As Mississippi struggles with the problems of having the highest obesity rates in the country, the use of bariatric surgery may become an increasingly important tool to help people lose weight and prevent the serious health consequences that can arise from obesity.
In 2001 a survey estimated that approximately 25% of adults in Mississippi — 520,000 people — are obese. That compares to 1990 when state’s obesity rate was 15.3%. Increasing reliance on fatty fast food diets combined with trends toward less exercise is blamed for the increase.
Because of the high levels of obesity, Mississippi has one of the highest rates of diabetes and cardiovascular disease in the country, said Adam Dungey, nurse manager of the Comprehensive Weight Management Center at the Central Mississippi Medical Center.
“Obesity surgery has been proven to provide long-term weight loss as per the National Institutes of Health Consensus 1991,” Dungey said. “After surgery, there is an improvement or resolution of co-morbid conditions to include hypertension, diabetes type II, obstructive sleep apnea, gastroesophageal reflux disease, decrease in cholesterol levels, decrease in joint pain, etc. There is generally an improvement in these illnesses within the first six months post-operatively. So, in the long run, the patient reduces their healthcare costs.”
Option isn’t a ‘quick fix’
Dungey said bariatric surgery has been around in various forms since the 1960s, and there have been a number of improvements and refinements during that time period. He said in the past five to six years, obesity surgery has become more popular due to more celebrities undergoing surgery.
“There are still risks involved,” Dungey said. “It is not a ‘quick fix.’ There are lifestyle changes that must be made with the surgery.”
There are three types of bariatric procedures: gastric bypass, gastric banding and biliopancreatic diversion. All three types work by making the patient feel full after eating small amounts of food.
Dr. J.R. Salameh, assistant professor of surgery at the University of Mississippi Medical Center, said studies have shown that more than 90% of the chronic illnesses due to obesity are resolved by the weight loss that follows bariatric surgery.
“For the long term, the cost effectiveness is pretty clear by looking at the result of more than one study,” Salameh said. “This is something we clearly see in our patients. It is actually pretty impressive. Obviously, you have some drastic changes in patient’s lives in terms of mobility and their level of energy. On top of the big things, there are a lot of subtle things they can do that they couldn’t do before. These include things like being able to pick up a grandchild, crossing their legs and sitting in a regular chair.”
Salameh said there is a lot of discrimination against morbidly obese in our society. There are even studies showing that obese people get paid less for the same work. Because of the stigma attached to being obese, once people lose weight, their self-esteem and self-confidence improves.
“It changes their personality,” Salameh said. “They are more open and outgoing. They are just more confident about themselves. It just goes to show the discrimination we have against the morbidly obese patient.”
Is it covered?
With Medicare now considering obesity as an illness, more Medicare patients may end up qualifying for bariatric surgery. One of the largest health insurance companies in Mississippi, Blue Cross Blue Shield of Mississippi (BCBS), doesn’t cover the surgery. A BCBS spokesman said that the long-term data does not support the surgery because of high risks of complications and death. But Salameh said lots of businesses that are self insured cover this operation and offer it to employees.
“If you don’t cover it, I would recommend looking into it long term because you will end up spending less money than on treating all of these other diseases that stem from obesity,” Salameh said. “Clearly, the data is out there: Bariatric surgery works, it works long term, and it is cost effective. Insurance companies that don’t cover it because they don’t consider it cost effective are probably not looking at it long term — perhaps because the patients don’t stick with the insurance company. They may have the surgery, and then a year or two later go with another insurance company.”
Recently the Centers for Medicare and Medicaid Services (CMS) determined that the bariatric surgery has low levels of complications, and results in weight loss that helps resolve illnesses associated with obesity. A study showed a 16.3% decrease in weight six years after the operation, compared to only .8% increase in weight during the same period for patients who received non-surgical treatment.
Saving a life?
The weight loss surgery can literally be a lifesaver, says Sharrie Entrekin, director of medical staff services, Mississippi Baptist Medical Center, who had the surgery in 1981.
“It actually saved my life because my blood pressure was so high,” Entrekin said. “I weighed more than 300 pounds. I am tall, five foot and eleven inches, so I didn’t look quite as heavy as I was. I was trying to have a child, and my gynecologist wouldn’t help me with that because my blood pressure was so high.”
In six months Entrekin lost about 100 pounds. In a year she was at a satisfactory weight, and hasn’t put the weight back on. Before losing the weight, she had three miscarriages and a tubal pregnancy. After losing the weight, she was able to get pregnant. Her daughter is now 21.
It is hard for people who haven’t experienced weight problems to understand how difficult it can be to lose weight. Some of the problem can be with biochemistry, a problem with not feeling full after eating a normal size meal. And “emotional” eating is also an issue.
“I was a nervous eater,” Entrekin said. “I would eat when I was happy, and I would eat when I was sad. Every year I would need bigger size pants. You don’t realize until almost too late that you have put on so much weight. I trained with Weight Watchers. I would lose 10 pounds, and then gain 30 back. Lack of exercise was also one of my problems. You get so heavy you can’t really do exercise. You can’t bend over. You can’t tie your shoes. You can’t do normal things. It is hard to have an incentive to lose weight once you get that heavy. If you haven’t been overweight, you don’t realize how difficult it is.”
She cautions that bariatric surgery shouldn’t be considered a cure all; it also requires a change in your thinking to take the weight off and keep it off.
“The surgery is risky,” Entrekin said. “It is something someone should not go into lightly. Just being put to sleep when you weigh that much is risky. Most everyone who is overweight has high blood pressure.”
Entrekin recovered quickly from the surgery, and even after all these years she still can’t eat a lot. Her only long-term negative was that she wasn’t getting enough calcium and other minerals due to food going through her system too fast for the minerals to be absorbed. So she now has osteoporosis.
“I believe they are aware of those things now and counsel you on eating the right things to make sure you get the right vitamins and minerals,” Entrekin said. “You need to consider that if you are going to have this type of surgery done, you need to watch the chemical balance of your body.”
Long-term follow up
Salameh advises all patients who undergo bariatric surgery take multi-vitamin and calcium supplement for life, as well as get yearly checks of calcium, iron, and other mineral levels.
“It isn’t an operation you have done and then disappear,” he said. “You need long-term follow-up with a doctor to make sure you don’t develop these deficiencies.”
Entrekin now eats whatever she wants. But her weight stays at a good level because she feels full after a couple of bites. Besides literally being a lifesaver that also allowed her to become a mother, losing the weight has made a huge difference in the quality of her life.
“The impact of the extra weight on your hips and knees is tremendous,” she said. “Losing weight really helps with knee and back pain. You can tell the difference.”
She now finds her biggest challenge is getting enough exercise. After a day of work, it can be hard to get motivated to head to the gym for a workout.
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.