A Fundamental Shift in Bariatric Surgery
Cascade Business News - October 3, 2007
by Dr. Kent Yundt & Dr. Stephen Archer
We've all heard the statistics - 35 percent of the U.S. population is considered morbidly obese. Along with the obvious debilitating effects of carrying around more body weight, obesity is often the cause of other health issues such as high blood pressure, diabetes and high cholesterol.
Morbid obesity is defined by body mass index (BMI), which is the amount of body fat based on height and weight. Having a BMI of 35 or above puts the patient at risk for myriad diseases, as well as decreasing their chances of dieting their way to health.
Dr. Stephen Archer of Advanced Speciatly Care is a general surgeon with a specialty in bariatric surgery. Bariatrics is the study and treatment of obesity, including such procedures as laparoscopic adjustable gastric band surgery and gastric bypass surgery.
These procedures are among the various tools Dr. Archer uses to bring a patient back to a healthy weight and combat the other diseases that may accompany obesity.
Dr. Archer is fellowship trained in laparoscopic surgery and has been practicing in Bend for six years. He relocated to Central Oregon from Atlanta, where he was an Assistant Professor of Surgery at Emery University, receiving his MD with Honors from the University of Tennessee, Memphis. He specializes in bariatric surgery because he believes that obesity, like alcoholism, is a disease and must be treated as such.
When a patient comes to Dr. Archer for the treatment of obesity, a health care team begins a three month, detailed workup including everything from BMI to psychological evaluation. Life-style changes are addressed, including referrals to support groups and a thorough education on the lifetime benefits and consequences of a surgical procedure. Once the patient is determined to be a candidate for surgery, Dr. Archer performs either the Lap-Band procedure, in which a band is placed around the top of the stomach decreasing the stomach capacity, or a gastric bypass, in which the stomach is divided with staples and the small intestine is attached to the new, smaller stomach.
These procedures drastically reduce the amount the patient can consume, taking the stomach from a 50oz capacity to 1oz capacity. This is the beginning of changing the patient's "metabolic set point", a weight the body strives to attain. People suffering from obesity have much higher set point than healthy people, and the goal of the surgery and the post-operative treatment is to get that set point to lower level. Changing the set point takes about 18 months and is helped by exercise and building muscle mass.
When patients come to Dr. Archer for treatment of obesity, they are getting a lifetime of treatment. After surgery, patients are assigned a mentor, someone who has been successful an is willing to help with lifestyle changes. As far as Dr. Archer knows, this is the only mentor program of its kind in the country. The patient is encouraged to attend support groups, work with the dietician and must have yearly checkups for the rest of their life.
But as Dr. Archer says, "There are not enough surgeries in my (or any bariatric surgeon's) career to take care of every one that needs this." In this country, there are 25 million people that could qualify for these procedures, but many are not covered by their insurance companies. Although insurance companies are starting to realize the cost benefits of treating obesity rather than treating all of the co-diseases, it is still a battle for many to get these procedures covered. "Obesity is the last safe place for prejudice, " says Dr. Archer.
As with any disease, preventative measures are preferable to surgical procedures. To prevent obesity, there must be a fundamental way we as a society change our eating and exercise habits. Living in Central Oregon, we may think we are ahead of the game because of the pervasive athletic culture. According to Dr. Archer, Deschutes County has the same obesity rate as the rest of the country - 35%.
To try to help that fundamental shift, Dr. Archer is on the board of Get Outta My Face (GOMF), an organization of kids that attack the marketing of unhealthy products geared toward youth. GOMF created a film that was accepted into the BendFilm Festival called Punk Da Junk: A Journey of Epic Nutrition, which has already received Best in Show honors at this year's Future Filmmaker's Festival.
Dr. Archer believes that by making this surgery more available through insurance coverage and hospital access, and educating our youth on food and exercise choices, we as a society can fight this disease.
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