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Surgical Solutions to Obesity
With: Dr. Elliot Goodman
There are a host of medical problems associated with obesity. Stroke, diabetes, heart disease, and joint problems are just a few of the known consequences, and yet nearly one quarter of American adults are obese, and this number is rising. An estimated three to five percent of adult Americans are morbidly obese. For these individuals, medical problems, in addition to social and practical problems, are a near inevitability. Fortunately for some, the battle against obesity has a surgical weapon. It's called bariatric surgery.
Below, longtime general and bariatric surgeon, Dr. Elliot Goodman of the Montefiore-Einstein Center for Weight Reduction Surgery, talks about the procedure, and its effect on the physical and emotional lives of his patients.
First, could you tell us what bariatric surgery is, and who undergoes this procedure?Bariatric surgery is the surgical treatment of severe obesity. And when we say severe, we mean anybody who is at least a hundred pounds overweight. People who undergo bariatric surgery have generally been obese for decades, and they most often have a history of childhood obesity.
What does the surgery entail?In the surgery, we staple the stomach to make it much smaller, and we reroute food so that it bypasses the first few feet of intestines. We actually rearrange the anatomy and the physiology of the intestinal tract.
And what does this do to the body?Well in addition to dramatically reducing the size of the stomach, the surgery also changes the hormonal condition of the patient. You're changing their sensitivity to insulin, you're changing their metabolism of iron and calcium and other nutrients.
And a lot of things which would otherwise get absorbed don't get absorbed. There are hormonal changes induced which suppress appetite. There are hormonal changes induced which increase the body's sensitivity to insulin, because most severely obese patients are resistant to insulin, which is why so many of them are diabetic. So it's one operation that has manifold effects on body metabolism.
Does this surgery actually treat diabetes in some cases?Absolutely. I hear stories of patients who are on three or four different medications for diabetes, and a hundred units of insulin -- which is a big daily dose of insulin -- and within a few weeks they're off. They're off the medications even before they've lost a significant amount of weight. Also, people who have very high cholesterols will often see their cholesterol dipping down to normal. So these are some of the more dramatic effects of the operation.
Coronary artery disease and high blood pressure also respond well. It's great to see patients who may be on five, ten, twelve different medications, over time say, "Well, I dropped this medication," or, "I halved this dose." Within a year or two, they may be down to the bare minimum of medications.
I imagine that the surgery may also solve some of the more structural problems in the body, like joint pain?Absolutely. People with aches and pains or degenerative joint disease are well served by this surgery.
Could you describe the experience of one patient who has responded well to the surgery?Sure. I operated on a woman about a year and a half ago who was about three-hundred and fifty pounds overweight, and had been obese for most of her life.
She was only in her early forties, but was so big that she had to come into the office with a walker. She was unable to sit in any of the chairs even though we have fairly heavy-duty armless chairs, and she was too heavy to weigh in our office. Our scale goes up to five hundred pounds.
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