Swedish offers weight loss surgery program
March 16, 2009
By David Hayes
A specific demographic will be targeted when the new Swedish Medical Center, Issaquah Campus, opens its first phase in fall 2010.
It’s a section of the population needing assistance that is unfortunately growing across the United States — the morbidly obese. According to the Center for Disease Control, 9 million Americans were classified as morbidly obese in 2004, about 1 in 20 people. Those numbers are now estimated at 13 million or 1 in 17 people.Swedish addresses this growing trend by debuting its Weight Loss Surgery Program this month at the Issaquah clinic. It will also be one of the first centers to open at the new medical campus.
“There is always a need for a weight loss surgery program wherever there is not currently one,” said Dr. Ross McMahon, bariatric surgeon for Swedish. “We’ve been trying to get a program to Issaquah, where I see patients all the time.”
A patient has to meet specific qualifications to qualify for one of the three types of weight loss surgery. The first step is to calculate the body mass index — multiply your weight in pounds by 703 then divide your height in inches squared. For example, a man who is 5 feet, 7 inches tall and weighs 150 pounds calculates as follows: 150 pounds x 703 = 10,5450, then divide by 4,489 (67 inches x 67 inches) = 23.49. A BMI of 23.49 falls within a healthy weight classification for this person.
The classifications are:
Underweight — BMI less than 18.5
Normal — BMI 18.5 to 24.9
Overweight — BMI 25 to 29.9
Mild obesity — BMI 30 to 34.9
Moderate obesity — BMI 35 to 39.9
Severe obesity — BMI greater than 40
McMahon said age is one of the biggest considerations for qualifying for weight loss surgery.
“Under 18, we have to be very careful. There are no pediatric programs, so we have to consider them on an individual basis,” he said.
And over 65, he added, the risk-to-benefit factor is not as low as for younger patients. They have to be in good health otherwise.
To qualify, then, a patient must have a BMI of 40 or higher, be between ages 18-65, have tried several attempts to lose weight unsuccessfully and be able to undergo a blood transfusion if needed during or after surgery.
There are three weight loss surgeries — gastric bypass, lap band and vertical (sleeve) gastrectomy.
Also known as Roux-en-Y (pronounced “ROO-en-why”), gastric bypass surgery restricts food intake by creating a small pouch at the top of the stomach. The pouch is then connected to a section of the small intestine, allowing food to bypass the lower stomach and the first two parts of the small intestine.
Most gastric bypasses are performed using laparoscopy, a minimally invasive surgical procedure performed through very small incisions in the abdomen.
McMahon said he could perform the Roux-en-Y on patients with a BMI of 30-35 who suffer from diabetes.
Lap band surgery limits food intake with minimum interference with the normal digestive process.
By wrapping a silicone band around the upper part of the stomach, the surgeon creates a small upper stomach pouch that is connected to the lower stomach through a narrowing created by the band itself.
The band restricts the amount of food that can be consumed at a single meal. Food passes slowly from the upper to the lower stomach region and creates a fuller feeling longer. This procedure is also performed laparoscopically. The lap band can be easily adjusted after surgery, according to how much weight the patient is losing.
McMahon said the procedure is recommended for patients with BMIs between 35 and 40 who have diabetes or other health problems, such as high blood pressure, sleep apnea or high cholesterol.
The vertical (sleeve) gastrectomy procedure generates weight loss by restricting the amount of food that can be eaten.
The stomach is divided vertically with 85 percent of it being removed. This part of the procedure is not reversible. The nerves to the stomach and the outlet valve (pylorus) remain intact to preserve the stomach function while reducing its volume. There is no intestinal bypass with this procedure, only stomach reduction.
McMahon said this procedure is usually reserved for patients over 40 on their BMI, but can be performed also on low numbers, too.
He said the three surgeries have a 90 percent success rate.
Surgery shouldn’t have a stigma
According to the CDC, about 1 percent to 2 percent of morbidly obese people die each year.
McMahon said he wishes that weight loss surgery didn’t carry a stigma of shame for a procedure with such a high success rate.
“You wouldn’t begrudge someone their decision to have cancer surgery,” he said.
The surgery, he added, significantly reduces a patient’s chances of getting cancer due to their obesity, prolonging their lives by at least seven years.
Post-surgery, clinic workers help a patient set up an exercise routine and lay out proper diet and portion control.
McMahon said he hopes more patients consider weight loss surgery.
“Considering numbers of morbidly obese have reached epidemic proportions, only about 250,000 people have weight loss surgery every year,” he said. “The amount of lives we can save through weight loss surgery is tremendous.”