Saturday, May 26, 2007
By: Jeffrey Kurz, Staff

MERIDEN -- Morbid obesity was threatening Elizabeth Carlson's health. Carlson had a family history of obesity-related health complications, including diabetes and high blood pressure, and knew she had to do something. Other obesity-related conditions include osteoarthritis, depression, sleep apnea and respiratory problems.

"I did not want to see myself heading into those diseases," she said.

Since undergoing gastric bypass surgery 15 months ago, Carlson has lost 110 pounds.

"I'm ecstatic," said Carlson, a Meriden resident who's an office worker at Nathan Hale School and is on her way to becoming a licensed massage therapist.

"It's like a whole new life," she said. "I feel like a different person. I'm active, healthier. It's good all the way around."

More and more people are turning to surgical treatments for obesity. Carlson said she recognized that the surgery was not enough on its own and depended on both the preparation and post-operative support she received from the bariatric program at MidState Medical Center.

"I think one of the most important things is that you need to pay very close attention to your mental health," she said. "A lot of the reasons you became overweight are still there."

Carlson was interested in laparoscopic adjustable gastric banding, a technique that performs essentially the same function without the bypass, but found that because she had acid reflux and a hiatal hernia she was not a suitable candidate.

MidState just recently has begun performing what's usually referred to as lap-band surgery.

While the technique has been around for more than five years, the deciding factor for Meriden's hospital was a recent study that showed that in the long run, the results of lap-band and gastric bypass were on par, said Dr. Aziz Benbrahim, medical director of MidState's bariatric program.

"With lap-band, you don't lose as much weight initially," he said. "But five years down the road, the results are the same."

And since the goal is sustained weight loss and control, MidState found it useful to begin offering lap-band as an alternative for some candidates, said Karen R. Darley, a social worker and coordinator of the hospital's bariatric program.

"The surgery itself is a tool for long-term weight management," she said.

Some may assume surgery is a quick fix for a cosmetic problem, allowing people to more easily shed unwanted pounds. But obesity is a significant health threat, placing people at greater risk for serious diseases that can lead to premature death.

It has reached epidemic proportions in the U.S., with about a third of the adult population weighing in as obese, which is measured by having a body mass index of 30 or more.

"We don't do surgery to make somebody look beautiful," said Benbrahim. "We do surgery to reduce morbidity."
A person with 100 extra pounds has bodily systems working "in red lights," said Benbrahim.

"If a patient loses 50 pounds, they've already stopped the problem or reduced the risk. With lap-band, in about two or three months they're in the safe zone."

Lap-band performs the same function as gastric bypass, but without cutting or stapling the stomach. The goal is the same: to create a small pouch of stomach that holds about an ounce of food. Both techniques are done with laparoscopy, in which several small incisions are made instead of a large one.

With lap-band, a band squeezes a separation between a small portion of the stomach and the rest. Fluid can be inserted into a balloon within the band to allow the tightness to be adjusted.

The technique is "a major advantage," said Benbrahim, because it does not require a bypass of the duodenum, the first part of the small intestine, which is where fat and sugars, and vitamins, are absorbed. So with lap-band, there are "no anatomical changes," Benbrahim said.

Benbrahim performed the first two lap-band procedures at MidState earlier this month. Another is scheduled in June.
But even such advanced techniques are only part of the solution.

"I tell patients the surgery itself just gets them to the playoffs, it doesn't win the Super Bowl," said Benbrahim. "Because for them this is only part of a big picture."

That's partly why Darley, who has been a social worker at the hospital for some time, is now full time with the bariatric program. The program also includes nurses, a pharmacist, dieticians and physical therapists.

"There's been a commitment made to become a full bariatric service," said Darley. "It's not just surgery, but a healthy lifestyle."

"The goal is to eat in a healthy fashion, for physical hunger and not to manage stress," she said. "You learn to eat in a mindful fashion."

"The support group is extremely important," said Benbrahim. "We are finding that people who follow with support groups do better."

Carlson says she found them essential. "It's very easy to fall back into the old habits," said Carlson, who is writing a book about her experience.

"It's fun to wear a size four, but you need to take care of yourself mentally, too," she said.