Who are the super morbidly obese? They are people who have a Body Mass Index (BMI) of 50 or over. Morbidly obese people have a BMI of 40 or over. To be considered obese, people must have a BMI of 30 or over. Renee Williams was one of the most well known overweight women in the world (Wikipedia. Renee Williams). She was super morbidly obese at the age of twelve. Some people have genetics that cause them to gain weight no matter how little they eat. Being genetically predisposed for radical weight gain can be a factor in becoming super morbidly obese. Renee Williams was in a car crash causing her to be further immobilized, and that could certainly be a contributing factor for her. But, Renee’s daughter reported that her mother ate as many as eight hamburgers in a sitting. So it’s not hard to understand why Renee was super morbidly obese. It is important to realize that many super morbidly obese people are not predisposed to being overweight. They can reduce their weight to a normal range and maintain it for the rest of their life which will be greatly extended because of losing the weight. If they have successful weight loss surgery, their post operative quality of life is just as important to them as it is to any bariatric patient. They will want to have the energy to live life to its fullest.
Lap-band over Gastric Bypass has been the surgical combination of choice…
…for super morbidly obese people. The combination of restrictive and malabsorptive procedures delivers maximum weight loss. The biggest problem with any treatment of super morbidly obese people is the state of degeneration of their overall health. Typically they have diabetes and heart issues: high blood pressure, high cholesterol and high triglycerides. They also have bad backs, knees and other musculoskeletal issues that keep them immobile. Being immobile further enhances all health issues. They have no energy as carrying hundreds of pounds of extra fat exhausts their system. Motion, especially physical therapy and exercise, is what they need to save themselves from serious health consequences. Motion very frequently is impossible because of their massive bulk and the lack of energy required to move it. Bypass surgeries are fantastic at facilitating weight loss because large amounts of calories cannot be absorbed by the shortened intestine. The problem is that this blockage of nutrition called malabsorption also blocks energy and that is exactly what super morbidly obese people need and have a shortage of.
Often the difference between surviving or not relies on how quickly the patient can get moving post-surgically. Renee Williams had a bypass at age 29, weighing 880 pounds. She died from a heart attack 12 days after her operation. Nothing could have saved her at that point. She had degenerated too much. But in many cases patients can save their lives when there is a larger window of time between surgery and potentially dying, if they can start exercising and get moving again. The time right after having bariatric surgery is the time a super morbidly obese person absolutely needs every ounce of energy possible. So if energy facilitates motion, is it wise to limit nutritional absorption when a patient needs it most?
Bypass surgeries are slightly more effective than restrictive procedures
All bypass surgeries include surgical reduction of the stomach. Another problem exists with gastric bypass in that the surgically reformed stomach (or pouch) can stretch larger over time. With RNY surgery, the stomach is transected (severed) horizontally. This requires the weight loss surgeon to construct a new outlet from the stomach into the small intestine. The RNY’s surgically formed outlet called the “stoma” can also stretch causing food to exit the stomach (now a pouch) too quickly for satiety to fully occur. Using the Lap-band over the bypass pouch establishes a counter to the effects of stretching. This is important for super morbidly obese patients in that their journey to a normal body mass is much longer than the typical bariatric patient. So their procedure must be more robust and capable for the long run. That is the reason for Lap-band surgery over bypass.
Gastric Plication Surgery is as effective as bypass
It is not completely understood why Gastric Plication is as effective as it is. But, studies show an amazing rate of weight loss almost identical to that of a bypass. Also, satiety occurs almost immediately after eating – faster than any other procedure. These features combined with the fact that it is the most reversible bariatric surgery to date might make this the best choice in weight loss surgery for many people.
Gastric Plication PLUS Lap-band Surgery (iLap) – new surgical solution for the super obese
Lap-band surgery plus Gastric Plication may be the perfect surgical combination for super morbidly obese patients. Because Gastric Plication causes a quicker more complete satiety, the patient can eat much less food. The lap-band further limits the amount of food that can be initially ingested. But its most important job is to heighten the sensitivity of the nerves at the top of the stomach. Those are the nerves that send the signal to the brain that you are full. So, the Lap-band reduces the desire for food over a long period of time. The combination of Gastric plication with Lap-band surgery results in fast and longer term satiety with much less food than the individual surgeries. iLap surgery is a double procedure that is adjustable to keep it working over the long run as is required by super morbidly obese patients. It can result in the same weight loss as the Lap-band surgery over bypass. But the small intestine is untouched and completely intact so it will deliver all the nutrition and energy in food consumed by the patient – the energy a super morbidly obese person desperately needs to get on their feet and move. Lap-band and Gastric Plication surgeries can be reversed because none of the stomach or intestines are surgically removed. Because both surgeries are less damaging than bypass, recovery time can be much shorter. Physical therapy and exercise may be able to be done sooner after having the operation and with more intensity, possibly improving the patient’s prospect for living.