what’s been stored over time. I oftentimes explain it to patients kind of like a bear that goes in hibernation. They have stored up all through the summer and spring lots of reserved energy so that then they can have something to draw on while they’re in hibernation. It’s just a simple way of thinking about it, but your body has enough reserved energy stored that you can go with a significant amount of less calories for days so that it can help to pull off the fat.
Melanie: Is this a permanent solution? Is this a permanent sort of situation that cannot be reversed and once you’ve made this decision, it’s permanent?
Catherine: It should be considered permanent. If medically necessary, because there is no change in anatomy as far as removal of anything, it has been reversed when it’s become medically necessary, but that’s extremely rare, I would say less than one percent of patients who have that. Having said that as well is if you do not make the behavioral changes, that we teach and do what it is that we ask you to do as far as food choice, exercise, you won’t be successful long term because over time you can graze your way back up to an elevated BMI again. That would take a tremendous amount of effort and full follow-up with your bariatric program.
Melanie: What’s involved in getting involved in a bariatric program, Catherine? Is there counseling that goes in with it? Is there psychological counseling? Is there something that would preclude somebody from being a candidate for this?
Catherine: Yes. We here at Maine Medical Center offer two procedures currently. We offer gastric bypass and sleeve gastrectomy. We also have a number of patients in our program that had lap-bands placed between the years of 2006 and 2011. We no longer are placing them, but we still manage many hundreds of patients that we have out there in the community. In order to qualify for sleeve gastrectomy or gastric bypass, you would need to have a BMI greater than 35 with at least one comorbidity or a BMI greater than 40 and no comorbidity. When I say comorbidity, I’m mentioning those things that I am concerned about: the hypertension, the diabetes, the poor cardiac function, sleep apnea. Those are the things that qualify. The way to get involved is to contact our program which you can do online. First thing you might want to do is talk with your primary care physician about your desire to pursue possible weight loss by surgery or even just medical weight loss management, and that requires a referral, an updated history and physical from your primary care physician and that referral is faxed over to our practice. That’s the first step. Then we have you go online or come to our session that we hold currently once a month that goes over the program entirely. Surgery is one small component of this. It is very helpful to have the surgery but what really needs to happen is you have to have a very extensive team that will work with you around lifestyle, behaviors, food choice, the emotional impact of this, and so, yes, you do meet with myself, a nurse practitioner. We have an RN, [Holly]. We’ve got social workers and dietitians that work very, very hard to make sure that a patient doesn’t get surgery until they are fully ready and actually qualify.
Melanie: Catherine, how does bariatric surgery affect your nutrition, affect the food that you eat—we don’t have a lot of time, only a few minutes—the food that you eat and the absorption of certain nutrients? Give a little bit of a lesson on how people have to eat afterwards and what they do about those certain vitamins B12 and iron, folate, those things, to make sure they are getting what they need.
Catherine: Sure. Gastric bypass, there is a little bit more of a concern of that than over sleeve gastrectomy. The sleeve gastrectomy just removes a portion of the stomach that gives you a banana-shaped stomach that gives you some restriction and helps with the amount of food you actually want to ingest, but doesn’t rearrange the intestines, doesn’t cause the malabsorptive side effect. There is less the concern with that with sleeve gastrectomy, but the numbers on is great as far as how much weight is lost overall when you look at averages. Gastric bypass is still the gold standard, has been for more than 50 years. That’s where you’ll get the greatest degree of weight loss, but there is some concern around absorption of essential nutrients. That’s why we require all of our patients to take a multivitamin twice a day initially—not for lifetime, but initially—vitamin D, B12, and calcium and iron if it becomes low. People who have gastric bypass can develop an iron deficiency, but there are also patients that never had gastric bypass that have iron deficiency so that’s not conclusive to a patient, but it does put you a little more at risk. We monitor all these very closely and we just have you take the supplementation you need to in order to have normal values.
Melanie: In the last 30 seconds or so, your best advice for people considering bariatric surgery and why they should come to MMC’s Weight and Wellness Program and get involved.
Catherine: Yes, absolutely. Our program is now called Weight and Wellness. I am a certified health and wellness coach and I am becoming licensed in a program, an award-winning mindful eating program called “Am I Hungry?” In that, I’m hoping to really help patients lose weight to behaviors and to great understanding around the relationship between food and emotions. The surgery itself is most appropriate if it’s for a patient who has longstanding obesity, has tried diet many, many times without success. We have a focus on both. Initially, we would evaluate, we would sit down with you individually and discuss with you what would be the best option. Some patients actually end up not even going on to having surgery but stay in our wellness program, where they learn how to eat properly, exercise, and become healthier. For sure, there are patients who really require the surgery to be able to get the weight off that they need to get off. We would encourage anyone who is concerned about weight and nutrition to consider our program.
Melanie: Thank you so much. You are listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.