By Mass Communication Specialist 1st Class Anastasia Puscian, Naval Medical Center San Diego Public Affairs
SAN DIEGO - Naval Medical Center San Diego’s (NMCSD) bariatric surgery program has provided more than 600 TRICARE beneficiaries another tool to lose unwanted and unhealthy weight.
Bariatric surgery or weight loss surgery is a procedure for people who are severely obese and cannot lose weight by traditional means or for individuals who suffer weight gain due to serious health problems. Morbid or severe obesity is a condition that can be difficult to treat through diet and exercise alone.
Diagnoses of morbid obesity is a minimum Body Mass Index (BMI) of 40 or a BMI of 35 with medical related diseases associated with weight such as Hyper-tension, obstructive sleep apnea, type-2 diabetes and gastro-esophageal reflux disease. Super obesity is a BMI of 50-60 or greater.
“Usually we see patients with a BMI of 40-60,” said Cmdr. (Dr.) Gordon Wisbach, NMCSD director of minimally invasive and bariatric surgery. “It’s an epidemic throughout the country, even though we are in southern California where a lot of people exercise and so forth, there is definitely a large population of people that are still obese that can benefit from significant weight-loss and if they can’t do it on their own, then we offer them surgery to do it.”
In order to lose weight through surgery, NMCSD surgeons reduced the size of the stomach with the following procedures: Roux-en-Y gastric bypass (stomach stapling), sleeve gastrectomy, or the lap-band.
Roux-en-Y gastric bypass or stomach stapling works by restricting food intake and decreasing the absorption of food. The stomach is stapled to create a small pouch and a passage for food to bypass a section of your small intestine. Sleeve gastrectomy restricts the amount of calories by reshaping the stomach. The surgeon removes about 80 percent of the stomach, forming a thin sleeve-like stomach. The smaller stomach sleeve remains connected to the duodenum (the first part of the small intestine) , which is then directly connected to a lower part of the small intestine. This operation preserves the continuity of the gastro intestinal tract allowing for the normal absorption of vitamins and minerals. The Lap-band is an inflatable band that is placed around the first part of the stomach. A port is placed under the skin to assist in adjusting the size of the band and offering restriction. The band wraps around the upper part of the stomach creating two pouches that restricts the amount of food intake.
Not only does NMCSD offer these procedures they also perform them laproscopically.
“Traditional surgery is done open, meaning making an incision down the middle of the abdomen and then performing the surgery,” said Wisbach. “Modern surgery you can make a few small incisions without making a large incision in the abdomen.”
The benefits of laparoscopy are faster recovery periods, less post operative discomfort, earlier return to full activities and much smaller scars with significant reduction in the formation of incisional hernias.
Only TRICARE beneficiaries are eligible for these surgeries. The only exception is active duty service members are not eligible. Eligible patients must have a referral from the Primary Care Manager, have a BMI of 40 or 35 with associated weight gain due to related health problems, participate in nutrition education classes and must loose ten percent of their body weight before surgery can be performed. The program also allows for self-referral. If a patient is interested they can call and schedule an appointment with the general surgery clinic.
“Surgery is the last step,” said Wisbach. “It is a tool for weight-loss, it’s not the end all be all. We don’t just jump into it. In order for patients to do well they have to be educated and realize it’s a life change and continue to work with weight-loss tools.”
Shirley Baker, the wife of a retired master chief used NMCSD’s weight-loss surgery program to shed 150 pounds.
“I was embarrassed from being classified a morbidly obese person,” said Bakery. “I had diabetes, was on two different types of medication and insulin, I had arthritis in my knees and had have them replaced and I had high blood pressure. “I wanted to have a better quality of life style and enjoy the years I have to spend with my husband.”
Success of the weight-loss surgery is based on the amount of extra body weight a patient loses. On average patients lose between 40 to 60 percent of their weight.
“Since the surgery I have maintained my weight-loss for the last three years. I have learned how important your diet, portion control and exercise are through the training I received,” said Baker.
Follow up care includes scheduled appointments every three months for the first year after the surgery and then yearly if doing well. During these visits, the weight-loss program staff asses the patient’s weight, any vitamin deficiencies or any complications.
“The biggest change was dropping clothing sizes from 28 to size 12. I gained more self-confidence, I feel healthier I’m not tired or hurting all the time. People compliment me on my weight loss and how much healthier I look,” said Baker.
Baker offers her personal advice for people considering weight-loss surgery.
“My personal life is so much better now. The places and activities I couldn’t do before because I couldn’t walk-I can do now. For example, I went to Disneyland for the first time in 15 years and spent the whole day there. You will have to deal with controlling weight the rest of your life. If not you could end up right back at being overweight.”
NMCSD’s weight-loss surgery program has been offered since 2004.
For more information on NMCSD’s Bariatric Surgery Clinic call 619-532-7576 or visit: http://www.med.navy.mil/sites/nmcsd/Patients/Pages/BariatricSurgeryClinic.aspx
For more news from Naval Medical Center San Diego, visit www.navy.mil/local/sd/.