Obesity in the U.S.

Obesity is defined as a body mass index (BMI) of 30 or higher. Extreme obesity is a BMI of 40 or higher. As weight increases, so do the health risks. People who are overweight or obese are more likely to have high blood pressure, elevated cholesterol and type 2 diabetes. In turn, these conditions increase the risk for coronary artery disease, heart failure and stroke. The excess weight puts stress on the musculoskeletal system and can increase the risk for back pain and arthritis. Obesity is also associated with an increased risk for respiratory problems, sleep apnea, liver problems, gallbladder disease and, in women, menstrual irregularities and reproductive problems.

According to the Centers for Disease Control and Prevention, roughly one-third of adults in the U.S. are obese and the incidence is rising. Researchers estimate, at current trends, by 2025, 40 percent of Americans will be obese. The Endocrine Society reports obesity causes 400,000 deaths each year in this country and costs $122.9 billion.

Sleeve Gastrectomy for Obesity

For patients who are very obese, traditional methods of weight loss (diet and exercise) are often not enough to help them lose a significant amount of weight. Bariatric surgery is the use of operative techniques to significantly enhance weight loss. The treatment is typically reserved for patients with a BMI of 40 or greater or a BMI of 30 or greater and obesity-related health problems.

One type of bariatric surgery is called a sleeve gastrectomy (also known as a vertical sleeve gastrectomy). The procedure was developed many years ago as a first-stage surgery in patients who were at high risk for complications from bariatric surgery. Now, some physicians are using the technique as a sole surgical treatment for obesity.

The surgery is performed laparoscopically (through several small incisions instead of one large incision). An elongated, narrow pouch is made in the stomach by stapling off a large section in a downward direction. Alex Gandsas, M.D., Bariatric Surgeon with Sinai Hospital of Baltimore, says the remaining, usable portion of the stomach is roughly the size and shape of a banana. The rest of the stomach is removed, leaving patients with about 15 percent of their original stomach. Compared to gastric bypass, there is no re-routing of the intestines and, thus no risk of leakage at new connections in the digestive tract. Unlike laparoscopic banding, there is no artificial device wrapped around the stomach that can become infected, migrate or cause an obstruction.

Sleeve gastrectomy promotes weight loss in two ways. First, since the size of the new stomach is very small, patients can only eat a tiny amount of food before they become full. Thus, they take in significantly fewer calories. Second, the portion of the stomach that’s removed produces a hormone, called ghrelin, which regulates hunger. Without this hormone, patients are less likely to become hungry and overeat.

Gandsas says, in his experience, patients who have the sleeve gastrectomy are losing an average of 60 percent of their excess weight within the first year. Patients have also seen a reduction in obesity-related medical conditions.

Since sleeve gastrectomy as a sole laparoscopic surgery is relatively new, not many insurance companies cover the procedure yet. To be considered for the surgery, patients must undergo counseling and have made a lifelong commitment to dietary changes and regular exercise.

If you have any questions about the best method of weight loss for yourself, talk with your health care provider. General information on surgical options for weight loss is available from the American Society for Metabolic and Bariatric Surgery at http://www.asbs.org.

For information about sleeve gastrectomy, go to http://www.lifebridgehealth.org/bariatricsurgery.

For general information on obesity:

Centers for Disease Control and Prevention

National Institute of Diabetes and Digestive and Kidney Diseases

The Obesity Society