Weight Loss Surgery: Patient Perspective
Aug. 5, 2022 - Weight Loss Surgery: Patient Perspective
Back for another Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is seated with Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS) with a specialty in bariatric surgery. Bariatric surgery treats morbid obesity and the health problems that are correlated with it. Morbid obesity is when a person’s weight is at least 100 pounds higher than their ideal body weight. Dr. Irgau explains, “another way to quantify that is to talk about body mass index (BMI), which is a number that is calculated by placing the height and the weight of the person together.” To be considered morbidly obese, an individual’s BMI must be at least 40. When a person has a BMI of 40, they meet the criteria for bariatric surgery. A person is also eligible for bariatric surgery if they have a BMI of 35 with illnesses related to morbid obesity such as high blood pressure, type 2 diabetes, or sleep apnea. Bariatric surgery is the best known way of treating obesity and the ailments that come along with the disease.
Today’s discussion focuses around the patient perspective. Erkan asks Dr. Irgau what his perspective is when he views obese cartoon characters, for example, the character from Family Guy, portrayed on television. Dr. Irgau explains that obesity is not a joke, and it is a life-threatening illness. “From our point of view, morbid obesity is far from being a trivial issue, and yet you are bringing up a very, very popular show in our country where the main characters are morbidly obese… it is normalizing morbid obesity… it is part of our society and the show is reflecting that.” He goes on to say, “but the other aspect to that is that they perhaps have chosen those characters who are morbidly obese to show the trivialization of morbid obesity.” Dr. Irgau mentions that, to the public, making fun of the morbidly obese seems to be an accepted form of discrimination. Dr. Irgau voices that even though they are doing as much as they can to help those who struggle with morbid obesity, it is so entrenched in society that they are barely scraping the surface. Only about one percent of the patients eligible for surgery are coming in for the most effective treatment we have for morbid obesity, which is bariatric surgery. Erkan says, “I am not saying they need to filter what they do in the entertainment world, but the impact… from the social responsibility standpoint… it is kind of scary.” The entertainment world cannot poke fun at other illnesses, so they ask why this one seems to be accepted by the public. “People fail to see morbid obesity as a deadly disease,” and Dr. Irgau states, “it was only 10-12 years ago that the American Medical Association defined obesity as a disease, until then it was an issue of appearance.” The public fails to see that many other diseases that are also life threatening, including cancers, are related to weight. It is seen as the individual’s problem, so others who are not affected do not seem to care.
Dr. Irgau conveys, “Morbid obesity is not a choice, morbid obesity is a disease.” Erkan then pulls up an example of a diagram that tracks the weight measurement of a patient. In this illustration, a patient gained 95 pounds in three years and now weighs 320 pounds. “Going back from that is almost… I don’t want to say impossible, but next to impossible.” From the patient's perspective, the patient does not have to live like this, but the media shows that a high weight is fine and the person can still live a happy life. The pair enforce that this individual can have an even higher quality of life with the help of bariatric surgery, and a person does not have to and should not have to remain morbidly obese.
Samantha and Katrina, two hypothetical patients being used for the demonstration of the bariatric surgery journey, return this Bariatric Friday. Dr. Irgau provides an update on their condition at their first followup appointment. He noted, “Both of them are doing very well, they are both on their liquid diet phase… because their stomach is very small now, they cannot drink a lot of fluid at once so they have to really learn to get as much fluid as possible with little sips. There is a risk for them to be behind in their dehydration at this stage… they are increasing their activity level.” He explains that the patients are at the stage in their journey where they
experience rapid weight loss, and they feel more energetic because of this. There are exercises that are not recommended at this time for the two; this includes lifting weights and anything that primarily engages their core abdominal muscles. These should be avoided until a month after surgery. Walking, stationary bike, elliptical and treadmill exercises are encouraged. During this followup, the patients are asked to report on pain, complications, and signs of fevers, nausea or vomiting. “I am happy to report that neither of them is having any of those issues… both, Katrina and Samantha were able to be off their pain medication within the 48 hours after surgery. They have very small wounds which is from the laparoscopic surgery and those wounds are healing well,” Dr. Irgau explains. Patients are asked to refrain from working for a minimum of two weeks; however, he explains that, if possible, even longer is recommended to ensure the patient has adjusted fully to their new diet. The first two weeks post-surgery the person is on a strict liquid diet and the following two weeks a pureed diet, which includes food that is the consistency of baby food. Dr. Irgau mentions that he tells his patients to imagine they have no teeth to ultimately decipher what foods are acceptable during this stage in the process. After four weeks, the patient can then introduce chewable foods.
A new round of patients are beginning the bariatric surgery process, so Erkan introduces us to Denise, Patrick, and Karen. These patients are hypothetical personas of real patient scenarios, similar to Katrina and Samantha. “I will be giving their backgrounds at the next session,” Erkan stated.. We will then learn of their age, comorbidities, and other facts regarding the patients.
The pair then explain how bariatric surgery was halted slightly during the pandemic because it was viewed as an elective surgery, similar to a cosmetic surgery; however, they have fought for the recognition that this is a vital surgery to the health of individuals. The sense of urgency is not recognized as opposed to other life-threatening illnesses. “It’s a health issue, it is a fundamental health issue, in fact, from an employer’s point of view, you would think they would want to encourage their employees to become healthy… they will be much more productive if they become healthy… and yet, that lack of understanding of obesity as a disease leads to those types of policies,” Dr. Irgau claims in reference to insurance policies that do not cover bariatric surgery. “We are hoping that patients can take action on these issues early on, so then hopefully we can make an impact on their lives,” Erkan states. It’s so important for patients to make the choice for a better and healthier life if they are able.