Good decisions must follow bariatric surgery, doctors say

In quality-of-life surveys, patients who were once morbidly obese but have lost significant weight after bariatric surgery report higher levels of physical activity, a greater sense of self-worth, improved intimate relationships and even gains in their employment.

But despite those impressive benefits, weight-loss surgery doesn't change clinical depression. And doctors who perform the surgeries are quick to point out they're not magic bullets. People need to make good nutrition decisions and commit to long-term exercise and lifestyle changes, too.

Dr. Sherman Smith, director of bariatric surgery at LDS Hospital, and Dr. Rodrick McKinlay, general and bariatric surgeon at LDS and St. Mark's hospitals, fielded calls from as far away as California on Saturday morning during the Deseret News/Intermountain Healthcare Hotline on bariatric surgery. Most of the calls involved either gastric bypass or the lap band.

Some of the calls came from older Utahns who have grown heavy over the course of time and wonder what surgery options they have now that they're senior citizens. The answer depends a lot on actual age and personal situation of the would-be patients, the doctors agreed.

You might consider one of the surgeries for someone who is 70 and in otherwise excellent condition, except for the weight. But the reality is that most people who are heavy enough to need a surgical solution are not going to be in excellent health. There are a number of other medical conditions that go hand-in-hand with obesity, the doctors said.

Smith said the lap band is Food and Drug Administration-approved for those 18 to 65. Using it in someone outside of that range would be unusual. It would require compelling reasons and probably some outside review, perhaps by an institutional review board.

A couple of callers said they'd had successful procedures but have since regained some of the weight. That's not uncommon if people don't closely follow the post-surgery advice for exercise and nutrition, the doctors said.

There are "revisions" that can be done to boost the weight loss effectiveness. A surgeon might even do a lap band over an existing gastric bypass. But McKinlay said that most of the time, a subsequent surgery doesn't yield as much weight loss as the initial effort.

There are benefits and risks associated with both types of surgeries and those should be discussed thoroughly, but "the risk from being obese is incredible, too," he said.

Occasionally, a lap band or gastric bypass needs reversed, and when that happens, most people regain the weight they lost within a year, Smith said.

Smith will be discussing surgical weight-loss issues at LDS Hospital's "Your Best Health" lecture series at 6 p.m. Jan. 21 in the education center, 8th Avenue and C Street.

The health hotline tackles a different topic the second Saturday of each month. Readers also were invited to e-mail questions for Smith and McKinlay. Their answers to a representative sample of those questions will be posted online Friday.

E-mail: lois@desnews.com