Risks and Benefits of Weight Loss Surgery | OSF Saint Francis Medical Center
Hello, my name is David Kelly, and I’m a metabolic and bariatric surgeon and the director of the metabolic and bariatric surgery program here at OSF. We’ll be discussing obesity and the risks and benefits of weight loss surgery in this video. First off, I wanted to welcome you to the weight management and metabolic bariatric surgery program here at OSF St. Francis Medical Center. We are here to help you start and continue your journey toward a better and healthier life. The Obesity Medicine Association has defined obesity as a chronic relapsing, multifactorial neurobehavioral disease where an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic and biomechanical and psychosocial health consequences.
So not a very simple definition to start. The most common and effective way to measure obesity today is by body mass index or BMI. This takes a ratio of your weight and your height. To give a relative picture of how you compare to other people. A normal BMI is between 20 to 25. Overweight is 25 to 30. Obesity is greater than 30 and morbid obesity is greater than 40 or 35 with obesity-related diseases, you can look at this chart to get an idea of where you stand. Obesity is a lifelong, progressive, life-threatening, costly, genetically related multifactorial disease of excess fat storage. Obesity develops as a result of a complex interaction of genetics, metabolism, culture, behavior, environment, and socioeconomic status.
An optimal approach to treating the disease of obesity is addressing as many of these factors as possible. There are several known genetic causes of obesity, but not all of this is completely understood. A basic study has shown that the chance of childhood obesity with one parent with obesity is 45 percent and if both parents suffer from obesity, the rate increases to 89 percent. The culture and environment that we have in America have led to significant behavioral changes over the years due to the excess availability of food.
Food has changed over the years to be available and encouraged to be available in larger portions and of poor nutritional value. All of which leads to weight gain. The average restaurant meal has increased in size by more than four times since the 1950s. This increase in the size of meals has very closely been linked to the increase in the population becoming overweight and suffering from obesity and super obesity. The food we eat today is in much larger portions and has more calories than the food we ate back in the early 1900s.
The Western diet has become much more processed and loaded with sugar and fat. Sugar and fat are more addictive than heroin. Given just these changes in our food, It is no surprise that we are dealing with an epidemic of obesity. Our society has changed from a society that relied on manual labor to a service, an office-based society that involves more sitting in place. We are moving around and exercising much less than ever before. The sedentary nature of our society has caused an increased risk for the development of obesity. Our modern culture and environment have become a setup for weight gain and obesity. Decreased exercise, increased stress, decreased sleep. The evolving Western diet and the use of many medications used to treat illnesses brought on by obesity, all lead to weight gain and increasing rates of obesity.
Increasing rates of obesity have led to an increase in a great number of obesity-related diseases. Obesity and increased fat content in our body affect every part of the human body and cause severe physiologic changes that lead to disease. Obesity has led to increased rates of metabolic syndrome, high blood pressure, high cholesterol, and diabetes, which leads to the development of heart disease that can result in heart attacks. Patients suffering from obesity have increased rates of obstructive sleep apnea, asthma, and other breathing conditions. Obesity causes fatty deposits in the liver and is now the leading cause of liver failure. Patients suffering from obesity are more likely to develop problems with their gallbladder, gout, varicose veins, and ulcers caused by poor blood flow in their veins. Stress incontinence. Lymphedema, strokes, cataracts, headaches, depression and anxiety. The heavier you get, the worse your joints will get, because the wear and tear of the increased weight leads to the early onset of osteoarthritis and the need for joint replacements. The hormones from the fat tissue will wreak havoc on your menstrual cycle and cause increased infertility and polycystic ovarian syndrome.
The rate of cancer is 60 percent higher in patients with obesity, and it’s been linked to cancer of the breast, uterus, cervix, colon, esophagus, pancreas, kidney, and prostate. Obesity is the second leading cause of preventable death behind smoking. It is directly attributed to approximately 350,000 deaths per year. Patients suffering from morbid obesity died in–, died 10 to 15 years earlier than their normal weight counterparts. The cost of everything increases with obesity. So the cost of food increases, and the cost of transportation increases. In 2006, it was estimated that Americans spent 993 million more gallons of gasoline were used to due to the increased weight of Americans. The cost of medical bills increases directly due to obesity and due to obesity-related diseases needing to be treated. The cost of clothing increases as we need more fabric. And you have more people shopping at big and tall stores because of it.
The costs of medication. We have more patients that require additional medications to treat obesity. The cost of gyms and diet pills. And the cost of productivity loss in the United States. So over 150 billion dollars of diet and diet products were consumed in 2006. That made 270 billion dollars in decreased work productivity was assessed that was related to obesity and greater than 200 billion dollars in medical expenses directly related to obesity. And that doesn’t even count the obesity-related diseases that need to be treated. All of this resulted in over 500 billion dollars directly related to obesity. The mantra of most medical history has been that energy or calories in versus energy or calories out will result in weight gain or weight loss, respectively.
So I’m sure all of you have been told that if you work harder and exercise more and eat better or just eat less, you’ll lose weight. They try to tell you that it is your fault that you look the way you do. The problem is that most scientific studies have shown that diet and weight loss alone are only able to provide sustained weight loss for about five percent of people. The reason for this is, is that you’re fighting thousands of years of evolution when you’re trying to lose weight. Set point theory helps explain why diet and exercise alone do not result in long-term sustained weight loss.
During most of our evolution, food was scarce and our bodies developed defense mechanisms that helped protect us from starvation. These hormone mechanisms have kept us safe from starvation for thousands of years. When you try to naturally lose weight by diet and exercise, most people have some success initially. But after a while, you find that you end up heavier than before they started to try to lose weight. You then end up repeating this process over and over. Because that’s the only thing you know how to do. And you just end up heavier and heavier each time. This happens because as you diet and exercise to lose weight, your body’s defense mechanisms kick in by changing those hormone levels to prevent you from starving, even though you weren’t trying to starve, these hormones cause your appetite to increase giving you desire to eat more as well as slow your metabolism so that the food you eat doesn’t get it used up as quickly. This is an excellent method to prevent you from starving, but this also causes you to gain weight.
Most people can’t beat thousands of years of evolution on their own. The only effective way that we have found to reverse this evolutionary process has been with bariatric and metabolic surgery. These procedures cause those hormones that have caused your weight set point to continue to increase, to be readjusted. This adjustment allows you to adjust your set point to a lower level and allows you to start from a lower set point. Studies have shown that adjustment of the set point works over the first year to a year and a half after surgery.
After that year, the knowledge and behavioral changes that you will learn through the weight management program will help allow you to keep the weight off. The surgery serves as a tool to provide you with a second chance to start from a lower set point and reverse the hormonal effects of evolution. The longest-term studies of bariatric surgery have shown that when patients continue to follow up and stick with diet and behavioral changes that they will learn during their weight management classes, they will be able to maintain weight loss for decades to come.
More recent studies have shown that the two most popular weight loss procedures that we use today, the gastric bypass and the gastric sleeve, both provide excellent long-term weight loss with very similar total weight loss between the two. When you meet with your surgeon, we will discuss your obesity, your obesity-related diseases, and specifics about you that will help us decide which procedure will be best for you. After metabolic and bariatric and metabolic surgery, many of your obesity-related diseases will improve or completely go away.
This figure shows the proportion of diseases that have been found to completely resolve after surgery. Of important note, diabetes will be cured in about half of patients, and the other half will reduce the medications that they require. Other significant improvements are seen in high blood pressure, high cholesterol, sleep apnea, gastric reflux, PCOS, infertility, and osteoarthritis, among many others. The risk of cancer decreases by 60 percent after surgery, and most importantly is that on average, patients will live 10 years longer than they would have otherwise if they hadn’t had the surgery. So all of that sounds great, but is it safe? Bariatric surgery is one of the safest surgical procedures that we do today. The rate of death after laparoscopic sleeve gastrectomy or gastric bypass is somewhere between 0.1 and 0.3 percent within one year of the procedure.
That makes the procedure safer than removing your gallbladder or appendix and much safer than removing a portion of your colon or having a cardiac bypass performed. But I’ve heard all these stories of patients who have had all these complications after bariatric surgery. While every surgical procedure has its risks, bariatric surgery has become one of the least complicated surgical procedures that we do in that there are fewer complications than most other procedures these days. Potential complications for bariatric surgery include DVT or pulmonary embolism, bleeding, leak from the staple line or anastomosis, internal hernia, marginal ulcer, stricture, and severe nutritional and vitamin deficiencies.
The rate of complications has decreased over several decades as we have moved all procedures to minimally invasive approaches and have become–developed a better understanding of why the complications occurred and changed our techniques and management to help reduce the risk of complications. Bariatric surgery has become widely accepted throughout most major, major medical specialty societies because of the vast benefits that can be offered by it. In the first major affirmation of bariatric surgery in 1991, the National Institutes of Health stated that weight loss, weight loss surgery for morbid– for the morbidly obese when combined with behavioral modification, is currently the most reliable and only choice for long-term maintenance of excess weight loss. Again, I want to welcome you to the next chapter of your life that will help make you a healthier and better person. All of us here at OSF are excited to help you along your journey to a better life.
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