With the start of a new year, one of the most common New Year’s resolutions is to lose weight. For many, though, changing their diet and getting more active isn’t enough to make the numbers on the scale drop significantly.
Losing weight isn’t only about getting into a smaller size or looking better. Being overweight is a known factor when it comes to heart attacks, stroke and some cancers. As COVID-19 spread across the world, doctors noted that being overweight was a significant risk factor.
The health care community is learning that weight is a complicated issue and how people respond to various weight-loss treatments can vary significantly.
One approach that has become increasingly more common in the last 20 to 30 years is surgical intervention, also known as bariatric surgery.
Nationally, bariatric surgery numbers have grown 40% over the past decade, reaching 256,000 in 2019 before the COVID-19 pandemic induced a drop in all nonemergency hospital events. And as the number of overweight Americans continues to rise, more people are weighing their options and considering bariatric surgery.
According to the latest information for 2022, Kentucky is in the top five in virtually every ranking for obesity rates. Adult obesity rates now exceed 35% in 19 states, with Kentucky and West Virginia battling for the No. 1 spot in most ratings. Between 2020 and 2021, the adult and child obesity rates increased in 17 states, including Kentucky, where the adult rate increased 10%.
“The obesity rates keep going up every year,” said Dr. Vincent Lusco, chief of surgery at UofL Health’s Mary & Elizabeth Hospital, where he and Dr. John Olsofka have combined to perform more than 5,000 bariatric procedures over the past 20 years.
“An epidemic of obesity is even being talked about now,” Lusco said. “It’s just really getting out of control. I think it all goes back to the plethora of fast-food places, high-calorie beverages and caloric-dense foods that are kind of engineered to taste good (to drive sales). That’s what people eat, and they aren’t as active as they used to be. So, it’s a ‘perfect storm’ to create this epidemic.”
A recent report from Trust for America’s Health, a nonprofit health policy organization, shows that Kentucky has the second-highest adult obesity rate in the country and Kentucky children aged 10 to 17 have the highest rate for that age group. Four of every 10 Kentucky adults are obese and 72.3% are either obese or overweight, third in the United States. Kentucky’s overall obesity rate is 40.3%, just behind West Virginia’s 40.6%.
Among the state’s high school students, 18.4% are obese and another 17.8% are overweight. Overall, Kentucky’s childhood obesity rate is 23.8%. Even in children ages 2 to 4, the rate is an alarming 16.3%.
In addition to a high-calorie food system, Trust for America’s Health chalks up the persisting increases in obesity rates to a number of factors, including societal, biological, genetic and environmental.
Other information resources put Kentucky in the same unhealthy neighborhood. By comparison, the lowest-rated states for obesity are Hawaii and Colorado, both at 25%. Kentucky also ranks in the top 10—the worst 10—in adults with diabetes (13.3%) and hypertension (40.9%).
With obesity causing or contributing to a variety of life-threatening or serious health conditions—including heart disease and stroke, high blood pressure, type 2 diabetes, nonalcoholic fatty liver disease and sleep apnea—it’s easy to see why bariatric services are so badly needed in Kentucky and are growing.
Bariatric surgery involves making physical changes to a patient’s digestive system to help them lose weight. It is an option when diet and exercise haven’t worked or when weight has caused serious health problems. Some procedures limit how much you can eat. Others reduce the body’s ability to absorb nutrients. Some procedures do both.
Many programs feature psychological evaluations in addition to medical and nutritional guidance in preparation for surgery.
Gastric bypass is the most common and best-known method. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients. However, Lusco says it isn’t as popular as it once was.
“There were a lot of people who stayed on the sideline because they didn’t want to have their stomach cut in half and their intestines rerouted,” he said. “Then in the early 2000s, you had the invention of the laparoscopic gastric band and the number of surgeries really took off because people thought it was a much safer way of losing weight.”
Now one of the biggest trends is the gastric sleeve procedure. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. Physically, it can’t hold as much food. Because it is smaller, it also produces less ghrelin, a hormone that increases the drive to eat.
“It really limits how much a patient can eat,” Lusco said. “I mean, it’s ridiculous how little their portions are. And it doesn’t involve much after-care, so that’s become a pretty popular procedure across the country.”
However, he said, a downside is that once the sleeve stretches and the stomach returns to normal, patients start to gain their weight back and may have to undergo further revisional gastric bypass surgery.
Rather than the sleeve procedure, Lusco said, UofL Health has had very good success with gastric banding, which is minimally invasive and laparoscopic. The adjustable gastric band, known as a Lap-Band, is placed around the stomach to reduce its capacity. The resulting shape is similar to an hourglass, which helps promote a feeling of fullness, limits the amount of food that can be consumed at one time, and slows the movement of food from the stomach.
Dr. Benjamin Tanner, bariatric and general surgeon at Norton Healthcare in Louisville, said a recent significant development has been the use of an intragastic balloon that requires no surgery.
“This nonsurgical procedure is performed with a (laparo)scope and inflates a gastric-safe balloon inside the stomach that is left in for six months to decrease appetite,” Tanner said. “However, to date this is not covered by insurance.”
An important component of Norton’s program, he said, is the nutritional and psychological support patients receive. Surgeries are performed at Norton Hospital and Norton Women’s & Children’s Hospital–St. Matthews. Clinic or patient visits are at the Norton Weight Management Center on Dupont Road in Louisville.
Baptist Health Lexington recently became the first Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) medical weight-loss site in the state.
To earn accreditation, an extensive Baptist Health Lexington and Baptist Health Medical Group Bariatrics site visit reviewed structure, processes and clinical outcomes data.
“This includes rigorous reviews at three-year intervals as well as ongoing monitoring and quality-improvement initiatives and submission of outcomes data. More insurance companies and employers than ever are recognizing the value that bariatric surgery and obesity medicine provide in managing the chronic disease of obesity,” said Nicholas Wiley, executive director, GI and Facilities Services, for Baptist Health Lexington.
In addition to its Lexington facility, Baptist Health has four locations that perform bariatric surgery: Richmond, Paducah and Louisville in Kentucky and New Albany in Indiana.
The Center for Weight Loss Surgery at Saint Joseph East in Lexington is nationally recognized as an Accredited Center for the American College of Surgeons/American Society for Metabolic and Bariatric Surgery.
Karen Hillenmeyer, director of the center, said more patients and referring physicians appreciate the relatively low risk and complication rate of bariatric surgery, so it has become more common and accepted.
“We perform all cases robotically or laparoscopically and newer postoperative practices allow patients to be discharged within 24 hours, with return to work on average being one week or less,” Hillenmeyer said.
Saint Joseph East has a multidisciplinary program that includes a bariatric dietician, exercise physiologist and psychologist. The entire team works with the patient prior to surgery and the program includes an extensive postoperative education and support program, she said. Bariatric surgery is one of the hospital’s major lines, including orthopedics, obstetrics and cardiac services.
“The type of bariatric surgery performed depends on each patient’s surgical and medical history,” Hillenmeyer said. “Considerations such as existing medical conditions and medication needs are important in choosing the right procedure for each patient. A recent development in the perioperative anesthesia care enables patients to require little to no pain medication upon discharge.”
One of the newest bariatrics providers is UK HealthCare’s Weight Loss Surgery Program. The program is under the direction of Dr. Joshua Steiner, who left private practice after 20 years to start the program. He is an experienced bariatric surgeon who specializes in endoscopic and laparoscopic procedures as well as minimally invasive approaches to treating gastroesophageal reflux disease. He says his goal is to “build one of the premier bariatric programs in the region.”
“This is a region that has such a great deal of obesity-related problems and diseases,” Steiner said. “And the university had such a great need for a program.”
UK Healthcare offers laparoscopic, sleeve gastrectomy and laparoscopic gastric bypass procedures at its Turfland campus. Besides its surgeons and nurses, the staff includes dieticians, psychiatric and psychological counselors, who can advise patients both before and after surgery.
Dr. Eric Smith, a surgeon at the Kentucky Bariatric Institute at Georgetown Community Hospital, said his program also uses a team approach that includes dieticians and mental health professionals.
“We know people get frustrated when they’re told they need to lose weight for their health, and the only tools they have are diet and exercise,” said Smith. “The truth is that diet and exercise alone isn’t enough for the vast majority of obese people who want to be nonobese. What we do at KBI is give people effective tools to overcome their obesity.”
One of Smith’s patients is Kentuckian Tammy Slaton, of TLC’s reality TV show “1000-Pound Sisters.” Smith appears on the show with her from time to time.’
Last year, Smith performed over 450 bariatric surgeries and Georgetown Community Hospital CEO Cliff Wilson says KBI is on track to do even more this year.
With so many Kentuckians dealing with the health risks associated with obesity, UoL’s Lusco hopes to erase the stigma of people being overweight and having surgery.
“What we find year in and year out is that only 1% of people who are eligible for weight-loss surgery (in Kentucky) go through with it,” Lusco said. “A lot of people stay on the sidelines. We are trying to grow the program for sure.