From the time that we are born we have many beginnings in life.  Throughout our life we don't always make the right choices and we are forced to live with our consequences somehow. Whether it is nature or nurture, or a little of both, that get us where we are today, we sometimes find ourselves in need of intervention.  Very seldom are we given second chances to correct our mistakes. 

The Surgical Weight Loss Program at Harlingen Medical Center is a method of long-term weight control for morbidly obese adults. Compared to non-surgical treatments, bariatric surgery has the longest period of sustained weight loss in patients who have failed other therapies. Obesity is now recognized by leading government health authorities, such as the Centers for Disease Control (CDC) and National Institutes of Health (NIH) as a disease. Weight loss surgery is recommended as a treatment option for people with obesity that have a BMI >   40 or a BMI of 35 - 39.9 with serious medical conditions.

If you are reading this, then you are investigating options of weight loss alternatives for yourself or someone you care about. Non-surgical treatments (i.e. medications, diet and exercise, behavior modification) have been tried and again nothing seems to keep the weight off. Well-established studies have demonstrated that 90 to 95 percent of the dieters will regain all of the weight lost during dieting. 

Are you or someone you care about a part of the 90 - 95 percentiles? Are you ready to venture down the path with us beside you, to a fresh start in life?

Call Harlingen Medical Center for more information, or see our Patient Information Seminar Calendar for dates and times that will provide you with more in depth information about our program. 

Overview of Obesity

Obesity has reached epidemic proportions in the U.S. over the past 20 years.  At any given time, 50 million Americans are on some type of diet and yet only 5 percent are able to maintain their weight loss over a period of time. 

Numerous factors have been identified that contribute to being overweight.  Obesity is genetic. Somewhere in your family, others have dealt with the same issues you are dealing with now. Environmental factors include lack of nutritional information and motivation, lack of self-confidence, and today's lifestyle that revolves around the television and fast food.

It seems that once a person exceeds a certain obesity level, it is often harder to lose the weight because of the complications and restrictions caused by the disease itself. "Yo-Yo" dieting is the worst enemy and yet it becomes a part of life. How many times do we say, "I am starting on my diet again come Monday?" We also tend to reward ourselves with dinners. We comfort ourselves with our favorite snack. These types of behaviors contribute to the vicious cycle of obesity. 

Individuals are usually morbidly obese if their weight is more than 100 pounds in excess of the Ideal Body Weight. Most physicians use a scale based off of the Body Mass Index (BMI). 

If you are categorized as very obese, then you may have a higher rate of medical problems. The more obese you are, the higher the BMI and the chance of associated problems (heart disease, high blood pressure, diabetes, asthma, etc.), which increase dramatically as weight increases. 

Obesity is associated with significant health problems (comorbidities):

The death rate from severe obesity can exceed 12 to 20 times that of ideal weight individuals of the same age. Autopsy studies have shown that sudden unexplained death occurs up to 40 times more frequently in the severely obese.

If the physical complications were not enough, obese individuals may lose their self-confidence, tend to isolate themselves and sometimes sink into a state of helplessness and no longer function outside their home.

Requirements

Who is Eligible

Patients must meet specific criteria before they are allowed to proceed with the process. Selection is based on guidelines established by the National Institute of Health (NIH). We look at the body mass index (BMI) of each individual person. 

There is a chart that informs us of your BMI. 

• If you have a BMI of 35 - 40 and have obesity related comorbidities, you are a candidate for this surgery.
• If you have a BMI greater than 40, even if you do not have comorbidities, you may still be a candidate for this program.
• If you have a history of failure in at least one medically supervised weight reduction program within the last two years.
• If you are between the ages of 18 - 65 years old. If you are older than 65 years old, you will be considered on a case by case basis.
• If you do not drink alcohol in excess.
• If you are prepared to make substantial changes in your eating habits and lifestyle and are willing to continue working with the specialist treating you. 

Ineligible Patients

• If your obesity is related to metabolic or endocrine disorder.
• If you have a history of substance abuse or untreated major psychiatric disease.
• Surgery contraindicated or high risk.
• Women who want to become pregnant within the next 18 months.
• You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, or Crohn's disease.
• You have cirrhosis.
• You have chronic pancreatitis.
• You are addicted to alcohol or drugs.
• You are under 18 years of age.
• You are on chronic, long-term steroid treatment.

Setting Realistic Expectations 

We believe the right patient is someone who understands the life-long commitment to healthy weight maintenance and is committed to that goal. We also need to make sure that you are an appropriate candidate for our program.  With the right patient and commitment, this can reduce or prevent health problems. This is not cosmetic surgery or an easy answer to weight loss.

Keep in mind that:

• Other medically managed weight loss methods must be tried first.  Surgery is only an option if other methods have not been successful.
• Surgery is meant to be permanent for bypass patients. You will need to make lifestyle changes for the rest of your life.
• You must commit to making good food choices and being more active after surgery. Otherwise, you will not maximize your weight loss. 
• The surgery is only a tool, which will help you lose weight. It is up to you to be diligent with exercise, attend support group meetings and stay compliant with healthy eating choices and your chances of losing more weight will dramatically increase. 

Procedures/Background Information

Normal Digestive Process

Your food is swallowed and it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold up to 6 ½ cups of food at one time. Food moves from stomach to duodenum, the first segment of the intestine, bile and pancreatic juice speed up digestion. Most of the calcium and iron in the foods we eat is absorbed in the duodenum. The two remaining segments are the jejunum and ileum. These segments of small intestine are nearly 20 feet long and complete the absorption of almost all calories and nutrients. The food particles that are not digested in these segments are stored in the large bowel until eliminated. 

Two Ways Surgical Procedures Promote Weight Loss

1. Restrictive -  Surgery limits the amount of food the stomach can hold by closing off or removing parts of the stomach. This operation also delays emptying of the stomach.
   NOTE:  The majority of patients report feeling full and satisfied after eating a small amount of food, and not feeling excessively hungry most of the time.  If much more than a quarter cup of food is eaten at once, the patient will feel uncomfortable and may vomit.
2. Malabsorption- Surgery causes the food to be poorly digested and absorbed. 
   NOTE:  Vitamin and mineral supplements and a high protein intake will be required for life to prevent the problem of nutritional deficiencies.

Surgical Procedures

Adjustable Gastric Banding (LAP -BAND Surgery)

A restrictive procedure where an adjustable gastric band is placed around the upper part of the stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result, patients achieve sustained weight loss by limiting food intake, reducing appetite, and slowing digestion. The band is then adjusted after surgery to either increase or decrease restriction by injecting a port placed underneath your skin on your abdomen. 

Gastric Bypass (Roux-en-Y)

This is a combination procedure using both restrictive and malabsorptive elements. A small, 15 - 20ml, pouch is created at the top of the stomach. The small bowel is divided.  The biliopancreatic limb is reattached to the small bowel.  The other end is connected to the pouch, creating the Roux limb. The small pouch releases food slowly, causing a sensation of fullness with very little food.  The biliopancreatic limb preserves the action of the digestive tract.

Comparison Table

Frequently Asked Questions

1. Is there an age restriction for the surgery?

Surgery is performed on patients between the ages of 18 and 65. 

2.   How do I know if I am eligible?

Patients must meet specific criteria before they are allowed to proceed with the process. Selection is based on guidelines established by the National Institute of Health (NIH). We look at body mass index (BMI) of each individual person. 

There is a chart that informs us of your BMI. 

• If you have a BMI of 35 - 40 and have obesity related comorbidities, you are a candidate for this surgery. 
• If you have a BMI greater than 40, even if you do not have comorbidities, you may still be a candidate for this program.
• If you have a history of failure in at least one medically supervised weight reduction program within the last two years.
• If you are between the ages of 18 - 65 years old. If you are older than 65 years old, you will be considered on a case by case basis.
• If you do not drink alcohol in excess.
• If you are prepared to make substantial changes in your eating habits and lifestyle and are willing to continue working with the specialist treating you.  

To see the list that may make you ineligible, read the information in "Requirements."

3.  How much weight will I lose?

The gastric bypass operation allows you to lose about 2/3 of your excess body weight; however it is almost 100% effective in reversing the obesity related comorbidities.

The Lap Band procedure will allow you to lose 50% of your excess body weight at 2 years. It is also effective in reversing obesity related comorbidities.
 
4.  What are the pre-operative requirements to have either surgery?

• You must attend one of the patient education seminars.
• You must have a dietician evaluation.
• You must have a psychological evaluation. Patients with bipolar disease are generally excluded from consideration and we need to verify that you are mentally ready for a lifestyle change.
• If you have a history of heart disease, if you have taken Fen-Phen in the past, if you are over the age of 50, or other cardiac risk factors you will require an echocardiogram.
• If you have not had your gallbladder out and have had abdominal pain, you will need to have an ultrasound of your gallbladder. 
• Before surgery you will have a chest x-ray, EKG and blood tests.
• If you have any history of smoking you might be require to have a pulmonary function test.
• If you have any history of sleep apnea or snoring, you will have to undergo a sleep apnea test.

5.  When will my surgery be scheduled? 

Once you have met all the requirements of the surgeon and the program, we will work with you to schedule your surgery. 

6.  What are the risks of the surgery?

Weight loss surgery is major abdominal surgery with significant risks. The following complications include, but are not limited to:

• Risk from general anesthesia
• Bleeding
• Infection
• Pneumonia
• Blood clot in the legs or lungs
• Hernias
• Blockage or obstruction
• Narrowing where surgeons suture the pouch to the intestine, which can require another endoscopy and dilation
• Leakage from the stomach or the intestines
• Injury to liver and/or spleen
• Pulmonary and/or cardiac and/or renal failure
• More than 1/3 of bypass patients' develop gallstones, which could lead to a procedure known as cholecystectomy to remove your gallbladder.
• Near 30% of patients who have bariatric surgery develop nutritional deficiencies such as anemia, osteoporosis.  These deficiencies can be avoided if lifelong vitamin and mineral intake are maintained.
• With the LAP BAND there is a risk that the band can either slip or erode. There is a risk that you will not lose weight if you do not follow the diet and exercise program.

NOTE:  It is important to know that gastric bypass surgery cannot be completely reversed. The decision to have this procedure must be made in consultation with your surgeon, and a very careful consideration of the potential benefits and risks, and the lifelong consequences.

7.  How do I know which operation is best for me?

Deciding which procedure, the gastric bypass or lap band is best for you is largely a personal choice best achieved in discussion with your surgeon. 

8.  Will my primary care physician (PCP) be involved in any part of my care?

Absolutely. Your PCP is an integral part of surgery and will be involved in the peri-operative care.

9.  Will I feel hungry? 

It is very important that you know and understand that this surgery will NOT remove your sense of hunger. It will NOT cause you to lose your desire to eat and it will NOT remove any of the psychological cravings that you may have for food. If you eat when you are stressed, you will still feel like eating when you are stressed. The success of your weight loss depends on understanding the stresses that make you feel like eating and identify other ways of dealing with the stress. 

How to Get Started

1. You must attend a Patient Information Seminar.
2. Call our office and schedule an initial consultation.
   We will make a copy of your insurance card. A questionnaire is completed and reviewed to determine eligibility. 
3. If you meet the requirements you will be given an appointment to meet with a surgeon.
4. The surgeon will review your medical history and determine which tests will need to be performed.
5. Once the pre-operative tests/exams are performed, you will be scheduled for surgery and a pre-operative appointment. 
6. You attend your pre-operative appointment and pre-register for your surgery.
7. You meet with your surgeon before your surgery date to review procedure and have any remaining questions answered.
8. Surgery is performed.
9. You will be given follow-up appointments with the surgeon.
10. You will need to attend support group meetings in order to achieve the best results of your surgery.

Glossary of Terms

Anesthesia -  The loss of sensation and feeling. Also refers to the process or drugs used to produce this effect. Anesthesia is commonly employed prior to surgery, so that a patient will not feel any pain or discomfort.

Bariatric -  Related to the branch of medicine that deals with the prevention and treatment of obesity.

Bariatric Surgeon -  A surgeon who specializes in the surgical treatment of obesity.

Body Mass Index (BMI) -  The most widely used measurement for obesity. The BMI approximates body mass, using a mathematical ratio of weight and height (kg/m²) or weight in pounds divided by height in inches squared and this amount multiplied by 703. A BMI of 30 or more is regarded by most health agencies as the threshold for obesity. A BMI of 40 or more generally qualifies as morbid obesity. However, the BMI does not distinguish between muscle and fat.

Chronic Pancreatitis -  A progressive inflammatory disease of the pancreas, which may be accompanied by abdominal pain and problems in digestion. 

Cirrhosis - A chronic condition in which the liver becomes scarred, fibrous, and filled with fat, thus reducing its ability to function.

Comorbidity -  A medical condition that exists in addition to and is caused or worsened by obesity or any other primary disease being studied or treated. With sufficient weight loss, obesity-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea generally improve or completely resolve. 

Contraindication - A factor that makes a particular treatment or procedure inadvisable.

Dumping Syndrome -   A physiological reaction frequently seen following gastric bypass surgery. This operation is designed to alter the function of the stomach and intestines and interrupt normal digestion. Therefore, whenever patients eat certain foods such as sugar and sweets, they may experience "dumping". The patient may feel nausea, flushing and sweating, light-headedness, and watery diarrhea. Of course no one likes these feelings, especially patients who love sweets. This is a real help to them in their efforts to lose weight. 

Laparoscopy (Laparoscopic Surgery) -  A minimally invasive surgical approach where the surgeon makes several small incisions to access the interior of the body. A long, slender camera attached to a light source and specially designed instruments are used to perform the operation. Compared to the large incision of conventional open surgery, there is typically less pain and scarring following this operation.  Usually, hospital stay and overall recovery time are also reduced. 

Morbid Obesity -  A disease in which excess weight begins to interfere with basic physiological functions such as breathing and walking. Generally, it can be defined as being 100 pounds overweight. A more precise indicator, however, is a Body Mass Index of 40 or greater.

Obesity Related Comorbidities - Diseases that are directly associated with morbid obesity:
  

Sleep Apnea -  The temporary cessation of breathing during sleep. Typically, the sufferer will awake gasping for breath. Sleep apnea may occur repeatedly, resulting in a poor night's sleep and daytime drowsiness. One of the comorbidities associated with morbid obesity. 

Type 2 Diabetes -  A chronic endocrine disorder characterized by the inability to properly utilize sugar, specifically glucose, a simple carbohydrate. This results in excessively high glucose levels in the blood. Diabetes involves a relative or absolute shortage of insulin, a hormone that regulates the body's breakdown of carbohydrates. A higher percentage of obese individuals have type 2 diabetes than does the general population.