Overweight? Think twice about surgery

Who can help determine if you're a good candidate?
Only a surgeon trained to perform obesity surgeries can determine your candidacy and the best surgical strategy for you, even if you believe that you are a good candidate and prefer a particular operation. Look for a surgeon and hospital that is accredited by the American Society of Bariatric Surgery (ASBS). This is an important designation to look out for to ensure that you get comprehensive care — before and after surgery. The University of Pittsburgh Medical Center is one of many in the United States that is accredited. You should be able to find a program near you.

What is new on the surgery horizon?
There continue to be more advances in the field of obesity surgery, with more options and techniques developing for future clinical use. Here are some on the horizon:

• Intragastric Balloon: Sometimes considered to be a non-surgical treatment, because it does not involve incisions, this procedure is performed by either a gastroenterologist or a surgeon. A deflated balloon is inserted into the stomach (patients are under light anesthesia for about 20 to 30 minutes), which is then filled with sterile salt water. The balloon floats freely in the stomach, taking up space and enhancing the sense of fullness. It can remain in place for up to six months, after which time it is deflated through another brief procedure and removed.
  
  The balloon is available in other countries, and, in fact, one of my center’s programs at our UPMC sister hospital in Palermo, Italy, has already had great success with it. This new development should be coming to the U.S. soon, as the FDA has approved the balloon for future testing, deeming it safe to investigate further.
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• Endoluminal Techniques: While in its very early stages, some kinds of obesity surgery can be done with a specially designed instrument that enters the stomach through the esophagus. This surgery is an area of great interest and research. 

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We may also see future techniques that use not only minimally-invasive techniques (such as Band-Aid-size incisions), but also non-invasive procedures. These may involve doctors using modified instruments that will let them enter the stomach from the mouth, reducing the need for surgical incisions for some procedures.

Dr. Fernstrom’s Bottom Line: Obesity surgery is a much-needed tool for many patients struggling with severe obesity. If you think you might need obesity surgery, first talk with your primary care doctor and then make sure you seek a program with ASBS (American Society of Bariatric Surgery) certification.

Madelyn Fernstrom, Ph.D., CNS, is the founder and director of the University of Pittsburgh Medical Center’s Weight Management Center. An associate professor of psychiatry, epidemiology, and surgery at the University of Pittsburgh School of Medicine, Fernstrom is also a board-certified nutrition specialist from the American College of Nutrition.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

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