Fight Obesity and Win!

With Dr. Mark Pleatman, MD

There is a certain portion of the population that is unable to lose weight despite diet and exercise. For these people, their obesity can lead to many health complications. Statistics have linked obesity to increased risks of diabetes, heart disease and vascular disease. Obese people generally have shorter life expectancy than their thinner peers.

In the past, when diet and exercise would fail these people, they did not have many other options. However, the advent of surgical procedures has given hope to patients who otherwise would have to live the rest of their lives morbidly overweight.

Gastric bypass surgery has been made popular by celebrities such as Al Roker and Carnie Wilson. But “chic” is not the reason to undergo this procedure.

“Bariatric surgery is not cosmetic surgery,” says Dr. Mark Pleatman, a board certified surgeon. “It is for treating obesity. It’s for those people who are more than 100 pounds overweight and have failed with diet and exercise.”

There are four types of procedures generally available for those wishing to undergo surgery to lose weight. These four options are: Lap-Band; Vertical Sleeve Gastrectomy (VG); Roux-en-Y Gastric Bypass; and vertical gastrectomy with duodenal switch. All procedures can be done with minimally invasive, or laparoscopic techniques.

The different procedures affect the modality of weight loss for an individual. The Gastric Bypass and Vertical Gastrectomy with Duodonal Switch affect the stomach and intestines and restrict food intake as well as cause malabsorption. The Lap-Band and Vertical Sleeve Gastrectomy restrict the intake of food into the stomach. With either of these procedures there is no bypassing of the intestines, which leads to fewer complications.

So how do you decide which procedure is right for you? First, a patient’s Body Mass Index may determine which procedure is available to them based on safety and results, says Dr. Pleatman. “The Lap-Band is popular in Europe and Australia,” says Dr. Pleatman. “The main attraction is that it is simple, it is an outpatient procedure, and patients experience a rapid recovery with return to normal activities in about one week.”

However, Dr. Pleatman points out that the Lap-Band does require the greatest degree of compliance and motivation on behalf of the patient. It also requires multiple visits to the physician’s office to have the band adjusted. “This can be a disadvantage due to the inconvenience and it can be expensive if you do not have insurance coverage,” says Dr. Pleatman. “Weight loss with the Lap-Band is not as good as with gastric bypass and a significant amount of patients do not lose the amount they want. There is about a 20-25% failure rate.”

The gastric bypass is best suited for patients with BMI over 35, but less than 60kg/m2. It is generally covered by most insurance companies, but does have higher complication rates. The gastric bypass can also cause anemia and osteoporosis because the body does not absorb these nutrients as well. This can be prevented by taking vitamin and mineral supplements.

Patients who undergo gastric bypass can expect to lose up to 70% of their excess weight and due to the history of gastric bypass, most insurance companies cover this procedure. It is more invasive, and patients can expect to return to normal activities between 2-3 weeks.

The latest advancement in bariatric surgery is the Vertical Sleeve Gastrectomy, which is also done laparoscopically with minimal invasiveness. “There are a number of surgeries being done using the laparoscopic approach and that makes it safer and much easier to recover from,” says Dr. Pleatman. “The vertical sleeve gastrectomy can be a bridge procedure for patients with high risk obesity. The advantage to this procedure is that it can be done on very obese patients to help them lose 100-200 pounds and a second procedure (the duodenal switch) can be done at a later date to get even more weight loss.”

Another advantage to this procedure is that it is less invasive and reduces the size of the stomach without rerouting the intestines. The patients have less of a risk of nutritional deficiencies and other long-term complications, according to Dr. Pleatman. “It has turned out that this procedure has been so successful on its own that it is now being used as a primary weight loss and patients are not having to go back for a second stage,” says Dr. Pleatman.

This procedure generally takes about an hour to complete and requires one night in the hospital. Normal activity can be resumed approximately 1-2 weeks after surgery. “Due to the safety and success of vertical sleeve gastrectomy, it has some potential advantage for adolescents because it does not interference with vitamins, nutrients and bone growth,” says Dr. Pleatman. “This also has an appeal for older patients who are too high risk for gastric bypass.”

Dr. Pleatman says the advancement of the VG procedure is leading more surgeons to utilize this procedure first-line when possible. “We are going to see a surge in (VG), especially in high risk patients,” says Dr. Pleatman. “The gastric bypass is a good operation and has been around a long time, and it will certainly still be chosen because we know it’s a good operation and it works.”

Many people are still concerned about the safety of such surgeries, but Dr. Pleatman points out that recent statistics show the current mortality risk with gastric bypass is 0.5% due to the lower complication rates. Post-op, patients can expect quicker recovery times. “The beauty of the laparoscopic approach is the incisions are tiny. Patients are up walking around the next day, showering, etcetera. They are eating and we are encouraging them to eat a small quantity at a time. They are on a progressive diet afterwards from liquids to solids over about 30 days,” says Dr. Pleatman.

“Many patients think it is safer to risk the surgery than it is to be morbidly obese,” says Dr. Pleatman. “Those patients statistically have a 10% chance of dying in the next five years without the surgery because of co-morbid diseases such as high cholesterol, diabetes or high blood pressure.”

In order to prepare for this type of surgery, Dr. Pleatman advises that patients educate themselves, start an exercise program, quit smoking and research physicians who perform this procedure. “Patients are generally asked to lose 5-10% of their weight before the surgery,” says Dr. Pleatman. “I won’t operate on someone who has gained more weight before the surgery because it increases the risk of surgery.”

The benefits for many patients far outweigh the risks. Patients have seen benefits in the reduction of their cholesterol levels, blood pressure and diabetes. The ultimate goal is to help these patients resume a normal, healthy lifestyle.

Dr. Mark Pleatman is certified by the American Board of Surgery, and a Fellow of the American College of Surgeons. He graduated from Haverford College, and received his doctorate degree from the University of Cincinnati College Of Medicine. He completed his Residency in General Surgery at Saint Louis University Hospital. He also completed a fellowship in Surgical Endoscopy at Mount Sinai Medical Center in Cleveland, Ohio. As a Major in the United States Army Reserve, he served in the Army during the Persian Gulf War. Dr. Pleatman’s practice is located in Bloomfield Hills. He is affiliated with many hospitals in the North Woodward area and the DMC hospitals.