In an effort to address the Keystone State’s growing problem with obesity, TCMC with host the 1st Annual Keystone Program – Obesity Symposium 2013 on April 6, 2013.
The World Health Organization has classified obesity as a chronic disease and determined that it is reaching epidemic proportions, not only in the United States, but globally. Moreover, closer to home, the Pennsylvania Department of Health has determined that PA ranks 17th among all states in the country for percentage of obese residents.
The purpose of the symposium is to provide strategies for health professionals and students to prevent childhood and adult obesity recognize risk factors and discuss various treatment options such as behavioral, pharmacological, and surgical.
“Health & Exercise Forum” will dedicate the next two weeks to a topic related to this local, national and international epidemic by Ryan Sugarman, 4th year medical student at TCMC.
Part 1 of 2 on Bariatric Surgery
Guest Columnist: Ryan Sugarman, 4th Year Medical Student TCMC
Ryan Sugarman is a 4th year medical student and member of the charter class of The Commonwealth Medical College (TCMC). He was raised in Long Island, NY and earned a Bachelor of Science in Chemistry at Tufts University. He has a special interest in preventive care and has researched diabetic foot care and ways to improve pneumonia vaccination in the Scranton area. Recently he investigated the average one year weight loss of three bariatric procedures performed at Wilkes-Barre General Hospital in Wilkes-Barre, PA. He is currently applying for Internal Medicine residency and plans to complete a fellowship in gastroenterology, nephrology or hematology/oncology afterward.
Nearly one of three Pennsylvanians is obese, quantified as a Body Mass Index (BMI) > 30. This places them at risk for diabetes, hypertension (HTN) or high blood pressure, obstructive sleep apnea (OSA), and many other diseases. These illnesses may be insidious, festering unnoticed until they cause a stroke or heart failure. While diet and exercise are encouraged, it is often not enough to be effective. In more severe cases, surgical measures should be considered based on specific criteria to be discussed later in this column.
Bariatric surgery is an operation designed to help a patient lose weight. There are different types of bariatric surgery which restrict nutrient intake (restrictive) and/or restrict absorption of food (malabsorptive). Three examples that are commonly done at Wilkes-Barre General Hospital are discussed in more detail below.
1) Gastric Band
This is a type of surgery in which an adjustable band is placed around the stomach. This band can be thought of as a belt which can be tightened or loosened as needed in the outpatient setting. The band restricts the rate that the stomach can fill.
2) Gastric Sleeve
This operation removes a large portion of the stomach, leaving behind only a small “sleeve” which is roughly the size of a banana. Not only is this surgery restrictive, but it also has a hormonal mechanism promoting weight loss. The stomach secretes a hormone, ghrelin, which stimulates hunger. By removing most of the stomach, ghrelin secretion is decreased so there is less sensation of hunger.
3) Roux-en-Y Gastric Bypass
This complicated surgery rearranges the gastrointestinal (GI) tract so there is less time for the absorption of nutrients to occur. The procedure also decreases stomach size to a gastric pouch which reduces its storage capacity.
The results vary as by case, but research has shown a dramatic benefit in long term survival of morbidly obese patients who undergo bariatric surgery. Obesity related diseases such as HTN and diabetes may resolve.
A recent research project of Wilkes-Barre General Hospital bariatric surgery patients compared their one year excess body weight loss (EBWL) results. The gastric band, gastric sleeve, and gastric bypass patients had EBWL of 38%, 45% and 60% respectively. The results are demonstrated below.
Adam Pascoe, coauthor of the project and a fourth year medical student at TCMC, said “Being a Tunkhannock native I wanted to give back to the area by educating people that these (procedures) should not be viewed as cosmetic surgeries, but rather life extending surgeries.”
The National Institute of Health (NIH) recommends bariatric surgery for those who are extremely obese as defined as a Body Mass Index (BMI) > 40) or those who are morbidly obese as a BMI > 35 with coexisting illness such HTN. You may calculate your own BMI by multiplying your weight in pounds by 703 and dividing by your height in inches squared. For example, a person weighing 200 pounds and is 5 feet 2 inches tall has a BMI of 36.5 and is well over the standard for obesity and morbid obesity according to BMI charts.
Body Mass Index (BMI) Chart
BMI 18.5 under weight
BMI 18.5 – 24.9 normal
BMI 25 – 29.9 overweight
BMI > 30 obese
BMI > 35 morbidly obese
Anyone interested in bariatric surgery are required to attempt a serious diet and have their medical history reviewed before they qualify. A psychiatric evaluation and upper endoscopy to visualize their digestive tract may also be required.
Dr. Clark Gerhart and Dr. Gary Neale, general surgeons who operate at Wilkes-Barre General Hospital, offer free seminars about the surgery to the public twice a month in Wilkes-Barre and as of 2013 there will also be a monthly meeting at Scranton Regional Hospital. Dr. Neale said “These (meetings) allow patients to better understand the surgery they are considering and gives an opportunity to ask questions without the time and expense of making an appointment. “ He added “With the program now entering its third year we are seeing friends and family of previous patients, who have witnessed the benefits and success that the individual has obtained through weight loss surgery.” Information about these seminars can be found at http://www.wilkesbarregeneral.
Next week we will discuss risks, benefits and outcomes of bariatric surgery.
NOTE: Images in article were reproduced with permission of Dr. Gianfranco Silecchia MD PHD FASMBS, Associate Professor of Surgery at Padiglione Universitario, Rome, Italy.
Read Dr. Mackarey’s Health & Exercise Forum in the Scranton Times-Tribune – every Monday…Next Monday Read “Bariatric Surgery - Part II
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.