by Eve Meinhardt
Paraglide



According to the Centers for Disease Control and Prevention, there has been a dramatic increase in obesity in the United States during the past 20 years. In 2008, in North Carolina, 26 percent of adults were considered obese with a body mass index greater than or equal to 30.

To help Soldiers and their Family members combat obesity, Womack Army Medical Center offers a number of options. The first stop is your primary care physician. After discussing your weight, possible health issues and medical history with your primary health care provider, he or she can discuss your next steps with you.

One option for Family members who are considered morbidly obese with a BMI greater than 40 along with accompanying health conditions, called co-morbidities, may be a surgical weight loss procedure at the WAMC Bariatric Surgery Clinic.

Individuals who qualify for and choose to undergo a surgical weight loss procedure become, in the words of Dr. Amy Olsen, a surgeon at the Bariatric Surgery Clinic, “the most informed patients at Womack.”

Patients undergo numerous education classes about the surgery and nutrition, attend support group meetings, take stress tests, develop exercise plans, take a test on the procedure before having surgery and must adhere to strict guidelines regarding pre and post-operation behavior.
One of the decisions a patient must make after learning about the options available to them is what type of surgery to have. WAMC offers three types of surgical weight loss: gastric bypass surgery; a sleeve gastrectomy; and gastric banding, commonly known as the lap band.

Gastric bypass essentially bypasses the majority of the stomach, leaving the only useable part of the stomach approximately the size of a shot glass. A sleeve gastrectomy removes most of the stomach, leaving only a small tubular segment. Gastric banding puts a “noose” around the top of the stomach that can be tightened or loosened. Each procedure has advantages and disadvantages. Patients are able to discuss their options with a surgeon and make an informed decision about which procedure is best for them.

No matter which surgery the patient chooses, they need to commit to a full lifestyle change in order to be successful.

“You need to be committed and motivated in this program because that is what will make you successful,” said Jasmin Black, the bariatric nurse coordinator.

Olsen agreed and said that patients can’t just expect to lose a lot of weight and then be able to eat and drink whatever they want again in the future.

“Surgery is a great tool, but it is only a tool,” she said. “Patients need to continue getting support and participating in the program after surgery by going to support group meetings and the education courses we offer.”

Patients not only receive education and training, they also meet with a psychologist who helps them work toward changing their life. One of the risks after surgery is depression because patients are essentially breaking an addiction and confronting body image issues.

Dr. Heather Corkins, a psychologist at WAMC, helps patients understand their own emotions and provides support throughout the process.

“I help patients understand how they got where they are at,” said Corkins. “If they don’t understand how they got to the weight they are, how are they going to lose the weight? The easy answer is by getting surgery, but without understanding their own strengths and weaknesses, they are just going to end up gaining the weight back. You can take their appetite away, but only they can change their mind.”

Darcy Sliger, a Fort Bragg Family member who underwent gastric bypass surgery in October 2009, has lost 77 pounds so far and is committed to the changes Olsen and the team at the Bariatric Surgery Clinic require. She attends the regular support group meetings, continues to exercise and sticks to a low carb/high protein diet.

While the immediate benefit of undergoing surgery is apparent by the amount of weight a patient can lose, Olsen said the positive changes in the patient’s health also save taxpayers and insurance companies money.

“It costs about $36,000 to operate,” said Olsen. “That is paid for in two years because the patient’s co-morbid conditions go away and they no longer need treatment for problems caused by their obesity.”

While many people may dismiss the need for surgical weight loss by saying a change in diet and the addition of exercise would have the same results, Olsen said statistically, surgery is a practical option for someone who is morbidly obese.
“Changes to diet and exercise allows individuals to lose about five to 15 percent of their body weight. They usually gain all that back, plus some more,” she said. “Surgery is not only a durable option, but it is relatively safe.”

The Bariatric Surgery Clinic devotes time and attention to each patient before and after surgery. Undergoing the procedure affects the rest of the patient’s life and the staff said they want each candidate to be a success story. Olsen said that she has never had to reverse a procedure.
While on the surface, surgery may seem like the easy way out of a bad situation, it requires the patient to commit and give up many of the things they love for the rest of their life including alcohol, caffeine and smoking.

“You have to be willing to make changes,” said Corkins. “It is a great surgery and it can change your life, but it will be the hardest thing you’ve ever done – I guarantee it. Your outlook on food and your lifestyle has to shift. You have to be ready for it.”

(Editor’s note: This is the last part in a series of three about Fort Bragg Family member Darcy Sliger’s journey back to health and the Womack Army Medical Center’s bariatric surgery team.)