Weight Loss Surgery: Bariatric Surgery Resolution of Comorbidities
July 8, 2022 - Weight Loss Surgery: Bariatric Surgery Resolution of Comorbidities
On this Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center is accompanied by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS). Their conversation, today, is focused on the resolution of comorbidities after undergoing bariatric surgery, also known as weight loss surgery. “Bariatric surgery is not just about weight loss, it is far more important than that; in fact, bariatric surgery is about improvement of health overall,” Dr. Irgau states. There are numerous illnesses that go hand in hand with obesity, such as sleep apnea, type 2 diabetes, and heartburn. These related illnesses are also defined as comorbidities. As the patient loses weight following surgery, the associated illnesses can go away with it.
Erkan says one of the biggest problems in health care is only, “one percent of the patients who are eligible for the surgery are choosing the surgery for curing the problem.” More people should understand the power bariatric surgery can have for a patient’s health. Patients who meet the criteria for surgery should be made aware that it’s a viable option for them. Primary care physicians may treat a patient with a body mass index (BMI) of 47 for sleep apnea without treating the patient for morbid obesity. It is important that the patient knows that there is a two in one solution, bariatric surgery.
Dr. Irgau explains the correlation of obesity and type 2 diabetes. “Type 2 diabetes is a progressive disease that can lead to heart disease, cardiovascular problems, kidney failure… over time it gets worse and its effects on the body are devastating. If you have obesity and type 2 diabetes, the chances of treatment of type 2 diabetes is going to be closely correlated to your chances of getting rid of the obesity of the weight and bariatric surgery does precisely that,” Dr. Irgau explains. This correlation illustrates how effective bariatric surgery is on the patient’s health. This is not specific to type 2 diabetes; bariatric surgery can resolve many weight related health problems. “When we talk about bariatric surgery, we’re talking not only about helping the person to lose weight and, of course, improve their quality of life, but also importantly help them tackle these very important health problems,” Dr. Irgau states.
Erkan brings up how obesity can take a toll on a patient's body physically and mentally. Carrying an immense amount of extra weight can exhaust the body and mind. Dr. Irgau elaborates “It is no surprise that a person who is struggling with obesity also struggles with depression… obesity itself leads to lower self esteem.” Society’s stigma around obesity can isolate individuals who are struggling with it. When a person undergoes bariatric surgery and begins to see weight loss, the depression associated with obesity can be resolved as well. Weight loss can greatly improve a person’s mental health, along with their physical health.
Erkan conveyed some interesting statistics related to bariatric surgery, “95% of the patients do have a positive outcome on their quality of life, 83% reduction in five year mortality, meaning to live longer… this is big… and yet we still have people who are dropping out and not benefitting from it.” People should be aware and know this is a clear solution for their overall health. Erkan then asks Dr. Irgau how this message could be communicated more clearly to morbidly obese patients who are eligible for this surgery. “More people are morbidly obese… why would patients not choose this route,” Erkan questions. Dr. Irgau explains how outreach is the biggest factor, “we have to continue doing what we’re doing… the sessions we are doing right here are really designed for us to pass on this important message to our community.”
Dr. Irgau then shares a story from his personal experience. He had a patient visit him for something unrelated to their weight, but he observed that the patient was at least 150 pounds overweight. In this instance, the patient required a minor surgery in which the patient would
need to be positioned laying on their stomach. Dr. Irgau acknowledged that because of the patient’s weight, they may have difficulties related to the anesthesia typically used for the procedure. He instead suggested that local anesthesia be used to numb the operative area. The patient’s obesity could put them in a life-threatening situation if local anesthesia was not an option. Because of this, Dr. Irgau asked the patient how they are managing their weight. He was pleased to hear the patient had spoken with their doctor about their weight and has been steadily losing weight. He summarizes by saying obesity affects so many assets of one’s health, so it is important to have conversations such as this with a patient. Dr. Irgau elaborates, “Cardiovascular disease, diabetes, and cancers, these are the three leading causes of death, and guess what, all three of them are actually related to obesity… so when we do bariatric surgery and reduce the weight of the person, we are actually having an impact on their mortality as well.” Patients are likely to live longer after bariatric surgery because the likelihood of developing these related illnesses decreases as their weight decreases.
“The way we have developed bariatric surgery right now, the risks are actually comparable to many other common procedures like hip replacement surgery,” Dr. Irgau states. In addition, he continues by stating, “we have to be able to educate our community and all other health care providers that we have really met very high standards of safety… so when we try to present the risks of bariatric surgery with the risks of staying morbidly obese, the patient is actually way better off having bariatric surgery than not.”
Erkan questions Dr. Irgau about the types of cancer that can be related to obesity. Dr. Irgau states, “in men, definitely prostate cancer, definitely colon cancer… in women, breast cancer, endometrial cancer.” Dr. Irgau further explains, “the higher the weight of a person the more chances that they may have these cancers… when obesity is present, these cancers tend to happen at a much younger age.”
Erkan tells how the patients go through an extensive process leading up to the surgery, so they are prepared when the day of surgery finally comes. “This is a three to six month process that we are going through to prepare you with several different clearances that you are going through for the best outcome,” Erkan states. The patients truly benefit from this preparation and ultimately the procedure. Dr. Irgau mentions how patients struggle when they try to tackle their weight on their own, but explains, “the problem is far deeper than willpower… it has intrinsic biological mechanisms that are driving the body into a higher weight.” He adds “it is very important that patients come out from the sense of guilt and really face the fact that they have a chronic illness that is really leading them to even worse chronic problems like type 2 diabetes, hypertension, heart diseases, and cancers… bariatric surgery is a very important treatment that is available for them”. Erkan closes with, “it’s extremely rewarding, and we want to be able to help more people.”