A Nation at Large: Choosing bypass

The struggle to lose weight affects millions of Americans on a daily basis. With so many gimmicks, "get-slim-quick" diet fads and celebrity exercise DVDs, it is hard to know what to believe and what really works.

Often, people with a lot of weight to lose who have not had much success with diet and exercise alone, consider bariatric surgery as an option.

Currently, there are two types of procedures performed in the United States.

The restrictive type of surgery provided by LAP-BAND and vertical banded gastroplasty involves using a band to make the stomach pouch smaller.

Malabsorptive weight loss surgery, including Roux-en-Y gastric bypass, is the most commonly performed weight loss surgery in the U.S., according to the Mayo Clinic.

"In gastric bypass, the stomach, which is normally the size of a football, is reduced to the size of an egg," said Shirley Kindrick, Ph.D., team leader with the Comprehensive Weight Management Program at The Ohio State University Medical Center in Columbus.

This restrictive approach allows patients to consume less food while still experiencing the sensation of fullness.

After the stomach pouch is created, the small intestine is bisected. The lower part of the small intestine is then attached to the new stomach pouch. Taking this step means food passed through the stomach pouch will bypass both the lower stomach and the top of the small intestine, known as the duodenum.

Kindrick said that she knows of many patients from the Marietta area who have traveled to Columbus for the procedure, but it hasn't always been the case that patients needed to travel so far to have the procedure done.

"In 2002-3, a successful gastric bypass program was established at Selby General Hospital," said Dr. Isidro Amigo, medical director of the Mid-Ohio Valley Lapband Center at St. Joseph's Hospital. "After nearly 60 successful operations with no perioperative deaths, the program was discontinued due to financial restrictions."

Amigo established the Mid-Ohio Valley Lapband program at Selby in 2008 but after failed negotiations with the Memorial Health System, with which Selby became affiliated in 2008, the program was transferred to St. Joseph's Hospital in 2009. Amigo no longer performs gastric bypass surgery.

There are no immediate plans for Memorial Health Systems to offer this surgery, according to Jennifer Offenberger, director of marketing and public relations.

"We have looked into it a little bit, but we are not pursuing it right away. There is a lot of cost involved; special equipment is needed," she said. "We don't see that there is that significant of a community need right now, but that doesn't mean that things won't change in the future."

According to information provided by Amigo, there are fewer gastric bypass procedures than LAP-BAND performed each year; the two procedures have nearly equivalent weight loss success after three years; and there is a 10 times higher risk of complications and death with gastric bypass compared to the LAP-BAND procedure.

Cost and recovery time are also things to consider. Gastric bypass involves the cutting and removal of part of the stomach and intestines where LAP-BAND surgery is reversible and removable.

A good candidate for gastric bypass would be unable to achieve or maintain a healthy weight through diet and exercise, have a body mass index of 40 or higher or have a BMI of 35 to 39.9 and also have a serious weight-related health problem, such as diabetes or high blood pressure.

According to Jeannie Morris, coordinator of the Laproscopic Gastric Banding program at Camden-Clark Memorial Hospital, which only offers the banding surgery, other good candidates for gastric bypass include someone who is over the weight restriction for gastric banding (because of the need to insert a needle), someone who needs to lose a lot of weight quickly because of health concerns and someone who isn't able to have follow-ups as often as is needed for the gastric banding.

The surgery can cost between $20,000 and $25,000. Most insurance plans, including Medicare, will pay for bariatric surgery; however, there are many requirements beyond simply having a high body mass index.

If a patient has another illness related to obesity, such as diabetes, high blood pressure or sleep apnea, the insurance company may be willing to provide partial reimbursement for weight loss services, as well as some weight loss drug therapy.

However, all insurance plans are different and it is important for all potential candidates to know what their insurance covers.