Surgery program starts Battling obesity
By CHRISTOPHER DIEM Journal Staff Writer
MARQUETTE — Every hour about 45 people around the country die from obesity-related health problems.
About 25 percent of the industrialized world is obese, equaling 1.7 billion people. In the United States alone, 65 percent of the population is overweight. Over 8 million of those are morbidly obese. Morbid obesity is the leading cause of preventable death in the country and Michigan is the 11th most obese state in the country.
To help combat this national epidemic, Dr. Wayne English, a surgical weight loss specialist, has been building a bariatric surgery program at Marquette General Hospital for the past several months.
“This is a very complex surgical procedure. But when you’ve done it as many times as I have — around 1,000 times — it’s second nature,” English said.
English first started performing bariatric surgery in 1999. He was one of the first doctors in the country to perform it laparoscopically, using a minimally invasive technique.
“We place a tiny telescope with surgical instruments into the abdominal cavity through small incisions and we watch on a monitor what’s going on inside you,” English said.
English specializes in a procedure called Laparoscopic Roux-en-Y Gastric Bypass surgery. It involves stapling off a portion of the stomach and creating what’s called a gastric pouch — no bigger than a thumb.
A length of the small intestine is removed from the bottom of the stomach and attached to the pouch, while the intestine that is left at the bottom of the stomach is reattached further down, bypassing a length of the small intestine and meeting near the small bowel.
“In the bypassed portion of the stomach you have all the gastric secretions — stomach, liver, and pancreatic juices coming into the small intestine and eventually meeting up where we reconnect in the small bowel,” English said.
English said bypassing the length of intestine limits the patient’s ability to absorb nutrients from food. If not watched carefully, this can lead to potential problems with vitamin and mineral deficiency.
Another potential complication is “dumping syndrome.” English said it is caused by eating something with a high concentration of sugar and can result in nervousness, anxiety, abdominal cramping, and explosive diarrhea.
“We generally consider someone morbidly obese if their (Body Mass Index) is 40 or more — more than 100 pounds overweight,” English said. “Complications include heart problems, diabetes, low self-esteem and physical limitations.”
Bariatric surgery is the only proven method for long-term weight control in obese patients, English said.
“With conventional weight loss, such as diet, exercise, behavior modification and anti-obesity drugs, we see a 95 to 98 percent failure rate in the obese population and close to a 100 percent failure rate in the morbidly obese population,” he said.
Studies show that surgical weight loss results in a 50 percent success rate at 16 years out, English said, meaning that patients have kept off 50 percent of their excess weight as a result of the surgery.
“The numbers that have been placed in terms of being a success is keeping 50-60 percent of the excess weight off. Some people will have lost up to 115 percent of their excess weight but I don’t advise anyone on losing more than what your ideal weight should be,” English said.
English said his goal is to create a bariatric surgical center of the highest quality, which has very strict criteria set forth by the American Society for Bariatric Surgery.
“Part of the requirements are getting a certain volume of patients — you need to have about 125 cases per year so we need to make sure that we can accommodate for that,” he said.
So far, around 90 patients have signed up for the procedure, English said. Many of the patients have to wait for a long period of time prior to the surgery for insurance reasons. Some insurance companies require more than 12 consecutive monthly visits to some sort of a physician-supervised weight management program.
English said that many of his bariatric surgery patients will be his patients for life. One of the requirements from the A.S.B.S. is that the surgeon have follow-up meetings with 75 percent of patients over a five-year period.
“The most important thing for patients to understand is that this operation is simply a tool to help modify their behavior and if they don’t utilize the tool correctly then they might not achieve the desired results,” English said.
“Rearranging the anatomy is really just a small part of making this work. The main issues are making sure that you eat correctly, drink plenty of liquids and exercise on a regular basis.”
Obesity Surgery