Obesity surgery is taking the country by storm. Almost everyone knows someone who used surgery to lose an incredible amount of weight. They have gone down several clothes sizes and look and feel like a different person.

Morbid obesity, being more than 100 pounds overweight, is a growing health problem, causing a host of co-morbid conditions, including type-2 diabetes, cardiovascular disease, high blood pressure, sleep apnea, hyperlipidemia, arthritis, and stroke, several types of cancers, and urinary incontinence. It is the second leading cause of preventable death in the United States related to 300,000 deaths per year. In addition, morbid obesity shortens the individual's life span by as much as 12 years.

Unfortunately, the cause of morbid obesity is not completely understood. Metabolic, genetic, psychological and behavioral factors play a role, making a medical cure unlikely. Several studies have confirmed that medical treatments using diet, exercise, and medications are successful less than 5% of the time.

However, there is clear evidence that bariatric surgery produces significant sustainable weight loss. This has led the National Institute of Health (NIH) to state that surgery is the treatment of choice for patients who have been unsuccessful at losing weight using medical treatments.

Operations to alter the gastrointestinal tract and produce weight loss have been applied for half a century. Restrictive operations limit caloric intake by restricting how much one can eat, while malabsorptive operations limit absorption of nutrients by the intestines. There is no magic involved, they work by limiting the amount of calories taken in by the gut and used by the body. If more calories are burned off than taken in, weight loss occurs.

The two most commonly performed operations for morbid obesity are the gastric bypass and the adjustable gastric band, or Lap Band ™. Both may be performed using minimally invasive laparoscopic surgery.

The gastric bypass uses stapling devices to create a small stomach pouch, the size of a shot glass which is connected to a loop of intestine in a Y formation. This allows the food you eat to travel down a “food tube” until it meets the digestive juices at the junction of the Y. The gastric bypass is a combined restrictive and malabsorptive operation.

The Lap Band ™ is a purely restrictive operation using an adjustable silicone band placed around the upper stomach to form a small pouch. This induces a full feeling while food slowly empties into the stomach.

The sleeve gastrectomy is another option which is being done more often. This involves removing 90% of the body of the stomach, so the food can only go down a thin tube. This is a restrictive operation shown to produce significant weight loss. This operation may need to be converted to a gastric bypass in the future if there is inadequate weight loss.

After laparoscopic gastric bypass (LGB), patients spend an average of two or three nights in the hospital and are back to work in 2-4 weeks. The Lap Band ™ patients spend one night in the hospital and can resume work within one week. It is possible to resume aerobic exercise in 10-14 days and lifting more than 20 pounds in four weeks.

A high protein low carbohydrate diet of about 800 to 1200 calories a day is paramount after bariatric surgery. This promotes breakdown of body fat and preservation of muscle. After either operation, patients are kept on a low sugar nourishing liquid diet for about two weeks, followed by two weeks of pureed or soft foods. After about a month, normal diet may resume, including small meals at restaurants and social gatherings.

After the Lap Band, only a multivitamin is necessary, while post-gastric bypass patients also need Calcium, Vitamin B12 and sometimes iron supplementation.

Patients who undergo LGB typically experience 60-70% excess body weight loss (EBWL) and 84% resolution of diabetes, 94% resolution of hypercholesterolemia and 87% resolution of sleep apnea. The Lap Band produces 40-50% EBWL and less predictable improvement of co-morbid diseases. The sleeve gastrectomy has been shown to produce about a 55% EBWL at three years.

We believe that modern bariatric surgery is a breakthrough in patient care and is life-saving in the long run, but may not be right for every obese patient. We highly recommend it to patients that are good candidates; those that are morbidly obese, have failed medical weight loss attempts, are motivated and well informed, and are free from significant psychiatric disorders.

We require a psychologic evaluation and nutrition consultation for preoperative evaluation and to help with postoperative management. The surgery is not a quick fix, nor is it guaranteed to work. It is a tool to help people conquer their dependence on food. Thus patients must be committed to making a life change.

Both operations carry the normal risks of an intraabdominal operation; bleeding, infection, injury to other organs, blood clots and pulmonary emboli, bowel obstruction and failure of the operation to work. Many media outlets exaggerate the bad outcomes and do not show the huge success stories. The truth is that for laparoscopic gastric bypass, the rate for serious complications is 2% and the mortality rate is 0.5 to 1.1 %. The rate for serious complications after the Lap Band is 0.2%, while the mortality is 0.05 – 0.4%.

There are now nine million morbidly obese Americans who need help. However, non-operative management is not working. Gastric bypass and banding offer patients the ability to lose hundreds of pounds, feel better, and have more energy. This can reverse the cycle of weight gain, associated diseases and early death. Our patients are uniformly happy about the choice to have surgery and are grateful that we were able to help them.

This surgery is a very big undertaking. It is not a quick fix. A patient must be committed to a life long change in his or her anatomy to halt the hunger drive and decrease caloric consumption. He or she must also be dedicated to a new healthy diet and increased exercise.

All patients will need a psychological evaluation to rule out underlying psychological disorders and allow treatment prior to surgery. It is also to assess their ability to understand the risks and benefits of weight loss surgery and the lasting effects on the gastrointestinal tract.

Patients are also evaluated by the nutritionist, and eating habits are assessed. The postoperative diet is discussed.

Some insurance companies require a 6 month pre-operative preparatory program of medical weight loss with diet, exercise, behavior modification and sometimes medications. This can be facilitated by the Center for Weight Management. We then apply to the insurance company and get pre-determination of benefits. When the patient is approved, we will schedule surgery.

After surgery is scheduled, they need a history and physical, cardiac clearance with EKG, possibly a stress test, cardiology consultation, pulmonary function tests, upper endoscopy and gallbladder ultrasound.

Dr. Haggerty obtained extra training in obesity surgery in 2003 after seeing the remarkable successes that are produced, giving patients a chance at a much healthier and longer life. It was an easy transition, since he has a special interest in gastrointestinal surgery and has been a pioneer in advanced laparoscopic surgery at Highland Park Hospital.

Experience in the field and routine post-graduate course work has given him a thorough understanding of morbid obesity, allowing him to meet the unique challenges these patients face. In addition, he is co-author of the Society of American Gastrointestinal and Endoscopic Surgeons guideline for clinical application of laparoscopic bariatric surgery.

Dr. Haggerty helps direct the NorthShore Highland Park Hospital Center for Weight Management. This is a multidisciplinary weight loss program using bariatric dietitians, psychologists specializing in weight, physician directed medical weight loss, exercise physiologists and bariatric surgeons. Patient support groups are available weekly to help patients maintain a healthy diet and attitude after the operation.

For more information see NorthShore University Healthsystem's website for details on their Bariatric Services and Dr. Haggerty.

We are ready to partner with you on this journey to achieve better health and self esteem. Please call 847-433-1060 to make your appointment.