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Bariatric Surgery - When All Other Options Fail

In the United States we are in the middle of an obesity epidemic. In 2010 there were twelve (12) states with an obesity prevalence of 20% or greater. Currently 66% of the US population is overweight or obese, and approximately 34 % of adults over the age of 20 years meet the criteria for severe/morbid obesity.

One of the results of this obesity epidemic has been the increased efforts to control it with 1) prevention through education, 2) correction through life style changes and 3) direct intervention through surgeries, both minor and major. One of the most drastic measures in this effort is Bariatric Surgery.

JUST WHAT IS OBESITY?

Obesity, simply put, is being very much overweight. Obesity is recognized as, and understood to be, a cause of, or contributor to, many other health issues... diseases such as diabetes, heart disease, hypertension, asthma, stroke, sleep apnea, arthritis and some cancers.

Generally obesity is determined by the measure of Body Mass Index. Body Mass Index, or BMI, is a measure obtained from the relationship between one's weight and one's height. BMI provides a simple numeric measure of a person's "healthy weight".

A healthy adult's Body Mass Index/BMI (Kg/m2) ranges from 18.5 to 24.9, while an overweight adult's BMI ranges from 25 to 29.9. Obesity is divided into three categories. Individuals with a BMI of 30 to 34.9 have Class I obesity; those with BMI of 35 to 39.9 Class II obesity; and those with a BMI of 40 or greater have severe/morbid Class III obesity. In addition, waist circumference has also been used to classify obesity. Females with a waist circumference of 35 inches or greater, and males with a waist circumference of 40 inches or greater are generally classified as obese.

Weight Loss Surgery

Weight loss surgery, also called bariatric surgery, has grown in popularity over the past two decades and it has become the solution of choice for many obese people. Unfortunately, in many cases it has become "a solution too soon." That is to say, that sometimes the surgery is chosen before other more practical and less invasive methods of weight control are considered or applied. Bariatric surgery should be considered a valuable "tool" in counteracting obesity but not as a cure for the condition.

It is recommended that before weight loss surgery, potential candidates be evaluated by a multidisciplinary team with medical, surgical, nutritional and psychological expertise. This team should evaluate and declare the patient to be in good health, demonstrating appropriate psychological motivation to succeed. The individual should be deemed to have the commitment to lifelong post operative lifestyle changes and surveillance. Ideally, the patient should be willing and required to participate in a preparation/behavior modification program and lose some weight prior to surgery.

So, just who is a proper candidate for bariatric surgery? Well, the National Institute of Health (NIH) suggests that a person who has tried and failed at non-surgical attempts to lose weight... things such as diet and exercise; pharmacotherapy; weight loss program(s), hypnosis, counseling, jaw wiring, and who has a Body Mass Index (BMI) of 40 or more... or a BMI of 35 to 39.9 for those with significant co-morbid conditions, qualifies for weight loss surgery.

Severely obese people find it difficult to lose weight by diet and exercise alone, and sometimes because of their current limitations, weight loss surgery may be their best and only option. But to be truly successful, the ultimate goal must be to bring about a total lifestyle change, and that the surgery must be viewed as one step in making that change possible. In addition, a post operative regimen must be adopted and maintained for long term success.

Beverly Russell, MA, is a Board Certified Adult Medicine Nurse Practitioner at Kaiser Permanente, Los Angeles Medical Center and has been working as a Bariatric Surgery NP for over 6 years. She is an Associate Clinical Professor with the Family Nurse Practitioner Program at UCLA, Adjunct Professor of Health, Los Angeles City College and a Continuing Educator Provider (CEP) Certified by the Board of registered Nursing. For more information visit: http://www.beverlyrussellseminars.com.

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