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Gastric Bypass Surgery

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Americans see thousands of ads about the next revolutionary weight loss book, diet, pill, program, exercise method, and countless other alternatives. With over 300,000 Americans dying each year and a $117 billion bill in health costs, it makes sense that attempts to provide solutions are increasing (Greenblatt, 2003). Surgery, however, appears to be the only true dramatic option for those seeking to lose significant weight. The most common method, gastric bypass surgery, is discussed by celebrities and late night infomercials alike. With claims ranging from miracle panaceas to terrible side effects, it can be difficult to decipher reality from puffery. In order to better navigate the truth, various several autonomous and reliable sources were consulted, ranging from medical journals to research studies to magazine articles. After examination of more credible sources, it is clear that the benefits outweigh the costs for gastric bypass surgery; however, it is a financial burden and there are not enough doctors to meet the demand. Therefore, traditional methods may be necessary, if surgery is not possible.

Due to the somewhat complex nature of the surgery, a thorough description is often disregarded in its various advertisements. According to Marc Ambinder, an Atlantic journalist who underwent the surgery, gastric bypass surgery is a procedure that re-directs the digestive system to the upper part of the small intestine, bypassing most of the stomach and duodenum (Ambinder, 2010).

Another less extreme but equal in price surgery called the Lapband procedure uses an adjustable band that restricts the amount of material that can pass through the stomach opening.

The most common of all gastric weight loss surgeries is, however, still the gastric bypass surgery. There are two types of gastric bypass surgeries: open and laparoscopic. Despite the significantly reduced cost of open surgery, on average $4,800, it is used in only 3% of bypass surgeries (Livingston, 2011). This is likely the result of its increased complications, hospital stays, intensive care unit admittance, and overall total cost, when compared to laparoscopic surgery. A laparoscopic procedure involves the use of small cuts and optic tools instead of opening the entire abdomen region, as the open method does. Therefore, the laparoscopic technique is much less invasive and risky than open surgery, making it a more logical and safe choice for most patients (Ambinder, 2010).

Not every individual can be considered for gastric bypass surgery. Because of the risks and limited supply of specialized doctors, surgeons typically only accept morbidly obese patients for the procedure. An obese person is defined by charts according to his or her height and weight. For example, a 5’ 6” male is considered overweight if he weighs 163 pounds or more. This male would be considered morbidly obese if he weighed 263 (100 pounds more than what is considered obese) pounds or more (Greenblatt, 2003). Thus, claims that the procedure is a panacea are false. Only morbidly obese individuals can receive this treatment type.

For those who qualify, gastric bypass surgery has numerous benefits. Of course, the main advantage is dramatic weight loss. On average, patients can expect to lose 100 pounds, depending on several factors including amount overweight, height, life changes, and genetics (Greenblatt, 2003). The direct benefit of weight loss is the paramount reason for undergoing gastric bypass surgery; however, there are several indirect benefits of the surgery. Overall, patients’ health improves with lowered obesity-related problems such as heart attacks, trouble sleeping, and breathing problems. In many cases, the procedure has even cured type two diabetes (Ambinder, 2010).

The extreme weight loss resulting from the surgery can also provide important social benefits. Since society does not regard obesity favorably, it can be difficult, as a morbidly obese individual, to navigate social situations and work. There is constant pressure to shed pounds that may or may not be easy to do. However, the procedure can make a significant step to reduce social segregation and return much needed self-respect and dignity. Marc Ambinder summarizes this sentiment when he says, “Walking by my office, a colleague calls me a ghost of my former self…I had the resources to conquer obesity and all its attendant miseries with major surgery” (Ambinder, 2010).

After experiencing the social and weight loss benefits, many patients gain the unusual but useful advantage of increased cognitive abilities. According to a study by psychology professor John Gunstad of Kent State University, individuals who lose significant weight, often through surgery, can make mental advancements. Gunstad studied a group of 150 overweight individuals of which 109 had some form of gastric surgery and the remaining 41 did not. The 109 persons who lost considerable weight (an average of 50 pounds) improved their memory and organizational skills. The others experienced slight declines in their cognitive abilities. Gunstad states that, “it’s a logical conclusion that as the body becomes healthier, the brain would become healthier also” (Hellmich, 2011). Thus, improved mental condition can be added to the list of benefits for gastric bypass surgery.

With so many advantages to the bypass procedure, it may be surprising that the government, insurance companies, and obese persons are often not willing to invest in the procedure. Not everyone participates because, as with most dramatic solutions, there is risk and cost involved. The Mayo Clinic states that side effects include “gallstones, bleeding stomach ulcers, kidney stones, damage to the intestines and stomach, low blood sugar, pneumonia and death from blood clots in the legs or reactions to anesthesia” (Butler, 2010). In Knuth’s case, the surgery meant 62 doctors visits and chronic, nearly life-threatening conditions that require specially formulated vitamin supplements and diet programs. While similar complications are common in all surgeries, a minor but more frequent side effect, malnutrition, is specific to gastric bypass surgery. The body cannot absorb all the nutrients it needs in such a small space and is starved for important vitamins and minerals, which can lead to diarrhea, skin inflammation, and even lasting nervous system damage. However, these side effects can be avoided through special diets and supplements prescribed by the surgeons that perform the surgery (Butler, 2010).

Another concern for patients considering gastric bypass surgery is relapse rates and addiction transfer. Some individuals substitute their addiction for food with another addiction such as drugs or alcohol. The rate to which this occurs is debated and is said to be anywhere from 5 to 30 percent. To prevent addiction transfer, patients should first deal with the fundamental emotional problems through therapy or counseling before considering the surgery. The other problem, relapse, is estimated to occur in about 10 percent of patients, according to Weight-control Information Network. If food is consistently forced into the smaller stomach, it can eventually stretch, allowing room for additional weight gain (Butler, 2010). Yet, this is a relatively small percent, and it can easily be prevented by diet change, which is essentially forced through the bypass surgery.

Perhaps the most important side effect is the financial burden. No surgery is cheap. Gastric bypass surgery is not exception, costing between 20,000 to 30,000 dollars, depending on the type (open or laparoscopic), condition of the patient, and other factors. Insurance companies determined that the financial benefits are not realized immediately enough to justify any contribution to the cost of the surgery and consider the preventative measures to be a higher priority (Ambinder, 2010). Therefore, individuals must pay completely out-of-pocket to achieve the benefits of gastric bypass surgery. Even financially secure individuals have difficulty producing $30,000 cash and often have to participate in payment programs. The chart below demonstrates how much the surgery can actually cost and how long it will take to pay it off, if a payment option is used.

Initial amount

$30,000.00

Minus down payment

$2,500.00

Payment amount

$27,500.00

Monthly payment

$250.00

5% interest

$12.50

Total Cost

$31,375.00

Years till paid

9.1666667

However, there were 220,000 individuals who had gastric bypass surgery in 2008 (Ambinder, 2010). For many persons, the cost is well-worth the numerous benefits provided by the procedure. It can also save money with decreased doctor visits, emergencies, overall health risks, and diabetic care payments.

Overall, gastric bypass surgery is successful, especially as advanced techniques and tools are used with continued experience in the field. The death rate has dropped to .05 percent, which is comparable to other similar surgeries. Improvements were made in long-term success rates (maintaining 50% excess weight off for an extended period of time). The rate of major complications is less than 3% (Ambinder, 2010). Thus, the surgery can be recommended as a solution for morbidly obese individuals who are unsuccessful with other methods and can afford its financial cost.

If the surgery is too costly or the patient is not morbidly obese, there are many effective alternatives. The first and easiest alternative is to drink less sugary beverages, which is a main cause of weight gain (Hasty, 2009). It is advised that the change is gradual, so that high sugar drinks may eventually become less appealing to the once heavy drinkers. The second tip, as cliché as it is, is to maintain an appropriate diet. The body needs certain amounts of vitamins, minerals, protein, and healthy fats. It does not need more sodium and sugar. A healthier diet can be achieved by simply cooking individual meals (instead of fast food or microwavable dinners) and maintaining a healthy balance of fruits and vegetables (Berkoff, 2005). Lastly, exercise is encouraged. Individuals can start slow by walking a few miles and a time and building up to running. The important aspect is to keep the heart rate up for long enough to burn excess fats and sugars. No matter what genetics are involved, consistent exercise is always good for the body and reduces risk of many health problems such as heart attacks and excess stress.

Gastric bypass surgery, despite its risks and cost, significantly reduces health issues for obese individuals. The risks have decreased with year of surgery perfection and advances in technology, placing it on par with many other simple surgeries. Thus, the main problem is the cost. Many individuals cannot afford the 20 to 30 thousand dollars it costs to receive the benefits of the surgery. However, it is important to note that the surgery essentially forces people to live a healthy lifestyle, something that can be done for free. It forces individuals to eat less, maintain a healthy diet, and exercise in a gradual process. The only difference surgery makes is an ultimatum of not being able to eat too much or take in too much junk-food. Traditional alternatives are just as effective and only take longer than surgery. Therefore, individuals who cannot afford the surgery are advised to slowly make better health decisions with the support and encouragement of others who have been in the same position.

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