Obesity Surgery an Effective Option for Some Seniors

Defined as having a body mass index (BMI, a ratio of height to weight) of 30 or greater, obesity increases the risk of heart disease, diabetes, stroke, cancer, and arthritis, among others. Exercise and a healthful diet can help you with obesity, but bariatric surgery may be an option if you have not been successful at losing weight through lifestyle changes. “While the surgery has been underutilized in the older population in the past, data has emerged in the last decade suggesting that it is just as safe in properly screened older adults as it is in younger patients,” says Daniel M. Herron, MD, chief of bariatric surgery at Mount Sinai. Even so, there are downsides from the surgery, and it’s vital to get informed about these before you decide to proceed. Also keep in mind that lifestyle changes are required afterward in order to gain lasting benefits. “It’s important that anyone undergoing bariatric surgery sees the procedure as just one strategy in a broader plan to achieve and maintain a healthy weight,” Dr. Herron confirms.

Types of Surgery Bariatric surgery makes the stomach smaller in order to limit the amount of food eaten. Several surgical options are available, and they are typically performed using laparascopic (keyhole surgery) techniques.

• Sleeve Gastrectomy This is now the most commonly performed weight loss operation—Dr. Herron notes that it comprises about 80 percent of the bariatric surgery carried out at Mount Sinai—and is not reversible. “In this option, the stomach is formed into a thin tube shape similar to the sleeve of a jacket,” Dr. Herron explains. “Some research is being done on carrying the procedure out endoscopically, through the mouth and esophagus.”

A 2016 study found that nearly 90 percent of people undergoing sleeve gastrectomy lost 25 percent of their excess weight or at least 15 percent of their total body weight. Blood sugar levels also were significantly reduced in people with diabetes, and blood pressure, triglyceride levels, and blood markers of liver damage dropped. “However, because the procedure is relatively new, its long-term effectiveness and risks are unclear,” Dr. Herron cautions.

• Roux-en-Y Gastric Bypass In this procedure, the top of the stomach is formed into a pouch and a section of the small intestine is attached to it, bypassing the rest of the stomach and small intestine. Like sleeve gastrectomy, a gastric bypass isn’t reversible.
• Biliopancreatic Diversion with Duodenal Switch In this procedure, a sleeve gastrectomy is performed, and a larger section of the small intestine is bypassed than with Roux-en-Y. “People who undergo this surgery typically lose more weight than with the Roux-en-Y procedure, and resolution of type 2 diabetes is as high as 90 percent,” Dr. Herron says. “There is a greater risk of malnutrition from this option, so it is typically restricted to people with a BMI of 50 or greater.”
• Gastric Band Gastric banding also seals off a smaller section of the stomach by “cinching” it with an inflatable band to restrict its size. “The operation has fallen into disfavor recently due to poor patient acceptance and suboptimal outcomes,” Dr. Herron notes. Unlike the other options, this procedure is reversible.

Consider Possible Complications Bariatric surgery comes with the same risk of bleeding and/or infection as other types of surgery. Recovery afterwards can take several months, and initially you will be restricted to a liquid diet that progresses to puréed foods. After you have fully recovered, you will be limited to smaller meals (overeating after bariatric surgery increases the risk of complications). Dr. Herron cautions that vitamin and mineral deficiencies can arise after bariatric surgery. “Levels of iron, calcium, and vitamins B1, B₁₂ and D can be affected,” he says. “Studies also have suggested that bone density may be impacted by the surgery, which may place you at greater risk for fractures.”

Is the Surgery Right for You? You’ll be extensively screened prior to bariatric surgery, and will undergo a mental health evaluation. Dr. Herron emphasizes that the surgery shouldn’t be seen as a “get out of jail free card” for unhealthy lifestyles. “You need to be willing to make changes to your diet and physical activity levels afterwards,” he says. “If you don’t, you may not lose as much weight as you hoped to—plus, overeating will stretch your stomach, increasing its capacity and defeating the object of the surgery.” Follow-up after bariatric surgery is long-term, and you’ll be monitored for malnutrition and likely encouraged to participate in support groups that can help motivate you to maintain lifestyle changes. The good news is that most people who undergo bariatric surgery feel better and often can better manage chronic diseases in the long-term.

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