Profound Impact

In his office at USC’s Health Sciences Campus, Namir Katkhouda, M.D., flips through photographs of former patients—once morbidly obese—now trim and smiling while posing in fashionable clothes or suntanned at the beach.

“The impact of bariatric, or weight loss, surgery is profound,” says Katkhouda, professor of surgery and director of the Keck School of Medicine’s minimally invasive surgery program. “It is one of the most gratifying surgeries I perform.”

Together, Katkhouda and Peter Crookes, M.D., associate professor of surgery at the Keck School and director of the USC Bariatric Surgery Program, perform more than 300 obesity surgeries each year.

Bariatric surgery involves surgical alteration of the stomach or intestine in order to produce weight loss. The most common procedures are the laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch and reroutes the intestine, and the Lap-band, which constricts the upper part of the stomach with an adjustable belt.

“Weight loss is achieved by three major routes: appetite is suppressed, a sense of fullness is created, and, in some cases, the food that is eaten is not all absorbed,” Crookes says. “While the precise mechanisms by which appetite and satiety are altered are still not known in detail, many patients find it easier to stick with a diet after surgery than before.”

The results are often dramatic. Most patients who undergo gastric bypass surgery lose about 75 percent of excess body weight within a year. With the Lap-band, it is about 50 to 60 percent.

However, Crookes notes, bariatric surgery requires patients to maintain a healthy lifestyle, get regular exercise and take vitamin supplements daily for the rest of their lives. A strong support system at home is important in order to maintain the positive effects of the surgery.

In the first few weeks after surgery, there is a small chance of a leak, a pulmonary embolus (blood clot that lodges in the lungs) and bleeding. While the risk of death is less than one percent in most cases, prospective patients should attend educational seminars to understand fully what is involved in the procedure, Crookes says.

“It helps if they are savvy with the Internet because there is so much information about these procedures available,” he says.

Weight loss surgery rose in popularity in the late 1990s with the introduction of laparoscopic, or minimally invasive, gastric bypass. In 2002, Katkhouda performed the first laparoscopic gastric bypass surgery at USC, and the number of cases grew exponentially in the following years. The American Society of Metabolic and Bariatric Surgery recently recognized the USC Bariatric Surgery Program at USC University Hospital as a center of excellence.

In the United States, where about one-third of the population is considered obese, bariatric surgery can be a useful tool against obesity and related diseases, Katkhouda says. However, patients must demonstrate that they have previously tried to lose weight through non-surgical diet and exercise programs before undergoing the procedure.

“Morbid obesity is considered by the government and medical profession as a chronic disease, no different from diabetes, cancer or anything else,” Katkhouda says. “And overeating is now recognized as an addiction no different than smoking, gambling or alcoholism.”

In determining who qualifies for bariatric surgery, the surgeons evaluate patients’ Body Mass Index (BMI), which is the weight divided by the square of the height. The threshold for surgery is typically a BMI over 40, or between 30 and 35 if the patient also has a disease related to obesity, such as diabetes or sleep apnea.

The surgery generally improves overall well-being and has been shown to help reduce obesity-related conditions such as diabetes, high blood pressure, depression and lower back pain. There has been discussion about offering the surgery to diabetics with lesser degrees of obesity, although it is not currently permitted in the U.S., Katkhouda says.

“It is a serious commitment, and patients considering bariatric surgery should research the program thoroughly,” he says. “But for many patients, the results are astonishing.”

For more information, see www.surgery.usc.edu/bariatric. To make an appointment for an evaluation, call 323-442-6219.

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