The obesity problem
Did you know that the World Health Organization estimates that nearly 80% of adults in the United States are overweight (BMI > 25 kg/m2)? Almost half of these people are considered obese (BMI > 30), and approximately 23,000,000 Americans are severely (BM I> 35) or morbidly obese (BMI>40). Every one of these people is at risk for serious illness --or even death -- from many conditions, including Type 2 diabetes, hypertension, heart disease, stroke and cancer.
Recognized by the National Institute of Health as a serious chronic disease, obesity has a complicated list of possible causes, including genetics, environment and behavior. Researchers do know, however, that it can affect anyone regardless of age, gender or race and is usually a life-long disease requiring life-long treatment.
While some people can control their weight with diet and exercise, many others cannot. With the serious complications of obesity, many of these people have turned to bariatric (weight loss) surgery. After discussion with their medical care teams, they have balanced the risks and benefits and have decided on a more reliable treatment. It’s very important to understand, however, that all obese patients still require lifelong changes in eating habits and other behaviors.
Gastric bypass was the first successful technique, first done about 30 years ago. Performed either through an open incision or using laparoscopy (“band-aid surgery” using a scope to see and guide tiny instruments inserted through thin tubes). Gastric bypass permanently reduces the size of the stomach, and shortens the small intestine by “bypassing” a portion of it. This results in both reduced intake and reduced area for absorption of nutrients, the job of the small intestine. Fewer surgeons do this procedure today, since it may be technically difficult and cannot be reversed.
In recent years, new techniques have been developed which are less complicated, but still work on “tricking” the stomach into feeling full on less food.
Laparoscopic banding (Lap-Band® System)
Using the “band-aid” surgery techniques, the surgeon wraps a soft hollow tube around the stomach. The tube is filled with saline, and a small stomach pouch is formed above the inflated tube. Stomach contents can then pass through a small opening at the base of the pouch, and travel normally through the gastrointestinal tract. The amount of saline inside the tube can be changed easily using a needle placed into a port just under the skin of the abdomen.
The whole procedure is done laparoscopically and leaves only 3-5 tiny scars on the abdomen.
Vagal nerve blocks (VBLOC Maestro® System)
The vagus nerve is the most important nerve controlling the normal activity of the internal organs. It’s been known for years that cutting the vagus nerve branches to the stomach can cause weight loss since the impulses that signal hunger to the brain are no longer available. Physically cutting the nerve requires surgery, and the nerve pathways often find a way to regenerate afterward, making the procedure less effective in the long run.
The VBLOC system uses high-frequency electrical impulses to block the vagus nerves. Small electrodes implanted at the two stomach branches of the nerve, and impulses are sent through a small rechargeable regulator – much like a heart pacemaker – inserted under the skin. The whole procedure is done laparoscopically and leaves only 3-5 tiny scars on the abdomen, as in most other laparoscopic surgeries.
There are similar procedures available. As noted before, the type of procedure will depend upon your individual needs and discussion with your surgeon. In combination with proper diet and exercise, bariatric surgery can be a viable way to reduce the health risks associated with significant obesity.
Contact Guilherme M. Campos, M.D., F.A.C.S., F.A.S.M.B.S.
VCU Medical Center at Stony Point
9000 Stony Point Parkway
Richmond, Virginia 23235
Phone: (804) 828-9331
Ambulatory Care Center
417 North 11th Street, 3rd Floor
Richmond, Virginia 23219
Phone: (804) 828-8000
Fax: (804) 827-0670
MCV Department of Surgery at Forest Avenue
7301 Forest Avenue
Richmond, Virginia 23226
Phone: (804) 828-8000