Expanding choices lead to shrinking waistlines
January 20, 2016
Surgeries to help people lose weight and become healthier are among
the most frequently performed elective operations in America today.
UC Irvine Health is at the forefront in offering the newest and most
effective bariatric procedures.
The program at the UC Irvine Health H.H.
Chao Comprehensive Digestive Disease Center is accredited by the Metabolic
and Bariatric Surgery Accreditation and Quality Improvement Program and
is led by Dr. Ninh T. Nguyen, chief of the Division of Gastrointestinal Surgery
and vice chair of the Department of Surgery, UC Irvine School of Medicine.
Live Well spoke with Nguyen about the latest advances in treating obesity
and how patients benefit.
We hear that obesity is an epidemic in America. Is it true?
The obesity epidemic is rampant. Right now more than one-third of
Americans are obese. Obesity is defined as a body mass index [BMI, based on
height and weight] equal to or greater than 30.
The gastric balloon procedure was just approved by the food and drug administration. Who is this procedure for?
The gastric balloon procedure is particularly exciting since we haven’t had
a procedure to offer to obese patients with BMIs less than 35—those who
are just 50 pounds over their desired weights. With this procedure, either
a single or dual balloon is inserted into the stomach through the mouth
with an endoscope, then inflated with a saline solution and left in place
for six months. The balloons take up a significant amount of space, and
patients cannot eat as much and they feel full sooner. After the balloons
are removed, patients follow up monthly with our team members, including
work with a dietitian and social worker to maintain their weight losses.
The FDA also recently approved a procedure called VBLOC therapy. How does it work?
We insert a pacer lead—a device like a cardiac pacemaker—around the vagus
nerve that periodically blocks signals between the brain and the stomach.
Unlike with the gastric sleeve and gastric bypass, we don’t need to remove
or reroute anything. Research has shown that people lost an average of 28
percent of their excess weight during the first year. We are offering VBLOC
therapy to adults with BMIs between 35 and 45 who also have an obesity related
condition such as type 2 diabetes.
What type of bariatric surgeries do you offer for severely obese patients?
For patients with BMIs of 35 with conditions such as diabetes or
hypertension, or BMIs of 40 or more, we offer the Roux-en-Y gastric bypass
and the vertical sleeve gastrectomy. With the bypass, we construct a
small pouch to restrict the size of the stomach and bypass parts of the
digestive tract to limit the calories absorbed as food passes through the
intestines. Patients with diabetes or metabolic syndrome are more likely to
be candidates for the bypass, as studies have shown that gastric bypass is more likely to improve or resolve these conditions. With the sleeve, we make
the stomach smaller, reducing its capacity by 80 percent, so patients feel full
sooner. We also remove a portion of the stomach that secretes the hunger
hormone, so the hunger sensation is decreased. We perform these procedures
laparoscopically—through incisions that are 2 centimeters or smaller.
Patients who have undergone bariatric surgery sometimes need a second procedure, either because of complications from the original surgery or problems after regaining weight. What can you do for them?
We perform revisional surgery for patients who have developed
complications—such as chronic obstruction, reflux or leakage—from their
original operations. Additionally, we perform revisional surgery for patients
who have not lost sufficient weight or have regained weight. For example, a
patient with poor weight loss after adjustable gastric band surgery may be
a candidate to have the band removed and undergo a sleeve gastrectomy.
In a patient who had a gastric bypass, endoscopic gastric revision may be an
option. After the patient is sedated, a flexible scope is passed through the
mouth into the stomach pouch. We then place sutures to reduce the size of the stomach and stomach outlet.
What's the cost of the obesity epidemic?
The problem with obesity is that it’s associated with a whole host of medical
conditions, such as hypertension, diabetes, high cholesterol, obstructive
sleep apnea and fatty liver, to name a few. Obese individuals with metabolic
syndrome—high blood pressure, diabetes and high cholesterol—are at high
risk for developing coronary artery disease and having heart attacks and
strokes, even at a young age. The health risks associated with obesity are
cumulative and costly: obesity-related disease drives more than 20 percent of
all healthcare costs—that’s almost $200 billion a year.
Who are the best candidates for bariatric surgery?
People who qualify for bariatric surgery are adults with BMIs of 35 with at least
one obesity-related condition, or those with BMIs of 40 or more. Individuals with
conditions such as depression, eating disorders and substance abuse have to be
treated before they can be candidates for surgery. Good candidates need to be
willing to continue follow-up care in our multidisciplinary program after surgery.
How successful are these surgeries in helping patients lost weight and control their disease?
Overall, patients lose 65 to 75 percent of their excess weight over the first
year, and 90 percent maintain that weight loss over the next five years. Studies
show they also experience a 60 to 80 percent improvement in their obesity-related
health problems. Many of the obesity-related conditions, particularly
high blood pressure and type 2 diabetes, improve or resolve relatively quickly
after the operation. We can see benefits within one month after surgery. Some
patients reduce their diabetes medication, and some will eventually get off
it altogether. Studies have shown a 40 percent reduction in the risk of death
associated with cardiac disease.
How do you help patients decide what procedure to undergo?
We spend time listening to the patient, evaluating the patient’s health
conditions and explaining the options and recommendations. It’s just one of
the reasons we have been designated a Boeing Center of Excellence for bariatric
surgery, one of only four in the country and the only one on the West Coast.
Learn more about weight-loss surgery
— UC Irvine Health Marketing & Communications
Featured in UC Irvine Health Live Well Magazine Winter 2016