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Everyone knows now

This article went out to all 3,000 employees at my state agency. Guess everyone knows now. Surgical maneuver: Amanda changes course with weight loss surgery Weight loss surgery is simply a cosmetic issue; it’s taking the easy way out. Amanda is witness to the fallacy of these notions. Candidates for surgery have exhausted other means of weight loss and are at risk of illnesses that can be life threatening. And treatment does not end with surgery. Success demands from patients a long-term commitment to a healthy lifestyle. For Amanda, weight loss surgery afforded her the opportunity to make the necessary and permanent change in her life that other methods had failed to do. Her body mass index was in the severe range. The three medicines she was taking were not stabilizing her high blood pressure. And Amanda’s doctor had diagnosed her as prediabetic. Amanda recalls, “I couldn’t even walk up five stairs to get into the building without [being winded]. Medically, I was completely unhealthy. And I had to do something to change that.” Choosing the right course Of the three main types of weight loss surgery, Amanda opted for the least invasive: laparoscopic gastric banding. She was concerned that sleeve gastrectomy, which involves removing about 75 percent of the stomach, is too new a procedure and is irreversible. And gastric bypass surgery, although more common, is also considered to be irreversible and has a higher risk of nutritional deficiency. Gastric bypass surgery involves sealing off the upper part of the stomach and connecting it to the lower part of the small intestine. Thus food skips part of the digestive tract, and the body absorbs fewer calories. Amanda chose laparoscopic gastric banding (lap bad surgery) not only because it is the least invasive but also because it is reversible and involves routine checkups. A band is placed near the top of the stomach and is inflated with a saline solution to create a pouch, or kind of funnel. When a patient eats, the pouch fills up with food much sooner than the entire stomach would. As a result, the patient feels full sooner. The food also takes longer to pass into the lower part of the stomach, which increases the amount of time that the patient feels satisfied between meals. The band is adjustable, allowing doctors to routinely evaluate and optimize its effectiveness. A tube runs from the band to an access port — a small, discreet incision under the skin on the patient’s stomach. The doctor inserts a needle into the port to add saline solution to the band. The solution tightens the band, which shrinks the size of the opening from the upper stomach to the lower stomach and so reduces the patient’s food consumption. The port can also be used to remove solution from the band if the band is too tight to allow food to move through the digestive tract or is causing problems, such as pain or vomiting. Regular checkups enable the doctor to find and maintain the “green zone,” the most effective opening size for the patient. The journey has just begun Amanda’s surgery was successful, but it was just the beginning. For the first two weeks after the operation, she could consume only clear liquids. She graduated to full liquids for the following two weeks. Only then could she move on to the luxury of mushy foods. Recalling her trial by diet, she says, “The first two weeks, [you’re not so hungry] because your stomach is full, and you don’t have an appetite. But once the swelling went down, the hunger returned with a vengeance.” Amanda did eventually get to move on to solid foods, but in order to avoid discomfort or potential problems, such as band slippage, she has had to adopt strict eating habits. She eats only about a cup of food per meal, which she serves on a side dish to appear more abundant. She chews her food very well, about 20 or 30 chews, before swallowing, and she must wait at least a minute between bites. She downloaded an app to help her time her bites. “The idea is that it takes you about 20 or 30 minutes to eat your meal. And then you’re full. If you follow those protocols, nine times out of ten you have no problem. Most complications are from patients’ not following the guidelines and not changing their eating habits.” Band or no band, most anyone would likely benefit from those eating practices. Steady as she goes Referencing Leslie Mitchell’s comment in a recent article about the Calorie Counter app, Amanda notes that surgery, like the app or any weight loss tool, is not a magic wand. The surgery helped Amanda lose 80 pounds in a year, but its success depended on her discipline to consistently make healthy choices, a discipline that she must enforce for the rest of her life. Amanda now exercises daily. Not only did she overcome those five steps that used to wind her entering the building, but she now climbs the stairs to her office each morning…on the eighth floor! And sometimes, she makes the trip more than once a day. “My exercise is walking. I don’t do gyms,” she laughs. Once a month, Amanda meets with a support group. Fellow members, who have all had lap band surgery, offer emotional and moral support as well as exchange recipes and ideas. Amanda also strictly monitors the food she eats. Since she is eating less food, she must ensure that every bite packs a nutritional punch. “I eat high protein — three to four ounces of protein per meal; then, veggies. Then if I’m still hungry, I add the carbohydrates. But most carbohydrates give you energy but don’t fill you. They make you hungry, especially…non-complex carbohydrates….If I’m going to eat something, I’m going to make sure it’s worth my while.” She’s even been known to turn down a piece of chocolate these days. Her rationale: A piece of chocolate may be only 45 calories, but that’s 45 calories of mostly empty nutritional value. The surgery, she explains, “doesn’t change the type of food you put in your mouth. You have to control that. Ice cream will go straight down — [the band] is a funnel. For a lot of the people who aren’t successful, it’s because they don’t change their eating habits. It’s the same with any of the surgeries. Like with the bypass — some people lose all this weight and then just gain it right back.” Although her new diet is strict, Amanda can still enjoy the occasional treat. “It all boils down to calories in versus calories out. It depends on how physical I am,” she explains. Eloquently articulating her new outlook, she says, “Now I eat to fuel the body and not the obsession.” Balancing the costs Unfortunately, costs for lap band surgery can be prohibitive. The procedure is expensive, and the amount of insurance coverage depends on the plan. To qualify under many plans, an individual must have a body mass index (BMI) of 35 or greater and two comorbid conditions, such as high blood pressure and prediabetes. Currently, the state of Texas plan uses a higher BMI minimum and includes some additional requirements. Naturally, other costs can include deductibles and copays. Individuals interested in weight loss surgery should consult their provider for details. The initial expense may be high, but the investment is sound. Weight loss surgery can be a valuable tool in promoting healthy lifestyles and likely reducing the high costs of long-term medical care. In addition, investing in healthy individuals can, as this agency has recognized with its successful wellness program, yield solid returns for all.

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