By Dr. Howard LeWine
Harvard Health Blog
New Jersey Gov. Chris Christie’s revelation that he’d secretly undergone weight-loss surgery should not have been a big surprise. Christie has been publicly, and privately, struggling with his weight for years and fits the profile of a good candidate for this kind of operation.
Although weight-loss surgery, also known as bariatric surgery, should only be considered a last resort when diet and exercise don’t work, it can do some amazing things. Among people who are severely overweight, it can yield a 25 percent to 35 percent weight loss within two years.
In many people who undergo the surgery, Type 2 diabetes, high blood pressure, high cholesterol, and the disruptive and potentially harmful snoring pattern known as sleep apnea disappear. It can also improve a number of other health problems, ranging from arthritis and heartburn to infertility and incontinence.
In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease or sleep apnea.
Much of the speculation about Christie’s surgery was whether he did it for political reasons or concerns about his health. But there shouldn’t be any speculation about whether he was a good candidate for the procedure. While the governor never made public his exact weight, the estimate is more than 300 pounds. At just under 6 feet tall, that gives him a body mass index of at least 41. Christie also acknowledged trying to lose weight many times, using different programs. He had some initial success, but like most obese people, regained all the lost pounds and more.
Even if Christie’s claims of otherwise being in good health are correct, he was at high risk of developing problems directly related to his weight. I believe his choice was a good one for his health.
TYPES OF SURGERY
Christie underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery.
Gastric banding is done laparoscopically, meaning through small holes made in the abdomen. The surgeon wraps an adjustable silicone band about two inches in diameter around the upper part of the stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The small size of the upper stomach makes a person feel full much sooner than before.
Depending on the person’s rate of desired weight loss and how he or she feels, the band can be easily tightened or loosened as needed by injecting or withdrawing sterile salt water saline through a port implanted just under the skin. Compared with gastric bypass, the surgery is simpler and has a lower risk of complications immediately following the operation.
Gastric bypass, also known as the Roux-en-Y procedure, shrinks the size of the stomach by more than 90 percent. This makes a person feel full after eating very small amounts of food. In addition, the body absorbs fewer calories because food bypasses most of the stomach and upper small intestine.
The operation is done through an incision made in the abdomen or laparoscopically. The surgeon converts the upper part of the stomach into a small pouch about the size of an egg. The small intestine is then cut. One end is connected to the stomach pouch and the other is reattached to the small intestine, creating a Y shape. This allows food to bypass most of the stomach and the upper part of the small intestine, although both continue to produce the gastric juices, enzymes and other secretions needed for digestion. These drain into the intestine and mix with food at the crook of the Y. Gastric bypass surgery is not reversible.
The gastric sleeve technique transforms the stomach into a small, narrow tube by removing the curved side of the organ. This creates a small pouch using the side of the stomach rather than the bottom. One advantage is that no rearrangement of the intestines is needed. The vertical pouch this procedure creates is less prone to stretching compared to the pouch left by a gastric bypass. Like gastric bypass, gastric sleeve surgery is not reversible.
For the first few months after surgery, appetite is usually turned down. Eating too quickly or too much overfills the stomach pouch. That can cause vomiting or pain in the chest and upper abdomen. After a high-carbohydrate meal, a person who’s had gastric bypass surgery may suffer from “dumping syndrome,” a reaction that causes flushing, sweating, severe fatigue, nausea, vomiting, diarrhea and intestinal gas.
To prevent nutritional deficits, it’s a good idea to take vitamins (especially vitamins B12 and D) and minerals (especially calcium and iron).
If you’re considering weight-loss surgery, realize that you must commit to a life-long change in the way you eat. Surgery without lifestyle change will either make you miserable or not result in successful weight reduction. Likely both.