More patients turn to weight loss surgery

A little more than a year ago, Anthony Accinno reached what he considered a low point when his weight reached an all-time high of 315 pounds.

Over the years, he’d won temporary victories in losing weight through diet and exercise, but would inevitably gain it back when he’d fall back into old patterns, he said.

“A lot of it came down to emotional eating,” Accinno said. “I’d lose 30 or 40 pounds and I’d turn to food to pacify my emotions and the weight would go back up and then a year later I’d start losing again.”

Now, Accinno is celebrating the first anniversary of his gastric sleeve surgery at the Stamford Hospital Center for Surgical Weight Loss as well as reaching his target weight of 215 pounds, a goal that once seemed unattainable.

Gastric sleeve surgery involves removal of a large portion of stomach and reshaping what remains into a banana-shaped pouch, Accinno said.

“This physical change is a permanent tool which forces me to keep working at it,” he said. “Even if I accidentally overeat, it is very uncomfortable.”

Accinno said he no longer desires, and is no longer capable of the type of excessive eating he once relied on during difficult times.

“I went from squeezing into a 48 and now I’m a size 38 and comfortable,” Accinno said.

Dr. Daniel Davis, the center’s director of bariatric surgery, said the number of people choosing bariatric weight loss surgery has grown in recent years thanks to less-invasive laparascopic surgical techniques requiring smaller incisions that limit pain and recovery time.

Since the center’s establishment at Stamford Hospital in 2010, Davis and other surgeons have performed procedures for more than 200 patients. The increase has also been partly linked to a gradual change in which employers have added insurance coverage for the procedures as an effective way to improve the health of overweight workers, Davis said.

“What we hope will happen is with more data about the impact of the surgery that more and more employees will realize that they will have employees who are healthier and absent less,” he said.

Obesity is defined as having a body mass index higher than 30. Body mass index is calculated using one’s height and weight. A normal BMI is between 20 to 25 and a BMI over 25 is considered overweight.

According to federal Centers for Disease Control and Prevention data released last September, 22.5 percent of adult Connecticut residents were obese, and 59.6 percent were overweight.

With a number of surgical options to choose from, Davis said patients select a procedure based on their approved weight loss goals and their willingness to adopt new dietary and lifestyle choices after the surgery.

Another popular choice for those seeking bariatric surgery is gastric banding, which is the least invasive form of common bariatric surgeries, Davis said. In the procedure, a saline-filled band is placed around the upper part of the stomach, limiting the amount of food a person can eat at one time.

In addition to not requiring any removal or alteration of the stomach or intestine, the band can also be removed if desired.

“I will sometimes encourage the banding procedure because it can always be removed,” Davis said.

The most extensive option is gastric bypass surgery, which combines both the creation of a smaller stomach pouch with a “duodenal switch” that reroutes part of the small intestine to limit nutrients digested by an individual. A greater amount of calories bypass the stomach and are eliminated, a process called malabsorption, Davis said.

Before undergoing the surgery, Accinno said he underwent a sleep study which discovered he was also suffering from sleep apnea, and also a psychiatric evaluation to ensure he would be able to adjust to the permanent reduction of his stomach capacity.

“I don’t know, I think I put myself at a disadvantage because I allowed my weight to lower my self-confidence but now that I’ve lost the weight I see myself as less introverted and more outgoing,” Accinno said.

Davis said candidates for bariatric weight loss surgery are evaluated psychologically and physically for other health issues such as high blood pressure, diabetes, high cholesterol levels, or cardiovascular stress, conditions that need to be under control before surgery.

Patients are also given nutritional counseling and education to understand the physical limits they will experience when their stomach is reduced or a gastric band is inserted, he said.

“We can’t just do a surgery and expect people to be able to handle the change,” Davis said. “As much as possible we pre-operatively counsel them to learn about the best eating habits to follow so they can understand what they can expect to deal with and have a greater chance of success.”

Dr. Anna Freitag, medical director for the hospital’s Diabetes and Endocrine Center and president of the Fairfield County American Diabetes Association said she has seen bariatric surgery procedures help diabetes patients who could not control their weight through dieting and exercising alone.

“I don’t jump to the surgery initially, but there are people who can’t lose weight any other way,” Freitag said. “Most of them don’t have their diabetes cured but they can get to the point where they come off their medicine.”

At the hospital, Freitag said she has seen a trend of more newly diagnosed diabetes patients in their 30s and 40s who have developed the disease because of their genetic predisposition being aggravated by poor diets and excessive eating.

Freitag also emphasized the importance of doctors instilling the necessary discipline and understanding of the lifelong adherence to smaller portions to prevent old eating habits and a lack of exercise from resurfacing.

“I do think it is a great thing for the right patient who is motivated,” Freitag said. “They need to know it is for the rest of their life. But I want to be positive, there are some patients who just look terrific and are doing terrific after bariatric surgery.”


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