Today it was announced that New Jersey Governor Chris Christie underwent lap band surgery for weight reduction in February. Governor Christie’s longstanding struggle with his weight has been the subject of intense media scrutiny–perhaps in some cases unfairly–in recent years, but at least the publicity has brought some high-profile attention to a problem that many find difficult to discuss openly: what to do about the American epidemic of obesity.
Bariatric surgery for weight loss has been around for a long time, but public awareness of the availability and benefits of bariatric programs has increased substantially in the past decade or so. There are now numerous surgical techniques to modify the anatomic volume and functional volume of the stomach and surrounding gastrointestinal structures to reduce hunger, food intake volume, and therefore weight. Historically bariatric procedures centered around the physical reduction of stomach size. More recently, however, technological advances have allowed for many to undergo less invasive procedures, such as gastric banding (commonly known as lap banding).
Aggressive measures to lose weight are not just for cosmetic reasons. Many people undergo bariatric surgery due to medical problems associated with obesity–such as diabetes and hypertension–or to reduce the likelihood of later developing obesity-associated chronic illnesses, including cardiovascular disease. Though it is a misconception that you have to be overweight to have obstructive sleep apnea, it is true that your chances of having sleep apnea increases substantially if you’re overweight or obese. Over the years a great many of my sleep apnea patients have undergone such gastric procedures, usually with great–and even dramatic–success. Usually these folks experience a gradual improvement in their baseline sleep apnea as the weight loss progresses, and in some cases the sleep apnea may go away completely with sufficient loss in weight.
It’s important to know that a sleep evaluation is usually a standard, integral component in the overall assessment for one’s fitness for bariatric surgery, not only because sleep apnea is a common medical problem for overweight people, but also because sleep apnea represents a peri-operative risk, particularly following extubation while recovering from anesthesia. Often I am called upon to evaluate a bariatric candidate’s sleep well prior to surgery. If sleep apnea is diagnosed, treatment is initiated and continued. In addition, the patient and the physician sleep specialist should interact regularly in the months following surgery. If CPAP (continuous positive airway pressure) is utilized for the patient’s sleep apnea, for example, the CPAP air pressures likely will start to feel uncomfortably strong as the weight goes down, and adjustments will need to be made accordingly. Mask and headgear fit often also require adjustments and re-adjustments. Finally, once the weight has “plateaued” (such that no further substantial weight loss is anticipated), it’s standard to reassess the patient formally to determine the extent to which the pre-existing sleep apnea has improved or, hopefully, resolved completely.
There are many great bariatric programs around the country. They offer hope to many people that have utilized more conservative measures to lose weight with limited success. I wish the very best for Governor Christie.
Have a great evening, everyone!