Surgical approaches to Obesity across the United States

Percentage of population with a body mass index of 30 or more. (Visit

www.nhlbisupport.com/bmi/ to get your number.)
Obese population
18.9%-22.49%
22.5%-26.9%

OBESITY
27%-31.49%
Wash. 31.5%-36%
Vt.
Mont. N.D. Minn. N.H. Maine
Ore.
Wisc. Mass.
Idaho S.D. N.Y.
Wyo. Mich. R.I.
Neb. Iowa Penn. Conn.
Nev. Ohio N.J.
enerally, surgery candidates have a body mass index of 40 or more, or about Utah
Colo.
Ill. Ind. Del.
100 pounds overweight for men and 80 pounds overweight for women, or a W.Va. Va.
Calif. Kan. Mo. Md.
Ky.
BMI between 35 and 39.9 with a serious obesity-related condition such as Type N.C.
2 diabetes or coronary heart disease. While the surgeries can promote signifi- Tenn.
Ariz. N.M. Okla. Ark. S.C.
cant weight loss, serious complications are possible, including those associated with any
Miss. Ala. Ga.
surgeries: heart attack, stroke, pulmonary embolus (blood clot that can travel to the La.
lungs); pneumonia, bleeding, blood clots in the leg, infections in incisions, hernia or weak- Texas District of
Columbia
ness in the incision, or death.
Fla.

The four types of operations Alaska

Hawaii
Highest: Mississippi 35.3%
commonly offered in the United States: Lowest: Colorado 18.9% Puerto Rico

Adjustable Gastric Band Roux-en-Y Gastric Bypass Obesity and surgery

by the numbers
Works by restricting food intake and decreasing food absorption. Food
(typically done laparoscopically) intake is limited by a small pouch, and absorption is reduced by routing
Works primarily by decreasing food intake. A small bracelet-like band is placed around food directly from the pouch into the small intestine. 15 million
the top of the stomach to produce a small pouch about the size of a thumb. After Estimated number of
surgery, a doctor can adjust the band in an office procedure to make food pass more How long does it last? Americans with
slowly or quickly through the digestive system. The procedure is permanent. morbid obesity
Advantages
Hollow tube
Research shows that weight loss is generally higher and quicker than with the band. 32.3
Results Percentage of Kentuckians
Access port considered obese in 2009
A doctor can Research shows weight loss can average 77 percent of excess
tighten or body weight a year after surgery, and after 10 to 14 years,
Gast
Gastr
ric
Gastric
band loosen the patients have kept off 60 percent of excess body weight. 29.9
band by Possible Percentage of Hoosiers
inflating or complications considered obese in 2009
How long does it last? Access port (placed deflating the
under the skin in a hollow connec- Post-bariatric surgery hypoglycemia, or
The band is meant to be
permanent, but can be removed. muscle in the chest tion tubing,
very low blood sugar levels after a
person eats, which can lead to severe
220,000
or abdominal wall) which is filled Estimated number of
Advantages neurologic symptoms such as visual Americans who had
with fluid problems, confusion and seizures; bariatric surgery in 2009
Restricts amount of food that can be development of an ulcer where the
consumed at a meal; can be adjusted; can small intestine is attached to the upper A small pouch is
be reversed; digestion and absorption of
vitamins and minerals are normal.
part of the stomach; gastrointestinal
tract leak; bowel obstruction;
created by stitching
the upper portion of
$14,000-
Results Esophagus
gallstones; poor absorption of iron,
calcium and vitamin B12.
the stomach $26,000
In one study, patients lost 41 percent of Esophagus Average cost of bariatric
excess weight in three years. Some doctors surgery; insurance
Hollow
say patients can lose 50 percent to 70
tube Food is routed coverage varies
percent of excess body weight in two years. directly to the small Liver
intestine from the
Possible
complications
Liver Pouch newly created pouch Pouch Staple 4.3%
30-day rate of at least
Gall bladder rows
Band slippage, leakage of one major adverse outcome
the balloon or tubing, port Gastric band among patients undergoing
infection, band infection, Stomach laparoscopic gastric banding
obstruction, nausea and Gall bladder or Roux-en-Y gastric bypass
vomiting, band erosion into
the stomach, gastric Stomach
Sto
perforation or tearing in
the stomach wall,
Pancreas Pancreas 33%
Colon 180-day complication rate
esophageal dilation, failure (risk-adjusted, any type
to lose weight. Also, the Colon
Small of complication) for
stomach pouch can enlarge. Small bariatric surgery patients
intestine
intestine studied in 2005 and 2006,
Risk of death or serious complications Risk of death or according to a 2009
Up to 30 days after surgery is 1 percent for laparoscopic banding, according to the serious complications federal study
Longitudinal Assessment of Bariatric Surgery Consortium data published in the July Up to 30 days after surgery is 4.8 percent
2009 issue of The New England Journal of Medicine. (Serious complications cited are for laparoscopic bypass and 7.8 percent for
deep-vein thrombosis or venous thromboembolism, re-intervention or failure to be
discharged in 30 days after surgery.) A 2004 Journal of the American Medical Associa-
open gastric bypass, according to the 2009 study in JAMA.
The 2004 study cited a death rate of 0.5 percent within 30 days of surgery.
1 in 1,000
tion article cited a 0.1 percent death rate within 30 days of surgery. to 5 in 1,000
Overall mortality within
30 days of bariatric surgery,
Vertical Sleeve Gastrectomy Biliopancreatic Diversion according to large studies
This procedure — also the first stage of Biliopancreatic Division with a
Duodenal Switch — involves removing a large portion of the stomach to
create a more tubular “gastric sleeve.”
with a Duodenal Switch 10%-25%
A complex bariatric operation that removes a large portion of the stomach, Estimates from federal
re-routes food away from much of the small intestine and re-routes bile and other researchers and other experts
How long does it last? digestive juices. of how many bariatric
The prodedure is permanent. surgery patients have
How long does it last? unsatisfactory weight loss
Advantages The prodedure is permanent. or regain much of their weight
Restricts the amount of food that can be consumed at a meal; Advantages
digestion and absorption are normal. Patients can eat larger meals than with a band or Roux-en-Y After the surgery
Results gastric bypass; patients can achieve greatest excess weight Obesity surgery is not a quick
loss because it provides high levels of malabsorption of food. fix. Patients must work hard
Research shows patients lost from 33 percent to 85
to lose weight, keep it off and
percent of excess weight, with an average of 55 Results stay healthy. Though exact
percent. One study showed an average excess Esophagus
Possible complications instructions vary by
weight loss of 74 percent at one year and procedure and patient, here
Splenectomy, gastric leak and fistula, 91 percent at three years. Stomach is made
Esophagus smaller (same proce- are some things most
small bowel obstruction, complica- patients can expect:
tions due to stomach stapling, such Part of Possible complications dure as the Vertical
as leaks from staple lines.
stomach is A leak from the stomach into the abdominal Sleeve Gastrectomy) Patients must exercise
cavity; protein deficiency resulting in regularly.
Risk of death removed hospitalization; frequent, bad-smelling Small intestine is Patients must see their
or serious stools; ulcers; poor absorption rearranged to doctors on a regular basis.
of nutrients, resulting in Liver
complications Liver separate flow of Patients must eat small,
possible protein malnutrition
For laparoscopic or vitamin and mineral Gall bladder food from flow of healthy meals. Food rules
sleeve gastrectomy, Gall Stomach deficiencies; increased is removed pancre
bile and pancre- vary by procedure, but
complication rates bladder atic juices common ones include
range from 2.9
is stapled risk of gallstones.
inhibiting the chewing food thoroughly,
percent to 15.3 absorption of limiting between-meal
percent and overall Risk of death calories snacking, not drinking fluids
mortality is 0.39 while eating, skipping sodas
percent within 30 or serious and avoiding foods high in fat
Pancreas
Pa
Panc
ncre
reas
as complications Pancreas
Panc
Pancre
reas
ass
days of surgery, Bilo- or sugar. Many doctors say
according to various Mortality rate pancreatic stomach pouches can only
studies. Colon ranges from 0.6 loop hold about half a cup of food.
percent to 6 percent
according to various Many patients —
Small studies and experts, particularly those having
intestine with the 2004 JAMA procedures that limit the
article placing it at Colon absorption of nutrients —
1.1 percent within are instructed to take vitamin
30 days of surgery. supplements regularly.

Sources: National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health; U.S. National Library of Medicine; Norton Healthcare; Ethicon Endo-Surgery Inc.; Mayo Clinic; American Society for Metabolic & Bariatric Surgery;
West Penn Allegheny Health System Bariatric Surgery Center; American Association for the Treatment of Clinical Obesity; Cigna; New England Journal of Medicine, BioEnterics Corp., July 2009 Courier-Journal reporting

By Steve Reed, The Courier-Journal