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Gastric bypass seen as solution to obesity by Heather Murphy Woolwine Public Relations They suffer discrimination, these “fat” people.  Jobs are inaccessible, clothing doesn’t fit, and stares and harsh words cascade into a never-ending waterfall of self-loathing.  They’ve done it all; Weight Watchers, diet pills, failed gym workouts, and attempts to gain leverage on an out-of-control thyroid gland.  Some did it to themselves, slaves to an insatiable pathological hunger. Others can’t move about like they used to, whether disease, disability, or injury is to blame. But no matter the reason, genetic or environmental, the pounds keep coming until health deteriorates into sleep apnea, diabetes, heart disease, and sometimes death. And now, many want to try the latest advancement in weight management, gastric bypass or bariatric surgery.  Stapling stomachs isn’t about changing appearances. It’s about saving lives. In a nation where half of the population is obese, bariatric surgery picked up serious momentum in the past five years as the last hope for people who are at least 100 pounds or more overweight. Karl Byrne, M.D., personifies that last hope. “For many people out there, it is a terrifying, outlandish concept,” Byrne said. “But a group of surgeons have demonstrated with good scientific data that it works. As early as 1991, the NIH (National Institutes of Health) held a consensus conference dictating that those individuals with a BMI (body mass index) of 40 and those with a BMI of 35 and health problems should be considered for this surgery.” Byrne attributes the recent influx of mass media attention and interest in the procedure to celebrities undergoing the surgery. “It was a pretty big deal when (singer) Carnie Wilson had her surgery broadcast live over the Internet,” he said. Another landmark moment in the bariatric world came when procedures were first done laproscopically in California in the late 1990s. “Patients can have the procedure, experience minimal downtime and be back to work in a week,” Byrne said. “Almost all of the weight loss drugs out there have been failures, like Fen Phen, and I don’t know of any pill that can block leptin receptors. For morbidly obese patients, this is the option.” A typical experience with gastric bypass surgery begins with an initial visit including the surgeon, a dietician, and a psychologist.  Paperwork detailing patient history and a psychiatric evaluation is completed.  Next, the surgeon, like Byrne, meets with a group of six to 12 potential patients the first Thursday of every month to discuss everything the procedure entails:  risks, benefits, laproscopic vs. open procedures, insurance procedures, and mortality. If the patients proceed, a surgery date is assigned while they wait for pre-certification from an insurance carrier. With the current mass interest also comes a bandwagon effect; thousands of surgeons who have no prior experience with bariatric surgery or gastric bypass attend quick “how-to” courses and then set up shop. The danger here is apparent from a patient perspective, but it also creates enormous problems for surgeons like Byrne who’ve been performing these surgeries for more than a decade. “This field has become extremely litigious, so of course malpractice insurance rates are skyrocketing,” he said. And speaking of insurance, the equivalent of a 12- round boxing match commences between patient and insurance carrier when a patient decides to go for the surgery.  “More insurance companies are paying for the procedure than they were four years ago, but they are in turn requiring an enormous amount of qualifying data for pre-certification. Some companies even require a documented, year-long period of nutrition where a diet plan failed,” Byrne said. “Some programs such as Medicaid pay so little for these procedures that it makes no financial sense for a hospital to accept patients who probably need it the most.” Here’s the kicker: a patient who receives gastric bypass surgery will cost an insurance carrier less then that same patient who for three years takes five medications for weight-related illnesses, like depression and diabetes. And while Byrne and his colleagues anticipate the day when malpractice coverage and insurance carriers re-evaluate their processes, a new frontier in bariatric procedures is gaining attention. Raised in the fast-food, instant-everything era, today’s children are seeing ever increasing rates of obesity, with some children as young as 11 already developing health complications related to too much weight on small frames.  Approximately 30.3 percent of children (ages 6 to 11) are overweight, and 15.3 are obese.  Thirty percent of adolescents ( ages 12 to 19) are overweight and 15.5 percent are obese. Some believe causes related to childhood obesity are a lack of regular activity, high frequency of television viewing or computer usage, low family incomes or non-working parents, over-consumption of high calorie foods, eating when not hungry, eating while doing homework or watching TV, genetics, and even overexposure to food advertising. Most parents would place their child on a diet. However, a recent study reported by Reuters claims that children’s dieting may actually promote weight gain.  This means that the children involved in the study may have actually gained weight because the body adapted to requiring fewer calories to maintain weight, so when a break in a dieting cycle occurred, weight gain was possible.  The investigators also did not rule out the possibility of binge eating after the conclusion of a restrictive diet during the course of the two-year study period. The envelope has already been pushed to allow some adolescents to receive bypass surgery; Byrne himself has done eight adolescent bypass surgeries and said that all are doing wonderful.  He recognizes the reason for mounting opposition to performing the procedure in young adults and adolescents, “I can understand and respect each ethical argument out there,” he said. “And there are other issues with parental consent and what happens if the adolescent comes back when he's 18 and dissatisfied for some reason with the procedure, etc.  “There are other operations in existence that aren’t as extreme and are usually attempted first. But what do you do when you see an 11-year-old who already has sleep apnea and diabetes from excessive weight, knowing that he or she will have completely lost control of themselves by age 20?”       Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.