Options for Obesity

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Obesity
Options for Obesity

Obesity is the elephant in every room in the RGV. Our region is notoriously unhealthy, with the rate of obesity and diabetes topping national lists year after year. While almost all of us could “stand to lose a few pounds,” there is a morbidly obese population whose lives are on the line – and these individuals know it. You see them taking steps towards better health: eating small, healthy meals and working out at the gym.

And sometimes you don’t. For people struggling with obesity, it can feel like it doesn’t matter what they do. “A lot of people who are severely overweight (with a Body Mass Index (BMI) over 35) can lose 15 to 20 pounds, but most people – like 99 percent of the time – will gain all the weight back or more,” says Mario del Pino, MD.  He says weight loss is not so simple for someone morbidly obese. “People say, ‘All you have to do is eat right and exercise,’” says  Dr. del Pino. “It’s impossible. They are fighting their body’s natural response to try to defend its weight.” However, Dr. del Pino offers a surgical solution to manage the high blood pressure, cholesterol, and diabetes of certain obese patients.

“Bariatric surgery is surgery to lose weight, but we realized as people lost weight they were improving their health,” says Dr. del Pino. “Now we use the term ‘metabolic surgery,’ because when we perform the surgery the metabolism changes, and that’s how we manage those medical problems like diabetes, high blood pressure, and cholesterol.”   He performs three main types of metabolic surgery: Robotic Gastric Bypass, Laparoscopic Sleeve Gastrectomy, and Adjustable Gastric Bands. Each surgery has its advantages and complications, which is why Dr. del Pino recommends that individuals schedule an appointment to better discuss their medical situation. Also insurance coverage can be an issue because some insurance plans do cover the surgery but others don’t. “Some insurance providers do have specific caveats, so we recommend that potential patients give us a call and we can see where we go from there,” says Dr. del Pino.

While bariatric surgery like gastric bypass is nothing new (Dr. del Pino has performed over a thousand of these operations), it has become safer and recovery is streamlined. “Most people who have gastric bypass, a sleeve or band go home the next day. Most people are back to work in two weeks – so in that regards we have already optimized it,” says Dr. del Pino.

Laparascopic surgery is a safe, minimally invasive technique in which the operation is conducted through small incisions (up to 2 cm). Dr. del Pino explains that several “arms” inserted through the incisions hold different tools, including a camera, which provides the surgical team a real-time, accurate vantage point to work from. Members of the surgical team control the arms.  When Dr. del Pino uses the da Vinci robot in surgery, he controls all of the arms from a seated console.

“The robot allows me to be very precise when I suture,” says Dr. del Pino, which is why he prefers to use it –especially when conducting gastric bypass surgeries.

Dr. del Pino always tells his patients that the main goal of the surgery is to improve their health. The weight-loss process is slow and progressive, and aesthetic benefits are a secondary consideration. Everyone’s weight loss is different based on their habits and starting weight. “When you lose weight, you are losing muscle, fat – all kinds of tissues,” says Dr. del Pino. He explains that the skin is like an envelope. “If we take out the insides, it will look like more ‘envelope’ because now it’s empty. People have different kinds of skin – some have more elastic fibers than others. We emphasize to patients that if they are going for the aesthetic outcome, it will require more time with a plastic surgeon, but we recommend they wait at least a year-and-a-half after the surgery before they have that done,”  he says.

The surgeries have a very high success rate, but it requires the patient to adhere to strict lifestyle and dietary guidelines. Dr. del Pino observes that the main reason patients gain weight after surgery is that they stop following through with their new habits. “Some people think I give you an operation, you keep eating whatever you want, and you lose weight – no,” he says.  The surgery is like a reboot, offering a fresh start for maintaining a healthy weight.  Ultimately, it is the patients who have control over their health.