By Stephen Spotswood
CHARLESTON, SC — With bariatric surgery becoming more common and reliable, VA medical centers are employing the treatment more often in patients previously unable to lose weight and reverse co-morbidities associated with obesity.
Questions remain, however, about the surgery’s long-term effects.
According to the Centers for Disease Control and Prevention, approximately one-third of U.S. adults qualify as obese, with a body mass index (BMI) over 35. In the VA patient population, the rate is 32%.
Obese patients are at greater risk for heart disease and diabetes, as well as some forms of cancer. Overall, obese individuals spend 42% more on medical expenses, 77% more on medications and, for those with the most severe weight problems, can expect to live a decade less than non-obese individuals.
The bariatric surgery program for Veterans’ Integrated Service Network (VISN) 7 at the Charleston, SC, VA Medical Center is trying to prevent those complications in obese patients who can’t lose weight by other methods.
Rana Pullatt, MD, director, VISN 7 Bariatric Surgery Program
Three years ago, Rana Pullatt, MD, sought to start a new bariatric surgery program at the Charleston VAMC, modeling it after a similar program he had begun at the Medical University of South Carolina, which is attached to the VA facility. After two years of getting funding and training staff, the program became operational.
“In the last year, we have performed 18 bariatric surgeries at the VA hospital, most of them laparoscopically. One of which was open surgery, because the patient had preexisting scar tissue from earlier surgeries,” Pullatt said. “A little over half of them were laparoscopic gastric bypass, and the rest were laparoscopic sleeve gastrectomies.”
Pullatt describes the results as extremely successful. “We have had no mortality or leaks from the procedure, and 95% of these patients have achieved tremendous weight loss.”
The majority of the patients also have been taken off insulin and other diabetes medications, sometimes very soon after surgery.
“What we’ve realized over the years of doing this is that weight loss happens over a long course of time, but diabetes resolution happens within weeks,” Pullatt said. “Research has shown that rerouting the intestine, especially the upper gastrointestinal tract, actually [ameliorates] type 2 diabetes.”
Admittedly, VA’s program has been extremely cautious in accepting patients for surgery. The maximum BMI of a patient that Pullatt has treated outside VA is 75, but in VA the maximum is limited to around 55, which reduces the chance of surgical complications.
“The first year, we wanted to play it safe,” Pullatt said. “We’ve been very selective.”
Despite the large number of patients who could benefit, Pullatt said he sometimes has difficulty convincing them that the procedure is safe.