Proven Benefits
Einstein Bariatrics - Why Surgery
Diabetes after Bariatric Surgery
Pregnancy and fertility after Gastric Bypass
Bariatric surgery can dramatically improve the quality of your life, give you new hope for the future, and change your attitude. People who are overweight have significant quality health obstacles to overcome including medical illness, physical limitations, and psychologic trauma. When you are in poor health, your life suffers in many ways. Chronic illness can reduce the scope of your daily activities and functioning resulting in a lowered self-esteem. Illness truly can limit your enjoyment of life. There are very few events in a person’s life that can have such a profound positive impact as bariatric surgery.
The psychosocial consequences include awareness of difficulties with personal hygiene and with simple acts such as picking things up off the floor. Even sitting comfortably in theater seats or on airplanes can become impossible. There is also the social stigma of obesity known all too well by every one of our patients.
The good news is that bariatric surgery has benefits far beyond its most visible result — dramatic weight loss. After surgery, many chronic illnesses markedly improve. In fact, most post-surgical patients have discontinued medications previously required due to obesity-induced disorders.
Researchers have looked at quality of life in areas that are known to be impacted by obesity: physical function, self-esteem, sexual functioning, public distress, and work/daily activities. Results thus far are very encouraging. Overall, quality of life has been shown to improve in gastric bypass patients by an average of 68 percent and six-month post-surgery scores in areas of physical function and self-esteem are similar to those of non-obese individuals.
Diabetes is a devastating illness resulting in numerous secondary medical problems including heart attacks, kidney failure, vision loss, infections, and severe vascular disease. Diabetes is strongly associated with obesity and, although daily medication regimens can control blood sugar when closely monitored, most patients with Type II diabetes and obesity require ever-increasing doses and numbers of medications.
Diet and exercise can improve weight control, but less than five percent of severely obese individuals can maintain significant weight loss for two years. As a result, few obese people truly benefit from these non-surgical weight loss programs. Diet and exercise showed no benefit because nobody could maintain significant weight loss. The average weight loss in these six studies was between six and 20 pounds and there was no reduction in the need for diabetes medication.
Significant reduction in excess weight, and long-term maintenance, is critical to the successful treatment of obesity-associated diabetes. Fortunately, long-term weight control and a dramatic improvement in diabetes is seen after bariatric surgery. In one large study published in the Annals of Surgery, 191 patients were followed over a period of four years after undergoing laparoscopic gastric bypass. According to this study, after weight loss, 83 percent of these patients had normalization of fasting blood glucose and hemoglobin A1C and were able to completely eliminate the need for diabetes medication. Additionally, among those patients who were diabetic for less than five years, 95 percent had no measurable evidence of residual diabetes after surgery-induced weight control.
Several large studies have retrospectively demonstrated that there is an improvement in life expectancy after bariatric surgery.
In 2007, the New England Journal of Medicine published two well-publicized articles containing evidence which proves what bariatric surgeons have known for years. Overweight patients who undergo bariatric surgery have a 40 percent lower likelihood of dying than people who are overweight that do not undergo bariatric surgery. Decreases in death related to cardiac disease (heart attacks), cancers and diabetes complications are marked below.
- 60 percent reduction in the risk of death from cancer
- 92 percent reduction in the risk of death from diabetes
- 56 percent reduction in the risk of death from heart attack
Obesity, Fertility and Pregnancy
Significant long-term weight loss offers hope to many women who are battling with infertility and other hormone imbalances. Women who weigh just 50 to100 pounds more than their ideal body weight often produce excess quantities of estrogens and testosterone. These hormone imbalances can challenge a women’s reproductive system in numerous ways. Infertility, complications during pregnancy, and significant gynecological diseases, such uterine cancer, are much more common in overweight individuals. Dramatic weight loss after bariatric surgery often results in improvements in obesity-related hormone abnormalities.
One of the most common conditions seen in women who are over weight is polycystic ovary syndrome (PCOS). PCOS causes abnormal menstrual cycles, male-pattern hair growth (e.g. facial hair), acne, and infertility. These women are also prone to develop diabetes, hypertension, and coronary artery disease. Frequently after significant weight loss, hormone balances improve, PCOS resolves and getting pregnant can be easier.
Not only do hormone problems associated with obesity cause a decrease in fertility, but once an obese woman becomes pregnant, she is at higher risk for many complications. Obese women have four to five times the risk of developing high blood pressure and other problems that can lead to the life-threatening disorder “eclampsia” during pregnancy. Also, compared with normal-weight women, their babies are also two to three times more likely to suffer a stillbirth after the 28th week of pregnancy, and are more than twice as likely to require a Cesarean section.
Many women fear that bariatric surgery will complicate future planned pregnancies. In fact, the typical outcome of a pregnancy after weight loss surgery has been shown to be generally better than the outcome of a pregnancy in an obese woman. Several studies looking at the gastric bypass have documented no increase in complications compared to normal weight individuals. When performed in expert, comprehensive centers, where patients are followed for life after surgery, bariatric surgery results in minimal to no risk of complications during pregnancy.
Joint Pain, Weight Loss and Orthopedic Surgery
Orthopedic surgeons, rheumatologists, and physicians specializing in rehabilitation medicine know that the knee joint has to support the force of three to six times one’s weight. The impact of extra weight is also multiplied on other joints, including those of the back, hips and ankles. The results of this increased wear and tear are impressive. For example, men who are just 40 pounds over their ideal body weight have a five-fold increase in osteoarthritis. This close link between obesity and osteoarthritis is well documented. Of course, the incidence of severe osteoarthritis in people that are one hundred or more pounds overweight is exponentially higher, and the age of onset is much earlier. As always in medicine, unless patients and their doctors attack the root cause of their disease, in this case arthritis, medications and other therapy will only temporarily alleviate the pain and allow for permanent injury to the bone and cartilage.
For patients who do not yet require surgery to replace damaged joints, substantial weight loss has been shown to alleviate the debilitating symptoms of osteoarthritis. Schauer, et al, documented that 70% of patients that were taking medications for joint pain had no pain and were off all arthritis medications after weight loss surgery. Another published study documented that 58% of patients undergoing weight loss surgery complained of chronic low back pain, but this number decreased to only 20% after surgery.
Unfortunately, not everyone will have resolution of his or her knee pain after weight loss since joint cartilage lost after years of obesity will never regenerate. This damage may result in the need for surgery to repair or replace the damaged joint. Of course, recovery from joint replacement is more difficult in obese patients and many orthopedic surgeons will not perform joint replacement surgery in severely obese patients because of the significantly higher risk of complications.
To evaluate the impact of surgical weight loss on patients requiring joint replacement therapy, the Mayo Clinic followed 20 patients who had hip and knee replacements after weight loss from gastric bypass. This recent study found a significant improvement in physical rehabilitation after joint replacement in patients who had previous weight loss due to gastric bypass.
For those people who are severely obese and are suffering from chronic joint pain, surgery for weight control may be an option.
Some Medical Conditions with proven improvements after gastric bypass surgery
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