Last year at this time, Mari Shay, a registered nurse at the Rockwood Weight Loss Surgery Center in Spokane, weighed in at about 100 pounds heavier than she does today. Shay says she was prediabetic, her cholesterol was rising, and she suffered from hypoglycemia, a condition that results from low blood sugar. Shay’s doctor told her it was all because of her weight. 

Shay and her physician at the Rockwood Surgery Center determined she was a candidate for gastric sleeve weight loss surgery. Although she is a registered nurse and has been at Rockwood for 15 years, she says she was just as nervous about the surgery as some of her patients. 

“I was still terrified. I wasn’t sure I could make the changes,” Shay says. “And I was scared this was going to be another failure.” 

Ten months post-surgery, Shay says she couldn’t be happier with the results and appreciates little things like getting in and out of the car without discomfort, and easily bending over to tie her shoes.

According to the U.S. Department of Health and Human Services, more than one in 20 Americans over the age of 20 are morbidly obese, increasing their risk of developing other health conditions, such as heart disease, stroke, and Type 2 diabetes. 

Health care professionals say weight loss surgery may be an option for obese and morbidly obese patients who haven’t been able to lose weight through diet and exercise or medications. 

Rockwood Clinic’s board-certified surgeons, Drs. R. Andrew Bright, Mathew C. Rawlins, and Jonathan D. Spitz, have completed more than 1,600 bariatric procedures locally since 2000, says Rawlins, who has been at the clinic since 2002.

Rawlins says candidates for the surgery include those with a body mass index of 40 or higher and those with a BMI of 35 or more who have a serious medical condition that might improve with weight loss. BMI is a measure of body fat based on a person’s height and weight; a BMI score between 18.5 and 25 is considered normal. 

Surgeons at Rockwood’s bariatric surgical department perform three types of weight loss surgery: the Roux-en-Y gastric bypass, gastric banding, and vertical sleeve gastrectomy. All three operations are done using a laparoscope, which involves small incisions that are less invasive than conventional surgery. 

With Roux-en-Y gastric bypass, the stomach is stapled, making it much smaller and bypassing part of the small intestine, Rawlins says, reducing the amount of food a patient can eat. Post-surgery weight loss is dramatic, and patients, on average, lose 60 to 70 percent of their extra weight. For example, a 350-pound person who is 200 pounds overweight typically would lose about 120 pounds. 

With gastric sleeve surgery, more than half of the stomach is removed, leaving a thin vertical sleeve about the size of a banana, which dramatically limits the amount of food that can be eaten to about one-half cup. With the sleeve, patients typically lose about 65 percent of their excess weight, Rawlins says.

With gastric band surgery, a surgeon uses laparoscopy to place an adjustable silicone band around the upper part of the stomach, Rawlins says. After banding, the stomach can hold only about an ounce of food.

Compared with gastric banding, gastric bypass surgery and gastric sleeve surgery have better outcomes for long-term weight loss—controlling Type 2 diabetes, high blood pressure, and lowering cholesterol levels, according to a recent study published in the Journal of the American Medical Association. 

Because of that, Rawlins says the most common weight-loss surgeries performed at Rockwood are the gastric bypass and the gastric sleeve surgery. He says more problems occur with bands, and they’ve proven to be less effective than the other two options.

Since he started practicing at Rockwood’s Weight Loss Center, Rawlins says, the numbers of weight loss surgeries have averaged about 200 a year and have gradually started to increase over the last three to four years. 

In 2013, he says, Rockwood Weight Loss Surgery Center performed more than 325 such surgeries, which doesn’t include revisions to surgeries done by others, which Rawlins says are fairly common here. 

“There is a lot of that in Spokane,” he adds. “I’ve had at least 100 cases myself so far this year—revising surgeries done by others outside of Spokane.”

The cost of the surgery can vary widely, but a survey released this year by ObesityCoverage.com puts the average cost at about $22,000.

Rawlins says Medicare has covered weight loss surgery to some degree for a long time, and Medicare leads the way for insurance companies. 

“Success in the long term is why Medicare is paying for it. And insurance companies are very aware of the financial aspects of this,” he says.

Rawlins says the operations are effective in resolving diabetes in about 80 percent of cases and high blood pressure resolves in more than 90 percent of cases. 

“Medications drop dramatically as well,” he says. “I’ve had people who were on as many as 15 medications go down to two or three. It pays for itself.”

Rawlins says Rockwood’s success with weight loss surgery is due to pre-op education and the center’s guidance of patients through a complicated system of doctor and surgeon visits, and insurance requirements through the surgery and recovery. 

Initially, patients attend a two-hour information session where one of the center’s surgeons and a dietician describe the surgeries in detail and answers questions. 

He says public interest in the surgeries is sufficient to justify holding three monthly sessions in Spokane and one in the Tri-Cities.

Rawlins says about 5 percent of his patients are able to move to a physician-supervised diet and exercise plan and lose weight without having surgery.

If a patient is a candidate for the surgery, the next step is getting insurance pre-approval of any tests required, including psychological tests, cardiac clearance, X-rays, and others, which collectively can take three to six months to complete. 

Once patients have insurance approval, they are scheduled for surgery, Rawlins says. 

The surgery is a two- to four-hour procedure and usually requires a two-night hospital stay, he says. After the patients return home, they can return to a normal routine in one to three weeks, depending on what type of surgery they’ve had, he adds. 

If no problems arise, a patient is seen at the surgical center after three months, again at six months, and at one year, he says.  The center sees patients on an annual basis for at least five years after the surgery.

 “It’s typical to gain back about 10 percent of what was lost after the first year,” he says. “But anything outside of that is fairly rare.” 

He contends part of the reason weight-loss surgery is so successful is that patients are excited to have it, knowing they will be losing “a ton of weight,” he says.

“They’ve already been through other weight-loss programs. So already more than 50 percent of patients have already exhausted most of the common solutions,” he says, adding, “Obesity is a very complex problem.” 

Mari Shay agrees with that assessment. She says surgery and recovery were easier than she expected. She lost the majority of her excess weight during the first six months after surgery. 

“The weight loss itself has made it easier for me to live a more active lifestyle,” she says. 

She wants to lose another 20 pounds, but says she is infinitely more comfortable since she’s closer to her goal weight. 

“I can do anything now. I am running, and everything I do is more comfortable,” she says. 

Rawlins says the surgery isn’t as quick of a solution as some people might think. 

“The surgery just enables patients to eat right and exercise,” he says.