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Big losers get to be winners through bariatrics: New medical team concentrates on overweight treatments

Dr. Jon Pressett
Ciji Karcich

By JOHN SERFUSTINI

The American Medical Association made headlines last June when its members voted to recognize obesity as a disease. That defines it as a disease of epidemic proportions, affecting nearly one in three Americans.

Aside from the hassle of hauling around extra poundage, an extreme overweight condition (called morbid obesity) is a gateway to a host of other medical problems, according to surgeon Jon Pressett.

It often leads to such things as high blood pressure, high cholesterol, sleep apnea and Type II diabetes, he said. Those things pose big problems for the heart and circulatory system. So a person who loses excess weight stands to win the benefits of better health.

Pressett has teamed up with Paul Thayn, a doctor of internal medicine, and other medical professionals at Castleview Hospital to launch a new program of bariatrics. (The word comes from the same root as "barometric," pertaining to weight.)

Pressett said it is a combination of medical specialties that has become a specialty of its own.

Ciji Karcich, office coordinator for the program, said the treatment begins with an orientation, followed by a physical by Paul Thayn to check for such things as diabetes, thyroid or apnea.

Those who choose to participate will learn how to make their diet healthy, said Pressett, and those for whom surgery is recommended will also be required to lose a few pounds through diet.

"It's difficult to lose weight on your own," Pressett said. "The body gets used to being at a certain weight, so weight loss and weight gain get to be cyclical. Surgery is not cyclical."

That surgery is to either excise or bypass part of the digestive tract. Pressett does this by "minimally invasive surgery" - small incisions or laparoscopy.

The two methods he prefers are gastric bypass and gastric sleeve.

In gastric bypass, the surgeon separates most of the stomach and part of the small intestine from the active part of the digestive tract. The remaining part of the small intestine is then connected to a small pouch of stomach that has remained connected to the esophagus.

The bypassed stomach and duodenum are left in the body as remnants. The stomach still secretes acid, but the duodenum can no longer help digest sugars and fats.

Eating too many sweet or fatty foods can lead to a reaction called "dumping," which is characterized by abdominal pain, rapid heart rate, sweating or diarrhea.

It is an unpleasant reminder

to avoid that kind of food. However, it is one of the ways the surgery produces weight loss.

The other two ways, far more pleasant, are restriction and hormonal change.

With less stomach volume, there is not enough room to cram in a lot of food.

Surgery also affects an apothecary shelf of hormones, reducing some or stimulating others.

"If we knew why, it would be worth a Nobel Prize," Pressett said, "because then we'd be able to use pills instead of surgery."

His other preferred surgery is gastric sleave. In this procedure, 85 percent of the stomach is taken out, with the remainder sewn up to resemble or tube or sleeve.

The advantage of this method is that the duodenum remains, so it can process and absorb nutrients.

The restriction and hormonal affects still enable rapid and permanent weight loss.

Speaking of dramatic weight loss, Pressett said there isn't much worry about starvation or malnutrition after surgery. "It's something that's a bigger concern for people before than after the surgery," he said.

The surgeon added that people will typically lose about 70 percent of their weight loss goal with the procedures. Losing the rest is something they have to do themselves.

Karchich explained that this is why the rest of the program emphasizes behavioral changes, nutrition and excercise to achieve the target weight.

"It's exciting to see what people want to do for themselves," Pressett concluded. "One patient even sent me a picture of himself dressed for a marathon."




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