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Lightness at the end of the tunnel; St. Vincent offering bariatric surgery as demand for weight-loss option rises.

Byline: Elizabeth Cooney

WORCESTER - Weight loss isn't easy.

Only about 2 percent of severely obese people successfully shed pounds through diet, exercise and lifestyle changes alone. Bariatric surgery offers them another solution, one that recent studies say can not only improve but extend life. A Swedish clinical trial found that obese people cut their risk of dying through the dramatic loss of weight that surgery gave them. A more recent study said type 2 diabetes was reversed when patients lost large amounts of weight through surgery.

With medical evidence accumulating and the obesity epidemic showing no sign of abating, demand for bariatric surgery is strong, a trend that saw a steep rise as surgical techniques improved. There were 150 of the operations in Massachusetts in 1996 but 3,447 in 2006, according to the latest figures from state Department of Public Health. UMass Memorial Medical Center has offered the surgery since 1999 and gained accreditation from the American College of Surgeons in 2006.

Now St. Vincent Hospital has also received accreditation through a new program that grants approval with a lower minimum number of cases per year while still requiring a comprehensive program, data collection on outcomes, and a site visit by inspectors. The St. Vincent program runs in cooperation with the Fallon Clinic, led by bariatric medicine director Dr. Paul L. Arcand, who previously operated at the Memorial campus of UMass Memorial Medical Center.

"People are looking for way to help their health," Dr. Arcand said. "Talk to people who are obese and morbidly obese. They've all lost weight, they've done Weight Watchers, Atkins, they've tried South Beach. They go on diet pills, they exercise, they lose weight, they stop or they go back to some of their old habits, they regain their weight. It's always with an additional 20, 30 pounds and then they start over. That's their whole lives. Surgery gives them a way to break that cycle."

St. Vincent is the 16th of 24 bariatric surgery programs in Massachusetts to win accreditation, a process whose standards were modeled on recommendations created by the state's Betsy Lehman Center for Patient Safety and Medical Error Reduction. St. Vincent's surgeons must perform a total of 25 surgeries each year to be in compliance while it builds volume, adhering to the principle that for certain complex operations, the number of times they are performed has a direct link to safety. A level 1a center like UMass Memorial must have 125 operations each year.

Dr. Arcand performed about 60 weight-loss operations last year, either gastric bypass or lap-band procedures. The bypass reroutes the digestive tract to minimize the size of the stomach to a small pouch the size of a fist. The lap-band cinches the stomach with a band that can be loosened or tightened.

Dr. Arcand had to do 50 of the surgeries annually at Memorial, a number he said was not hard to reach. He has been joined at St. Vincent by surgeon Dr. Michael Potter to meet anticipated demand.

Dr. George L. Blackburn, a surgeon at Beth Israel Deaconess Medical Center in Boston and a professor of nutrition at Harvard Medical School, applauds the new accreditation system. It means St. Vincent will not have to wait two or three years as it might have under the previous system. Dr. Blackburn not only chaired the Betsy Lehman expert panel that came up with standards for weight-loss surgery, he also was the first person to perform gastric-bypass surgery.

"We're very pleased to see St. Vincent step forward to pioneer this new program," he said. "We want to make sure we are accommodating all the needs of people in the commonwealth."

Surgery is only one part of these programs. Interested patients attend information sessions, undergo evaluations by the medical director, attend behavioral sessions and learn from nutritionists. They must have a body mass index of 40 to be a surgical candidate or a BMI of 35 with another condition such as diabetes. Before they meet with a surgeon, they must demonstrate their commitment by losing 5 percent to 10 percent of their body weight in order to prove they can abide by post-surgical guidelines.

Gastric bypass involves a hospital stay of about five days while the lap-band is a same-day procedure.

Then comes the hard part, two patients of Dr. Arcand's say.

Andrea Fletcher, 34, and Karen Romano, 32, have been friends for about 20 years. The two Fitchburg women are Fallon Clinic patients who went through the weight-loss program, which their insurer, Fallon Community Health Plan, covered. Ms. Fletcher had a gastric bypass last year and Ms. Romano chose a lap-band procedure, which was done in August. They are steadily losing weight and gaining energy and health. No more sleep apnea or foot pain for Ms. Romano. Ms. Fletcher, who works as a waitress, is at the gym every morning.

But recovery wasn't easy. They had to learn how to eat again, taking care not to tax their new stomachs. Ms. Fletcher has to be careful about getting enough protein and potassium. Ms. Romano needed her lap-band adjusted. Mistakes in what they eat can be painful.

"It's not a quick fix," Ms. Romano said.

"This is the hardest diet I've ever had to do," Ms. Fletcher said.

Ms. Romano, who works in the highway department and one night a week in a hair salon, has lost 85 pounds.

"If I don't lose another pound, I'm happy. The way I feel is so much better," she said. "I look at my son, who's 85 pounds, and think of carrying him around all day. No wonder I was so tired."

Ms. Fletcher, who lost 100 pounds, said she cut her cholesterol numbers in half and also lowered both her blood pressure and blood sugar.

The two friends walk together, remembering when it felt like their old weights had aged them past their 30s. They go out to lunch and share a plate. They attend monthly post-op groups at St. Vincent and also tell people considering weight-loss surgery what it was like for them.

"It's a whole new lifestyle," Ms. Romano said.

Dr. Blackburn of the Betsy Lehman Center preaches prevention - eat a healthy diet and exercise regularly - as the best treatment for obesity, but for 9 million people who are considered morbidly obese, he sees surgery as a solution.

"The most malignant disease now has the best practices for taking care of it," he said.


CUTLINE: (1) Friends Andrea Fletcher, left, and Karen Romano have undergone different types of weight-loss surgery at St. Vincent Hospital in Worcester. Both are losing weight and gaining energy, but it hasn't been easy. (2) Dr. Paul L. Arcand, director of bariatric medicine at St. Vincent Hospital. (CJART) Increased Demand for WLS

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Title Annotation:LIVING
Publication:Telegram & Gazette (Worcester, MA)
Article Type:Clinical report
Date:Apr 28, 2008
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