Few Surgeons Perform Procedure : Many Doctors Say Life Style Change Is Key to Weight Loss
The operation that helped Joyce Rue lose 212 pounds is a controversial procedure performed by only a handful of doctors in San Diego County.
One of its proponents is Dr. Wesley Clark, for whom Rue now works.
The surgery, called bilio pancreatic diversion, is a major operation that shortens the bowel and redirects the flow of food. As a result, the patient does not digest fats or starches very well, and they are eliminated from the body. Clark said his patients can eat normally after the surgery and enjoy everything from pizza to eggs Benedict, as long as they observe certain restrictions.
“It’s only for people who are very seriously overweight and can’t lose weight by dieting,” Clark said.
Hospital Stay Required
The procedure generally costs between $15,000 and $20,000, including anesthesia and hospitalization. A hospital stay of three to five days is required, and a follow-up program of diet, counseling and regular checkups is usually recommended.
However, many weight-control specialists believe that surgery is rarely, if ever, the answer. While many doctors now believe there is a strong genetic predisposition to obesity, most still say that diet, exercise and behavior modification will eventually bring the desired results.
Doctors first began dabbling in surgical procedures for weight loss in the 1960s, but some of the early techniques produced severe medical consequences, such as diarrhea and kidney stones, and had to be reversed.
“Actually, these folks did lose weight very nicely, but many of them did lose their lives,” Clark said. The new procedure has minimized the medical complications, he said.
Another procedure is gastric stapling, commonly known as stomach stapling. The procedures that fall into this category create a small pouch in the stomach and limit the intake of food to a few tablespoons at a time.
Dr. Ronald M. Johnson performs a procedure similar to stomach stapling called vertical banded gastroplasty.
Leakage Can Be Fatal
“It’s not a piece of cake,” he said, noting that all stomach stapling procedures have about a 1% mortality rate.
“The most common cause of death is a leak, with an abscess and infection,” Johnson said.
Another variation on the gastric stapling procedure is the gastric bypass, which makes a small pouch in the stomach and a bypass directly to the intestines.
Despite the fact that the surgeons report high rates of success, Dr. Richard Ikeda, chief medical consultant for the state Board of Medical Quality Assurance, takes a dim view of such procedures.
“There have been a whole host of different surgical procedures over the years since weight gain has become one of our national obsessions,” he said. “But the problem in most of the cases is just the person’s motivation.”
“Most of heart disease is due to bad life style, and you know the hardest thing to do in the world is change your life style,” Ikeda said. “I think a life style change would handle probably 90% of the problems of obesity.”
Dr. Peter V. Sacks, a weight specialist at Scripps Clinic and Research Foundation in La Jolla, also advocates methods less drastic than surgery.
“Unfortunately, if the surgical procedure was a panacea for morbidly obese people, we would all recommend it, but it is not,” Sacks said.
While the surgery is often very successful in the short run, some patients learn to overcome the modifications to their bodies and end up regaining the weight years later, he said.
“Even if you operate on the stomach, that is not where the problem is,” Sacks said. “The problem is in the brain and the metabolism.”
