Bariatric Surgery and Benefits

[Sparda29]

What do you guys think about bariatric surgery as a treatment option for obese patients? It costs about $18000-35000 to perform the surgery, and usually people who have the surgery lose about 60% of their weight within a year of the surgery. Other problems associated with obesity are resolved due to the weight loss, such as hypertension, diabetes, high triglycerides and cholesterol.

The cost of dealing with those disease states/disorders such as hypertension, diabetes, high triglycerides and cholesterol over a lifetime can be astronomical compared to the cost of the bariatric surgery.

And yeah, people should still try diet and exercise, but sometimes that doesn't work.

What do you guys think about it?

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[evilolive]

Or we could all start downing caffeine pills and Alli!

 

[twilightz]

Well, I'm not sure if you're looking for a definite answer: a Yes/No type answer. If not, then the answer is quite simple.

It depends on the situation, each patient is a unique individual, and their illness experiences are unique. Some obese patients can be put on an individually tailored exercise and training regimen and may show improvement without the need for surgery. Others may require a less invasive, less expensive procedure before being put on a regimen. Those who don't qualify for either program can choose to undergo a more invasive type of bariatric surgery.

The point is: modern day health-care provides plenty of treatment plans, each of which can be tailored to fit the unique needs of the patient. This issue highlights the importance of health-care teams, where doctors must work with pharmacists, nutritions, physiotherapist etc in order to maximize a patients treatment plan.

You can go on and on, but I guess you have to be careful not to digress from the main point and go off on a tangent as I seem to have done.

Is this an assignment question?

 

[Sparda29]

Well, I'm not sure if you're looking for a definite answer: a Yes/No type answer. If not, then the answer is quite simple.

It depends on the situation, each patient is a unique individual, and their illness experiences are unique. Some obese patients can be put on an individually tailored exercise and training regimen and may show improvement without the need for surgery. Others may require a less invasive, less expensive procedure before being put on a regimen. Those who don't qualify for either program can choose to undergo a more invasive type of bariatric surgery.

The point is, the modern day health-care system provides plenty of treatment plans, each of which can be tailored to fit the unique needs of the patient. This issue highlights the importance of health-care teams, where doctors must work with pharmacists, nutritions, physiotherapist etc in order to maximize a patients treatment plan.

You can go on and on, but I guess you have to be careful not to digress from the main point and go off on a tangent as I seem to have done.

PS: Is this an assignment question?

Nope, just something I was thinking about.

 

[ethyl]

The health plan I interned at covered the procedure after failing 6 months of a weight loss program. Looks pretty cost effective to me. A family member had it and she was on a dozen+ medications. Now all she has to take are vitamins... no more diabeeetus meds, HTN meds, sleep meds, or pain meds.

 

[Farmercyst]

My mother-in-law lost >100 lbs on Weight Watchers and is taking 5 mg Zestril for her BP as opposed to higher dose combo Zestoretic, but has changed her eating habits, increased exercise and is leading a somewhat normal life at her new weight.

My sister-in-law had Roux-en-Y doen about 9 months later than my mnl started losing her weight. She has lost ~90lbs, but is still overweight for her height. She has come off some of the meds she was on, but hasn't changed her diet other than portion size and some adjustments based on what makes her nauseas. She has the malabsorption issues you should expect when you bypass the stomach and upper small intestine and has to be very cautious what she eats to avoid GI upset/diarrhea.

I know which way I'd recommend to most of my patients. But as mentioned, not everyone is the same, and quite frankly, it's probably better that my sister-in-law lost the weight with her current issues than maintain the weight with no benefit. But for those that can change lifestyle and stick to it, it's sooo much better than the issues caused by gastric bypass.

 

[Sparda29]

My mother-in-law lost >100 lbs on Weight Watchers and is taking 5 mg Zestril for her BP as opposed to higher dose combo Zestoretic, but has changed her eating habits, increased exercise and is leading a somewhat normal life at her new weight.

My sister-in-law had Roux-en-Y doen about 9 months later than my mnl started losing her weight. She has lost ~90lbs, but is still overweight for her height. She has come off some of the meds she was on, but hasn't changed her diet other than portion size and some adjustments based on what makes her nauseas. She has the malabsorption issues you should expect when you bypass the stomach and upper small intestine and has to be very cautious what she eats to avoid GI upset/diarrhea.

I know which way I'd recommend to most of my patients. But as mentioned, not everyone is the same, and quite frankly, it's probably better that my sister-in-law lost the weight with her current issues than maintain the weight with no benefit. But for those that can change lifestyle and stick to it, it's sooo much better than the issues caused by gastric bypass.

Definitely, if you can lose the weight and stay healthy with lifestyle modifications then good. But not everyone has great willpower to avoid unhealthy foods and exercise religiously 5 times a week.

Personally, the only plan that worked for me only worked for 3 months. Summer of 2003, went on the Atkins diet and exercised a lot, lost 35 lbs. Come September, school started and I couldn't do the Atkins diet anymore, kept exercising the same and all the weight came rushing back plus more.

 

[evilolive]

A lot of people grew up with bad dietary habits. Imagined if all you grew up on were transfats and other high rewards foods that would make everything else taste bland in comparison? It would be awful to grow up on McDonalds and then have to switch to low calorie, fat, and salt alternatives. It's torturous to think about it that way, but I can see why people can't stick to certain diets because it goes against all sorts of lifelong imprinting. I'm just lucky that my parents made me eat very healthily and so it's natural for me to continue that tradition. Oh to think the days that McDonalds were a treat...

 

[Sparda29]

A lot of people grew up with bad dietary habits. Imagined if all you grew up on were transfats and other high rewards foods that would make everything else taste bland in comparison? It would be awful to grow up on McDonalds and then have to switch to low calorie, fat, and salt alternatives. It's torturous to think about it that way, but I can see why people can't stick to certain diets because it goes against all sorts of lifelong imprinting. I'm just lucky that my parents made me eat very healthily and so it's natural for me to continue that tradition. Oh to think the days that McDonalds were a treat...

I've all but abandoned Mcdonalds, burger king, wendy's, and white castle. Those I eat like once very 2 months when I'm on a road trip or something since that's the only thing available.

Pizza is my thing, I have it about 5 days out of the week.

 

[Glycerin]

Regardless of your opinion of the surgery, the fact of the matter is people get the surgery. Therefore, as a pharmacist, it becomes extremely important, especially in a hospital setting, to be mindful of these patients that have a past surgical history of Roux-n-Y procedures and check their at-home, inpatient, and discharge medications to make sure the patients are not taking extended-release or enteric coated products; otherwise, these patients do not get maximum absorption or benefit from these medications, and they are at risk for developing bezoars.

These patients will also need daily vitamin and mineral supplementation for the rest of their lives. For example, most of the calcium taken is in carbonate form, which requires an acidic environment for dissolution. Bariatric surgery patients need to be on calcium citrate instead, because they are not utilizing up to 150 cm of their GI tracts--including most of the stomach and the duodenum.

There is a lot of good we as pharmacists can do to improve the lives of these patients, regardless if we feel they need the surgery in the first place. This month's Pharmacist's Letter has an article on this very topic.

 

[KUMoose]

Damn you Glycerin for stealin mai Thundar. 😉

Seriously, the article did a good thing bringing up those points but one thing that we can do is ensure pill size. Having friends and family go through lapband it's important to realize that taking a lot of meds just isn't feasible because it hurts or sits in the esophogus for longer then designed.

It's also a good way to work in compounding into a pharmacy, partner with the out patient places that lapband. I'm sure some enterprising pharmacist can turn that into some profit.

 

[Pharmavixen]

It would be cheaper for the health care system if we encouraged wt loss through behaviour modification rather than surgery. Since the cause of obesity is partly societal, people need social supports because self-discipline just isn't enough for most folks.

I know a couple of folks who have lost tons of wt, ~ 100 pounds each, and they are both stubborn, extremely determined people. One of them told me she had to completely re-make her life. Most of us are not so driven - we need to get past this whole, "Just put the fork down" mentality, and figure out how we can help these people without the completely unhelpful judgement.

Bariatric surgery is a quick fix, but what's needed is massive sociological change such that people walk more, eat better as a part of their lifestyle. But the food lobbies in N. America don't want to experience the damage to their bottom line that would ensue if everybody in N. America suddenly started eating just what they needed.

Basically, if people didn't overeat, it would be bad for the economy.

 

[evilolive]

Will power is such a fickle thing. There have been times where I've almost lost it in pharmacy school due to stress. I wonder if I'd be able to do the same in order to lose 100+ lbs assuming I were in other peoples' predicaments.

 

[Farmercyst]

Regardless of your opinion of the surgery, the fact of the matter is people get the surgery. Therefore, as a pharmacist, it becomes extremely important, especially in a hospital setting, to be mindful of these patients that have a past surgical history of Roux-n-Y procedures and check their at-home, inpatient, and discharge medications to make sure the patients are not taking extended-release or enteric coated products; otherwise, these patients do not get maximum absorption or benefit from these medications, and they are at risk for developing bezoars.

These patients will also need daily vitamin and mineral supplementation for the rest of their lives. For example, most of the calcium taken is in carbonate form, which requires an acidic environment for dissolution. Bariatric surgery patients need to be on calcium citrate instead, because they are not utilizing up to 150 cm of their GI tracts--including most of the stomach and the duodenum.

There is a lot of good we as pharmacists can do to improve the lives of these patients, regardless if we feel they need the surgery in the first place. This month's Pharmacist's Letter has an article on this very topic.

I emailed the pdf table to my SNL yesterday and she said she'll talk to her surgeon about some of the stuff. So definitely worth bringing the stuff up, since, like you said, people will get the surgery anyway.

 

[hdtv]

Bariatric surgery decreases the volume of the stomach. Decreased stomach volume means less food can get in before you feel full. Less food getting in means less food being eaten.

Solution: eat less food.

"But most people don't HAVE that kind of will power!"

 

[Sparda29]

Bariatric surgery decreases the volume of the stomach. Decreased stomach volume means less food can get in before you feel full. Less food getting in means less food being eaten.

Solution: eat less food.

"But most people don't HAVE that kind of will power!"

That's the whole point, to force a lower consumption of calories. A lot of times people can't stop themselves from eating until they feel full.

 

[Glycerin]

Damn you Glycerin for stealin mai Thundar. 😉

I emailed the pdf table to my SNL yesterday and she said she'll talk to her surgeon about some of the stuff. So definitely worth bringing the stuff up, since, like you said, people will get the surgery anyway.

Coincidentally, that article came out now. I did a pilot study last year of a retrospective chart review at a 420-bed hospital assessing the appropriateness of drug formulations and vitamins and minerals in patients with a PSH of bariatric surgery, and there was a problem with every patient's inpatient medication profile as well as most of their prior to admission and discharge medications. This mean that their physicians prescribed medications without considering the history of bariatric surgery, and the pharmacists, who were unaware of the PSH as well, verified the orders for the inappropriate formulations and supplements.

 

[hdtv]

That's the whole point, to force a lower consumption of calories. A lot of times people can't stop themselves from eating until they feel full.

 

[hornblower]

What happens to their excess skin?

 

[Sparda29]

What happens to their excess skin?

This isn't liposuction. The surgery either makes a bypass of the stomach, where the top portion of the stomach is stapled and then the entrance to the small intestine is re-routed to the now newly made small section of the stomach.

Or, they put an elastic band on the stomach, which creates a small pouch. Basically, the small pouches made by these surgeries are only about 30 mL in volume. Hence, a person takes 1-2 tablespoons of food and is full.

 

[hornblower]

Your low GPA/PCAT shines through.

If 100+ pounds of fat melts away, what happens to the skin that once surrounded it? It'll droop down like a beef curtain.

Leaving the Folds

After a Gastric Bypass, Some Formerly Obese Patients Need a Riskier Surgery To Shed Excess Skin

http://www.washingtonpost.com/wp-dyn/content/article/2006/05/29/AR2006052900752.html

 

[Sparda29]

Your low GPA/PCAT shines through.

If 100+ pounds of fat melts away, what happens to the skin that once surrounded it? It'll droop down like a beef curtain.



http://www.washingtonpost.com/wp-dyn/content/article/2006/05/29/AR2006052900752.html

You still gotta work out. Start building up muscle mass.

 

[tkim]

You still gotta work out. Start building up muscle mass.

You don't get it. For some, no amount of working out will help. Skin after being stretched out for such an extended period does not allow it to shrink back to normal:

 

[hornblower]

You don't get it.

Don't bother.

He lacks a basic understanding of A&P.