In the past, chronic diseases were managed and minimized by physicians. Now, there is a whole new era of surgeons offering a solution to health problems like diabetes, sleep apnea, high blood pressure and heart disease.

Dr. Carl Weiss at Auburn Memorial Hospital is one of those bariatric surgeons performing the weight-loss surgery that has the ability to practically cure many of the sicknesses associated with morbid obesity.

Candidates for gastric bypass must typically be 100 pounds or more overweight, and be willing and ready to make behavioral changes. Because these patients are not in very good shape, the risks associated with surgery are extremely real, Weiss said.

“They are sick,” he said. “They might have a bad heart, bad lungs, kidney functions are probably compromised, liver functions are probably compromised. A lot of people are looking closely to make sure we are doing the best we can.”

Because of the high risk factor #- a mortality rate of about one in 200 -bariatric surgery receives a lot of negative attention, yet the good feeling Weiss gets when he sees a patient's life change is what has made him an advocate of this weight-loss procedure.

He assures, however, that surgery is not the only answer, and, in fact, it should only be a last resort, but when it comes to the morbidly obese, other weight-loss options inherently will have a 99 percent failure rate.

Success is measured by durability, Weiss said, adding that medical weight loss programs work, but the results don't last like gastric bypass. Yet, only 1 percent, or “the lucky few” of morbidly obese patients make it to surgery.

“Medical weight-loss programs are effective; they just aren't durable,” he said.

It can be difficult for a 100-pound over weight person to burn off a lot of calories due to physical problems like knee pain or shortness of breath that is unfortunately caused by their weight, Weiss said. The physiology of a person also plays a factor.

“Calories, protein and nutrition is so disorganized (in their bodies); it's difficult for them to get back on track,” he said. “And people want to know, ‘Why don't you just stop eating?' They can't.”

Auburn Memorial Hospital, therefore, offers a combined approach to losing weight. And if a patient is not 100 percent ready to make lifestyle and behavioral changes Weiss will not move forward with the operation.

“Underneath the surgery are behaviors,” he said. “It's like AA (Alcoholics Anonymous). Those engaged in meetings, talking about behaviors, they have the best chance of ultimately changing their behaviors. It's the same thing with morbid obesity.”

Working with a team of dietitians, counselors, support groups and exercising at the hospital, Weiss said bariatric surgery is just one link in its programmatic approach to weight-loss.

Behaviors are at the root of America's weight epidemic, so patients must be committed to losing weight and will work at the hospital's weight-loss program before, during and after surgery, he said.

“It's about a 90 percent success rate,” Weiss said. “If we operated on everyone who showed up at the door, there would be about a 50 percent success rate.”

Weiss often thinks of the operation as a marathon.

“Those that train are going to do the best. Those who don't train, we try not to operate on,” he said.

After surgery, patients are tracked through course work and kept in contact with electronically. Up-to-date charts are available for doctors and patients, and any questions are just an e-mail away to the doctor to help manage health problems.

“They are really in flux,” Weiss said about losing a large amount of weight. “A lot of things get better and a lot of their medications need to be eliminated gradually over time. Something like that needs ongoing medical input.”

A patient must for the rest of their life after surgery be cautious of their behaviors and continue to talk about their habits and what they are doing to stay healthy, Weiss said. If something, like a death, triggers a depression, food can become a crutch for many, and the weight will come back, which the patient needs to be cautious of once weight stabilizes.

The stomach, which produces a hunger hormone, is made into a much smaller pouch, decreasing the hunger signal in the brain, and food is led to bypass the gastric reservoir to the bowel.

The bowel is not designed to absorb food as well as the stomach. However, in time it can adapt and begin absorbing more, which means a patient unaware of food behaviors will go back to old habits and weight, Weiss said.

Unfortunately, Weiss said bariatric surgery will become more prevalent in the future, and his biggest concern is America's youth.

Obesity is a result of cultural, ethnic and societal factors, which he said means, unless something is done, future generations are in trouble.

“It's not a simple problem; it's a complex combination of issues. It's real and getting worse,” he said. “The real problem is going to be our adolescents. If you can imagine a 16-year-old with diabetes, with hypertension, what is that person going to do to our health care system over the course of 50, 60, 70 years? They're going to bankrupt us. So we better find a non surgical answer for our adolescents soon.”

The problem is self-perpetuating, he said. If a child has obese parents, it is highly likely they too will be obese, and this is seen largely in low-income areas.

“The most problematic are calorically dense foods that you can get for $3 - that's so damaging,” Weiss said. “It's cheap, available; it's delicious and just packed with high-density, low-nutritional value.”

With numbers rising, a procedure like bariatric surgery becomes a solution, but it is also an expensive option. Weiss said he currently only operates when a patient has insurance, and noted that Medicare recently released a statement in favor of it.

And with the minimally invasive lapriscopic procedure Weiss uses, recovery is much quicker, and better for a patient who already has multiple health issues.

Despite the frustration of seeing the numbers of overweight Americans continue to grow, Weiss finds satisfaction in restoring a patient's quality of life, and that is what he said has kept him going for all 250 procedures he has done.

“That's what's gratifying for me,” he said. “You see a patient six months down the road and you don't recognize them.”

Staff writer Laura Boyce can be reached at 253-5311 ext. 236 or at laura.boyce@lee.net