Bariatric surgery

Bariatric surgery can be life-saving option for the obese


Who qualifies for bariatric surgery?

• According to the National Institute of Health, patients with a Body Mass Index of 40 or higher.

• Patients with a Body Mass Index between 35 and 40 who have health conditions associated with obesity, such as sleep apnea, type 2 diabetes and heart conditions.

• To calculate Body Mass Index: Divide weight by height, squaring the inches in the height. Multiply the results by 703.

Special to the Miami Herald

To lose weight, husband and wife John and Sandy Grouten had tried almost all of the commercially available weight-loss plans: Weight Watchers, Medifast, Slim-Fast.

Nothing worked.

“We’d lose weight, then we put it back on and a little more,” said John Grouten.

What did work was bariatric — or weight-loss — surgery that the husband and wife underwent last year.

For the Groutens, diagnosed as morbidly obese, losing weight was as much of an aesthetic as it was a health issue.

John, 75, had type 2 diabetes and high cholesterol. About 10 years ago, he had to have his knees replaced. Sandy, 72, was battling high cholesterol and high blood pressure.

One year after their surgery, John takes only a low dose of heart medication and Sandy takes a low dose for her cholesterol.

“I also used to take medication for depression, I think just from not being happy with myself. We’ve saved a lot of money now from prescriptions,” said John Grouten. “Instead of prescriptions, we need new clothes.”

The Groutens’ surgeon, Dr. Samuel Szomstein, associate director of the Bariatric and Metabolic Institute at Cleveland Clinic Florida, said the surgery’s benefits go way beyond appearance: “Bariatric surgery is not cosmetic surgery. This is lifesaving surgery.”

A 2013 Cleveland Clinic study indicated that in the long run, bariatric surgery leads to patients’ type 2 diabetes going into remission. Specifically, the study found that in 24 percent of patients, type 2 diabetes went into remission, and that in another 26 percent, type 2 diabetes went into partial remission. Another 34 percent reduced their blood-sugar levels.

For the study, doctors monitored 217 patients for up to nine years after bariatric surgery.

Szomstein identifies three most common types of bariatric surgery: gastric banding, where a silicone band divides the stomach in two, giving it an hourglass shape with a small pouch on top that restricts the food intake; gastric bypass, where a small pouch is created much like in gastric banding, but doctors also construct bypasses in the small intestine to decrease the body’s ability to absorb food calories; and gastric sleeve, where about 80 percent of the patient’s stomach is stapled and removed from the body.

The Groutens, who live in Marathon in the Keys, had the gastric sleeve procedure.

“We are left with a stomach the size of a small banana,” said John Grouten.

John has lost 100 pounds. Sandy shed 75. Prior to their surgeries, John weighed 279 pounds, Sandy 240.

When it comes to weight loss after the gastric-sleeve procedure, Dr. Nestor de la Cruz-Muñoz Jr. said the surgery works not because the food intake is restricted, but because a patient no longer craves large amounts of unhealthy food.

“Somehow these surgeries change the amount the patients want to eat,” said Cruz-Muñoz, associate professor of surgery, chief of the Division of Laparoendoscopic and Bariatric Surgery at University of Miami Miller School of Medicine, and medical director of bariatric surgery at University of Miami Hospital.

That may be because the parts of the stomach that are taken out are also the parts that send signals to the brain that the gut is hungry.

“The GI (gastrointestinal) tract is a hormonally functioning organ. It’s usually the GI tract that is telling the brain that it is hungry,” said Cruz-Muñoz. “What we are finding is that changing the anatomy of the tract changes hormonal productivity. These surgeries make people choose healthier foods.”

This rationale seems to match what the Groutens say about their post-surgery diet.

“We eat much less. Sometimes we would forget about eating,” said John.

Before their surgeries, beef was a staple in the couple’s diet. “Since the surgery, I don’t think we’ve had three steaks,” said John.

While Sandy was nearly addicted to diet soda, the two also enjoyed dessert after dining on a large pizza.

“We used to eat ice cream left and right,” said Sandy.

Now, they split a plate of grilled fish with coleslaw and from time to time reward themselves with a sugar-free Fudgsicle. For breakfast, they enjoy a multigrain pancake.

“I think that’s what this whole program teaches you — to eat differently,” said John.

By “this whole program,” he means the follow up five-phase meal guidelines that patients at Cleveland Clinic Florida undergo after surgery.

“Bariatric surgery is a tool to help them lose weight, so the surgery itself is only one component,” said Lillian Craggs-Dino, a registered dietician at Cleveland Clinic Florida.

In the first phase of the meal plan, which takes place before and after the surgery, patients are allowed to consume only sugar-free liquids. Over time, they add protein to their diets — first in the form of shakes, then in the form of puréed food.

“Everything in your body is protein,” said Craggs-Dino, adding that with the rapid weight loss, patients need to replenish with proteins. “So if you eat mashed potatoes, there’s very little protein in that. If they don’t get the needed protein, they can develop other problems. Their hair could fall out.”

Craggs-Dino also leads bimonthly support groups for post-bariatric surgery patients.

“They do a lot of talking just to encourage each other and to share recipes,” she said. “Some people, even though they know they shouldn’t be eating sugar, they are eating it anyway.”

Such was the case with Terry Zarikian, who underwent gastric-band surgery about 10 years ago.

Cruz-Muñoz said that in about half of the patients who have this type of surgery, the procedure does not work in the long run. Zarikian is one of these patients.

“When people consider these types of surgeries, they need to consider their mental attitude toward food,” said the 59-year-old restaurant publicist and director of product management at China Grill Management. “You are constantly exposed to having to eat in this business. Restaurants rely on my expertise to tell them what I think.”

After his surgery, Zarikian, of Brickell, lost 100 pounds. But soon, he found a way to eat foods, such as puréed meals and fish, which fit into his small stomach pouch easier than bread and harder foods. By 2010, he gained back 70 pounds.

Cruz-Muñoz said that success after bariatric surgery is identified as losing about half of the patient’s excess weight and keeping it off. In that respect, about 30 percent of gastric-sleeve patients and 20 percent of gastric-bypass patients fail.

He said reasons include surgical failure; the patient’s genetic predisposition to gain weight and eat unhealthy food; and the patient’s behavior post-surgery, such as eating the wrong foods.

“In my mind, I kept saying I wanted to eat. I wanted to eat everything,” said Zarikian. In recent years, he has managed to lose 60 pounds through Weight Watchers and strives to lose another 40 to get back to 270 pounds, his post-surgery weight.

There are other downsides of these surgeries, even if successful. They include predisposing people to low blood sugar, gallbladder stones and bowel obstruction from adhesions. Also, follow-up plastic surgeries to get rid of excess skin.

“There’s no free lunch, and you have to take the good with the bad,” said Cruz-Muñoz.

But for the Groutens, the bariatric surgery was the right choice after a lifetime of fighting obesity.

“It was hard going up the stairs in our house,” said Sandy. “Now we can do it without puffing. Our whole life has changed.”

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