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CNN Sunday Morning

"Weekend House Call"

Aired December 07, 2003 - 8:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ELIZABETH COHEN, CNN CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. Our topic today is weight loss surgeries. As more and more Americans become obese, hundreds of people are on waiting lists for bariatric surgeries. These procedures can save people's lives by helping them lose sometimes hundreds of pounds, but not all procedures have a happy ending.
(BEGIN VIDEOTAPE)

COHEN (voice-over): We've seen them all on TV. Carnie Wilson, Al Roker, Roseanne Barr. They once were large and now they're not. Thanks to what seems to be all the rage these days, gastric bypass surgery. So is this the easy fix for the millions of Americans who are morbidly obese? Two new studies show us that gastric bypass surgery can be a dangerous procedure. According to one done at the University of Washington, one out of every 50 patients will die within the first 30 days following surgery and early death from surgical complications is directly linked to how experienced your surgeon is.

Another study released this week, this one from the University Hospitals of Cleveland, says gastric bypass surgery is riskiest for the most obese, those, of course, who need it the most.

Still, 98 percent of patients who undergo these procedures do survive. So why not do it? For one, anyone considering this surgery has to realize that their lives will change dramatically.

DR. DAVID FLUM, UNIV. OF WASHINGTON: Actually, they'll never have a normal meal again.

COHEN: That's because you're stomach is essentially reduced to the size of an egg. According to the centers for disease control, 30 percent of American adults over the age of 20 are obese. That's nearly 60 million people. So, with more obese Americans means more surgeries and a greater chance for more complications.

FLUM: There are many elements of gastric bypass surgery that are the conditions of a perfect storm, if you will, for adverse outcomes. Increased commercial demand, increased surgeon interest and increased patient interest.

COHEN: Bariatric surgery has become big business with more and more surgeons wanting to get in on the act. According to the American Bariatric Association, 63,000 people had the surgery last year. This year, that number is expected to climb to 100,000.

(END VIDEOTAPE) COHEN: Let's take a look at who qualifies for this surgery. According to guidelines from the National Institutes of Health, you should be 100 pound or more overweight or have a body mass index of 40 or higher, that means if you're 5'2", you should weigh at least 218 pounds or if you're 5'10" at least 278 pounds. The guidelines also say you should have tried to lose weight in less dramatic way before resorting to surgery. Gastric bypass surgery consists of a surgeon stapling your stomach so it becomes a pouch the size of an egg and then they reroute your intestines to the new stomach. Surgeons either open up your abdominal cavity or they can do the surgery laparoscopically through small slits. This procedure is less invasive and generally leads to a quicker recovery. There can be side effects which may include nutritional deficiencies, liver problems, sugar intolerance, and after losing all that weight you can end up with a lot of droopy skin, and as we heard earlier, some people can die from this procedure.

We want to hear your questions about weight loss surgery, so give us a call at 1-800-807-2620 or you can e-mail us at Housecall@cnn.com.

Here to talk about these increasingly popular surgeries is Dr. Philip Schauer, director of bariatric surgery at the University of Pittsburgh Medical center.

Dr. Schauer, welcome to our show.

DR. PHILIP SCHAUER, DIRECTOR OF BARIATRIC SURGERY: Good morning, Elizabeth.

COHEN: Good morning.

First off, let me ask you how many of these procedures have you done this year?

SCHAUER: This year, approximately about 800 operations.

COHEN: That's a -- that's a huge number. There are many surgeons who are just starting this and who've done very few, I imagine.

SCHAUER: That's correct.

COHEN: How do you know? When you go to the doctor, what do -- what should you ask? Should you ask for a number?

SCHAUER: That's a great question. I think you should ask the doctor how many he has performed, and I think experience definitely improves the outcomes.

COHEN: That's right. That's what those studies show that we were talking about earlier. Well we're getting flooded with calls and e-mails, so let's get right to an e-mail. This one is from Joyce in Texas who writes:

"I'm scheduled to have gastric bypass surgery in February, I am doing it because I am a diabetic, and my doctor is sure that by having the surgery to lose weight, I can get my diabetes under control. How true is this?"

Dr. Schauer, diabetics sometimes, are they able to go off their medication once they have the surgery?

SCHAUER: Certainly. And Joyce, you can be very confident that your diabetes will improve dramatically. There are a number of studies including a study we published just a few months ago that showed that about 80 percent of patients who have diabetes, who have this surgery, essentially are cured and the blood sugar's turn to normal and they get off all their medication, including insulin. Just very effective.

COHEN: We have a question now from Jennifer in Louisiana who wants to know:

"Do you think this surgery is dangerous for children under 18? If not, what procedure do you think is the best for a teenager?"

Dr. Schauer, you do surgeries on teenagers, is that correct?

SCHAUER: Yes, and it's a very -- you know, careful decision and it's a risk/benefit analysis. There are some adolescents that have very severe obesity, they may have diabetes, other medical conditions and the obesity is dangerous, so it's a matter of matching the danger of surgery versus the danger of their disease -- of obesity.

COHEN: But, how can you tell? The NIH has said you should have tried everything before you resort -- or tried less dramatic things before you resort to surgery. How can a 16-year-old really have tried all that many other things before resorting to surgery?

SCHAUER: Oh, certainly. There are many 16-year-olds who have been heavy all their life. In grade school and in junior high school and they have tried many diets, they've tried exercise programs, they've been in intense therapy, and there are some kids that have a rough time losing weight.

COHEN: We have a phone call now, from Judy in Kansas.

Judy, welcome to WEEKEND HOUSE CALL and go ahead with your question for Dr. Schauer.

JUDY, KANSAS: OK Doctor, I had a roux-en-Y September 13, 2001 and since then -- well, I've lost over 100 pounds and I'm off my blood pressure medicine which is nice, but I've had nothing but problems since with acid reflex and closing of the esophagus, it's had to be reopened twice and I'm still having a lot of trouble eating.

SCHAUER: Yes. Well I think, Judy, this problem is called a stricture where there can be scarring around the connection between the stomach pouch and the intestines and often this can be relieved by a procedure called endoscopy where the surgeon goes in and actually stretches that area. This is a uncommon complication. It occurs about maybe 4 percent or 5 percent of patients. And generally it can be resolved sometimes requiring two or three of these dilations. COHEN: Dr. Schauer, I certainly just my group of friends, know people who had the surgery, everything went beautifully, never had another problem, and then I know other people who had terrible problems. What's the difference? Is it the difference in the patients, the difference in their surgeons?

SCHAUER: Well, I think a combination of both, and it's not just the surgeon's experience, but also the program the surgeon builds around the operation. And, surgeons should involve the patient in an intense learning program prior to the operation. And there's an adaptive phase. Months and even years after surgery where the patients need to adapt to their new eating style, and this requires a lot of help. In our program, for example, we have nurses, nurse practitioners, dietitians who help the patient adjust to their new eating style. This is very important.

COHEN: Well, gastric bypass isn't the only weight loss surgery out there. When we come back, we'll take a look at some other surgical choices. Give us as call at 1-800-807-2620 or e-mail us at Housecall@cnn.com. Stay with us.

(COMMERCIAL BREAK)

COHEN: Welcome back to WEEKEND HOUSE CALL we've been talking about obesity surgery, a relatively new option in this procedure is called the Lap-Band. Here's how it works: The surgeon goes in through a small incision in your abdomen and places a band around the upper stomach. It is then inflated and cinches the stomach creating a tiny passage between the two pouches. The band can be adjusted and is designed to stay in place permanently. There can be side effects with this surgery, as well, such as nausea, vomiting, heartburn and some bands can slip out of place and surgeons have to go back in and readjust.

Talking with us this morning is Dr. Phillip Schauer, a surgeon who performs this procedure, along with other types of weight loss surgeries.

Dr. Schauer, there are several different procedures out there. How do you know which is best for you? Are certain types of patients more suited for one type of procedure than the other?

SCHAUER: Well, I think the surgeon and the patient need to discuss the pros and cons of the different operations and come to a conclusion what works best for that particular patient.

COHEN: But if you're -- if you're heavier, are you better suited for one type than the other? Or if you have less weight to lose?

SCHAUER: Right. Well, the gastric bypass is a more invasive procedure, it's a bit more powerful than the Lap-Band and result perhaps, more weight loss, but it does carry higher risks.

COHEN: Well, we have calls and e-mails coming in from across the country on this issue. Let's go to Jennifer in Tennessee who wants to know: "Could you give me the pros and the cons of the Lap-Band procedure?"

SCHAUER: Yes, the Lap-Band procedure, it's an operation that's been around for about ten years, primarily developed in Europe. The pros are it's a very minimally invasive procedure, there's no stapling or cutting of the stomach involved, there's no rerouting of the intestines. This band is simply placed around the upper stomach, so the risk of major complications are much, much less.

COHEN: We have an e-mail now from J.J. In British Columbia who writes:

"I'm having gastric band surgery in January. Have there ever been any serious problems with this type of surgery? Also, how long has this procedure been around?"

SCHAUER: Right. Well, even though it's a minimally invasive operation, still a major surgery. So, complications can happen. The band, for example, can slip down the stomach and cause problems, this is uncommon, though. The band can also erode into the stomach, which may require it to be removed.

COHEN: Sidney in Mississippi also has a Lap-Band question. She writes:

"I am told that a Lap-Band is removable. Is there associated scarring after the removal?"

Doctor, why would you ever want to remove one in the first place?

SCHAUER: The band can be removed if there are complications, it could be removed, and is quite simple to remove it. You just cut it and remove it. It does leave a little bit of scarring, but rarely is this a problem, and when it's removed, it restores the patient's anatomy to their original form.

COHEN: Well, we want to know: Is weight loss surgery a good fit for everyone who qualifies? When we come back, we'll be talking about this and we'll also be talking about the need to think about emotional issues when you're considering this surgery. That'll be after our break.

(COMMERCIAL BREAK)

COHEN: Welcome back to WEEKEND HOUSE CALL. Obesity is a major problem in this country, in fact, one in three American adults is considered to be obese. If you're one of the thousands of people struggling with their weight, surgery may be for you. We're talking today with Dr. Phillip Schauer, a surgeon at the University of Pittsburgh Medical Center.

Doctor, let's get right back to our e-mail questions. Patricia in Texas writes:

"I had obesity surgery two years ago and have not experienced any problems. The only thing is that I am having problems not being able to control my eating when nervous. This has resulted in extreme discomfort at times due to my stomach becoming smaller"

Doctor, many people eat because they're depressed or because they're having emotional issues, after you have the surgery, if you keep up that emotional eating, you can really be in trouble, can't you?

SCHAUER: That's right, and that's why the operation could be -- should be considered a tool to help you control your eating, and it definitely decreases appetite, decreases your capacity to eat. But again, the operation should work in conjunction with a program to have dietitians, nurses, and other healthcare professionals to help the patient deal with some of these issues.

COHEN: Katherine from Virginia e-mailed us. She wants to know:

"I'm 33-years-old and was recently told by my general practitioner that I am a perfect candidate for gastric bypass surgery. I want to move forward, but I'm concerned about pregnancy complications. I want to have children in the next two years. Are there any complications between the surgery and pregnancy and/or the actual child delivery?"

Doctor, I'm sure you've probably faced this question in your practice.

SCHAUER: Yes, certainly. And, we counsel our patients to try to avoid becoming pregnant at least within the first year after surgery, and so therefore, they should practice -- you know, prophylaxis. But beyond that, once they lose -- you know, their weight, we've had a number of young women have children, have very healthy pregnancies, and in fact, they say that their pregnancy was easier than when they were heavy.

COHEN: We have a phone call now from Michelle in Ohio.

Michelle, welcome to WEEKEND HOUSE CALL and go ahead with your question for Dr. Schauer.

MICHELLE, OHIO: Thanks Elizabeth, Yes, Dr. Schauer, my aunt is approximately five feet tall and weighs about, I would say, 400 pounds, and she certainly has considered this surgery, but she's in her 60's and I think she's concerned because of her age. Could you tell me how old is too old to have this surgery?

SCHAUER: Yes. There's no age limit, per se, for patients to have this surgery, in fact, we've operated on patients in their 70's, but the older patients do require a very extensive evaluation prior to surgery to make sure that their heart and lungs and so forth are in good condition to withstand the operation. But, there's no age limit, per se, for weight loss surgery.

COHEN: We have an e-mail now from Adena in Alabama. She wants to know:

"I had gastric bypass surgery in July of this year. I have already lost more than 100 pounds and am concerned about the inevitable plastic surgery that will be required. Is there an accepted time limit or guideline for when you should have plastic surgery after weight loss?"

Doctor, is it inevitable when you lose that much weight, do you need to have plastic surgery for the -- all that sagging skin afterwards?

SCHAUER: Not always, Elizabeth. It depends on how large the patient is prior to surgery. Patients that have only 100 pounds to lose often will have just a minimal amount of loose skin. Folks that lose 200 or 300 pounds from surgery, yes, they usually will have a lot of loose skin. We counsel our patients to have the plastic surgery when they've reached a stable weight. And this is usually two, maybe three years after the operation. They'll get the best results when their weight is stable.

COHEN: We have a phone now from Betty in the Virgin Islands.

Betty, go ahead with your question for Dr. Schauer.

BETTY, VIRGIN ISLANDS: Yes. I have a friend's daughter who weighs 377 pounds and she had extensive invasive gastric bypass, and she has only lost 67 pounds. She's still able to eat everything and large amounts. What happened?

SCHAUER: Yes. Well, there are number of factors that will predict weight loss. The average weight loss for this operation is about 70 percent of the excess weight. So, 70 pounds, if someone's 100 pounds overweight, but there's quite a variation. A lot depends on how the patient adapts to the surgery, how they're counseled before and after the operation, there are many factors involved with the ultimate weight loss.

COHEN: We have on the phone now, Linda in Minnesota.

Linda, welcome to WEEKEND HOUSE CALL and go ahead with your question.

LINDA, MINNESOTA: Thank you, Elizabeth. Dr. Schauer, why aren't there any support groups for us? I'm in Minnesota, and I have over two -- oh, about an hour and a half to drive to where I had my surgery two years ago. It seems like there should be something, some place we can go where we can talk with other who have had the surgery to find out if we have problems instead of having to go back to the doctor or go to a dietitian that costs us extra money our insurance doesn't pay for. Help!

SCHAUER: Yes, ma'am, that's a very good question and we believe strongly that most programs should have support groups. In our program in Pittsburgh, for example, we have a monthly meeting where we invite all of our patients to come and it gives them the chance to talk to other patients, as well as, health care professionals about the surgery, about problems they're having and it's very healthy. There are support groups now being developed over the internet, and if you have a home computer, you can get on the internet and, for example, our program we broadcast our support group over the internet and you can even e-mail questions in. So, I think that is a developing process. Support groups are very helpful. COHEN: And, we'll -- actually we'll be giving your -- the website later for your hospital so that people can do that virtual support group. It sounds like a great idea. So, grab a pen, we'll give that you website and some others to check out on more information on weight loss surgeries. First, take a look at some of this week's medical news in today's "For Your Health."

(BEGIN VIDEO CLIP)

COHEN (voice-over): A new study in the "New England Journal of Medicine" this week, suggests that a virtual colonoscopy may be just as effective as a normal, more invasive colonoscopy at detecting colon cancer. The procedure using a spiral CAT scan to create a virtual image of the patient's colon.

Also, Echinacea may not be Mother Nature's answer to curing colds, after all. A study released this week in the "Journal of the Medical Association" found the herbal supplement did not relieve cold systems in the children studied and in some cases it caused mild skin rashes.

(END VIDEO CLIP)

COHEN: For more information on weight loss surgery go to www.mayoclinic.com where you can find all kinds of information on the risks and rewards. Also try going to Dr. Schauer's hospital website at www.upmc.edu/obesitysurgery.com, there you'll be able to find information on all of these procedures, or if surgery isn't the right choice for you, there are links to weight management sites, as well.

Thanks so much for joining us this morning where we've been talking about obesity surgery with Dr. Schauer from the University of Pittsburgh.

Doctor, can you give us an example -- obviously after the surgery you can't eat the way you used to, give me an example of what a typical meal would be after the surgery?

SCHAUER: Yes, it would be really normal food; a patient can eat meat, vegetables, but probably about a quarter of what they could eat before. An example would be a kid's meal instead of -- you know, a full adult meal.

COHEN: Well we're out of time for today. Thanks to all of you for your great phone calls and e-mails.

And, Dr. Schauer, thank you for being with us this morning.

SCHAUER: You're very welcome, Elizabeth.

COHEN: Make sure to watch next weekend when we're talking about new outbreaks of antibiotic resisted infections. Is misuse of antibiotics to blame? Tune in next weekend at 8:30 a.m. Thanks for watching. I'm Elizabeth Cohen, "CNN Sunday Morning" continues right now.

END

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Aired December 7, 2003 - 8:30   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. Our topic today is weight loss surgeries. As more and more Americans become obese, hundreds of people are on waiting lists for bariatric surgeries. These procedures can save people's lives by helping them lose sometimes hundreds of pounds, but not all procedures have a happy ending.
(BEGIN VIDEOTAPE)

COHEN (voice-over): We've seen them all on TV. Carnie Wilson, Al Roker, Roseanne Barr. They once were large and now they're not. Thanks to what seems to be all the rage these days, gastric bypass surgery. So is this the easy fix for the millions of Americans who are morbidly obese? Two new studies show us that gastric bypass surgery can be a dangerous procedure. According to one done at the University of Washington, one out of every 50 patients will die within the first 30 days following surgery and early death from surgical complications is directly linked to how experienced your surgeon is.

Another study released this week, this one from the University Hospitals of Cleveland, says gastric bypass surgery is riskiest for the most obese, those, of course, who need it the most.

Still, 98 percent of patients who undergo these procedures do survive. So why not do it? For one, anyone considering this surgery has to realize that their lives will change dramatically.

DR. DAVID FLUM, UNIV. OF WASHINGTON: Actually, they'll never have a normal meal again.

COHEN: That's because you're stomach is essentially reduced to the size of an egg. According to the centers for disease control, 30 percent of American adults over the age of 20 are obese. That's nearly 60 million people. So, with more obese Americans means more surgeries and a greater chance for more complications.

FLUM: There are many elements of gastric bypass surgery that are the conditions of a perfect storm, if you will, for adverse outcomes. Increased commercial demand, increased surgeon interest and increased patient interest.

COHEN: Bariatric surgery has become big business with more and more surgeons wanting to get in on the act. According to the American Bariatric Association, 63,000 people had the surgery last year. This year, that number is expected to climb to 100,000.

(END VIDEOTAPE) COHEN: Let's take a look at who qualifies for this surgery. According to guidelines from the National Institutes of Health, you should be 100 pound or more overweight or have a body mass index of 40 or higher, that means if you're 5'2", you should weigh at least 218 pounds or if you're 5'10" at least 278 pounds. The guidelines also say you should have tried to lose weight in less dramatic way before resorting to surgery. Gastric bypass surgery consists of a surgeon stapling your stomach so it becomes a pouch the size of an egg and then they reroute your intestines to the new stomach. Surgeons either open up your abdominal cavity or they can do the surgery laparoscopically through small slits. This procedure is less invasive and generally leads to a quicker recovery. There can be side effects which may include nutritional deficiencies, liver problems, sugar intolerance, and after losing all that weight you can end up with a lot of droopy skin, and as we heard earlier, some people can die from this procedure.

We want to hear your questions about weight loss surgery, so give us a call at 1-800-807-2620 or you can e-mail us at Housecall@cnn.com.

Here to talk about these increasingly popular surgeries is Dr. Philip Schauer, director of bariatric surgery at the University of Pittsburgh Medical center.

Dr. Schauer, welcome to our show.

DR. PHILIP SCHAUER, DIRECTOR OF BARIATRIC SURGERY: Good morning, Elizabeth.

COHEN: Good morning.

First off, let me ask you how many of these procedures have you done this year?

SCHAUER: This year, approximately about 800 operations.

COHEN: That's a -- that's a huge number. There are many surgeons who are just starting this and who've done very few, I imagine.

SCHAUER: That's correct.

COHEN: How do you know? When you go to the doctor, what do -- what should you ask? Should you ask for a number?

SCHAUER: That's a great question. I think you should ask the doctor how many he has performed, and I think experience definitely improves the outcomes.

COHEN: That's right. That's what those studies show that we were talking about earlier. Well we're getting flooded with calls and e-mails, so let's get right to an e-mail. This one is from Joyce in Texas who writes:

"I'm scheduled to have gastric bypass surgery in February, I am doing it because I am a diabetic, and my doctor is sure that by having the surgery to lose weight, I can get my diabetes under control. How true is this?"

Dr. Schauer, diabetics sometimes, are they able to go off their medication once they have the surgery?

SCHAUER: Certainly. And Joyce, you can be very confident that your diabetes will improve dramatically. There are a number of studies including a study we published just a few months ago that showed that about 80 percent of patients who have diabetes, who have this surgery, essentially are cured and the blood sugar's turn to normal and they get off all their medication, including insulin. Just very effective.

COHEN: We have a question now from Jennifer in Louisiana who wants to know:

"Do you think this surgery is dangerous for children under 18? If not, what procedure do you think is the best for a teenager?"

Dr. Schauer, you do surgeries on teenagers, is that correct?

SCHAUER: Yes, and it's a very -- you know, careful decision and it's a risk/benefit analysis. There are some adolescents that have very severe obesity, they may have diabetes, other medical conditions and the obesity is dangerous, so it's a matter of matching the danger of surgery versus the danger of their disease -- of obesity.

COHEN: But, how can you tell? The NIH has said you should have tried everything before you resort -- or tried less dramatic things before you resort to surgery. How can a 16-year-old really have tried all that many other things before resorting to surgery?

SCHAUER: Oh, certainly. There are many 16-year-olds who have been heavy all their life. In grade school and in junior high school and they have tried many diets, they've tried exercise programs, they've been in intense therapy, and there are some kids that have a rough time losing weight.

COHEN: We have a phone call now, from Judy in Kansas.

Judy, welcome to WEEKEND HOUSE CALL and go ahead with your question for Dr. Schauer.

JUDY, KANSAS: OK Doctor, I had a roux-en-Y September 13, 2001 and since then -- well, I've lost over 100 pounds and I'm off my blood pressure medicine which is nice, but I've had nothing but problems since with acid reflex and closing of the esophagus, it's had to be reopened twice and I'm still having a lot of trouble eating.

SCHAUER: Yes. Well I think, Judy, this problem is called a stricture where there can be scarring around the connection between the stomach pouch and the intestines and often this can be relieved by a procedure called endoscopy where the surgeon goes in and actually stretches that area. This is a uncommon complication. It occurs about maybe 4 percent or 5 percent of patients. And generally it can be resolved sometimes requiring two or three of these dilations. COHEN: Dr. Schauer, I certainly just my group of friends, know people who had the surgery, everything went beautifully, never had another problem, and then I know other people who had terrible problems. What's the difference? Is it the difference in the patients, the difference in their surgeons?

SCHAUER: Well, I think a combination of both, and it's not just the surgeon's experience, but also the program the surgeon builds around the operation. And, surgeons should involve the patient in an intense learning program prior to the operation. And there's an adaptive phase. Months and even years after surgery where the patients need to adapt to their new eating style, and this requires a lot of help. In our program, for example, we have nurses, nurse practitioners, dietitians who help the patient adjust to their new eating style. This is very important.

COHEN: Well, gastric bypass isn't the only weight loss surgery out there. When we come back, we'll take a look at some other surgical choices. Give us as call at 1-800-807-2620 or e-mail us at Housecall@cnn.com. Stay with us.

(COMMERCIAL BREAK)

COHEN: Welcome back to WEEKEND HOUSE CALL we've been talking about obesity surgery, a relatively new option in this procedure is called the Lap-Band. Here's how it works: The surgeon goes in through a small incision in your abdomen and places a band around the upper stomach. It is then inflated and cinches the stomach creating a tiny passage between the two pouches. The band can be adjusted and is designed to stay in place permanently. There can be side effects with this surgery, as well, such as nausea, vomiting, heartburn and some bands can slip out of place and surgeons have to go back in and readjust.

Talking with us this morning is Dr. Phillip Schauer, a surgeon who performs this procedure, along with other types of weight loss surgeries.

Dr. Schauer, there are several different procedures out there. How do you know which is best for you? Are certain types of patients more suited for one type of procedure than the other?

SCHAUER: Well, I think the surgeon and the patient need to discuss the pros and cons of the different operations and come to a conclusion what works best for that particular patient.

COHEN: But if you're -- if you're heavier, are you better suited for one type than the other? Or if you have less weight to lose?

SCHAUER: Right. Well, the gastric bypass is a more invasive procedure, it's a bit more powerful than the Lap-Band and result perhaps, more weight loss, but it does carry higher risks.

COHEN: Well, we have calls and e-mails coming in from across the country on this issue. Let's go to Jennifer in Tennessee who wants to know: "Could you give me the pros and the cons of the Lap-Band procedure?"

SCHAUER: Yes, the Lap-Band procedure, it's an operation that's been around for about ten years, primarily developed in Europe. The pros are it's a very minimally invasive procedure, there's no stapling or cutting of the stomach involved, there's no rerouting of the intestines. This band is simply placed around the upper stomach, so the risk of major complications are much, much less.

COHEN: We have an e-mail now from J.J. In British Columbia who writes:

"I'm having gastric band surgery in January. Have there ever been any serious problems with this type of surgery? Also, how long has this procedure been around?"

SCHAUER: Right. Well, even though it's a minimally invasive operation, still a major surgery. So, complications can happen. The band, for example, can slip down the stomach and cause problems, this is uncommon, though. The band can also erode into the stomach, which may require it to be removed.

COHEN: Sidney in Mississippi also has a Lap-Band question. She writes:

"I am told that a Lap-Band is removable. Is there associated scarring after the removal?"

Doctor, why would you ever want to remove one in the first place?

SCHAUER: The band can be removed if there are complications, it could be removed, and is quite simple to remove it. You just cut it and remove it. It does leave a little bit of scarring, but rarely is this a problem, and when it's removed, it restores the patient's anatomy to their original form.

COHEN: Well, we want to know: Is weight loss surgery a good fit for everyone who qualifies? When we come back, we'll be talking about this and we'll also be talking about the need to think about emotional issues when you're considering this surgery. That'll be after our break.

(COMMERCIAL BREAK)

COHEN: Welcome back to WEEKEND HOUSE CALL. Obesity is a major problem in this country, in fact, one in three American adults is considered to be obese. If you're one of the thousands of people struggling with their weight, surgery may be for you. We're talking today with Dr. Phillip Schauer, a surgeon at the University of Pittsburgh Medical Center.

Doctor, let's get right back to our e-mail questions. Patricia in Texas writes:

"I had obesity surgery two years ago and have not experienced any problems. The only thing is that I am having problems not being able to control my eating when nervous. This has resulted in extreme discomfort at times due to my stomach becoming smaller"

Doctor, many people eat because they're depressed or because they're having emotional issues, after you have the surgery, if you keep up that emotional eating, you can really be in trouble, can't you?

SCHAUER: That's right, and that's why the operation could be -- should be considered a tool to help you control your eating, and it definitely decreases appetite, decreases your capacity to eat. But again, the operation should work in conjunction with a program to have dietitians, nurses, and other healthcare professionals to help the patient deal with some of these issues.

COHEN: Katherine from Virginia e-mailed us. She wants to know:

"I'm 33-years-old and was recently told by my general practitioner that I am a perfect candidate for gastric bypass surgery. I want to move forward, but I'm concerned about pregnancy complications. I want to have children in the next two years. Are there any complications between the surgery and pregnancy and/or the actual child delivery?"

Doctor, I'm sure you've probably faced this question in your practice.

SCHAUER: Yes, certainly. And, we counsel our patients to try to avoid becoming pregnant at least within the first year after surgery, and so therefore, they should practice -- you know, prophylaxis. But beyond that, once they lose -- you know, their weight, we've had a number of young women have children, have very healthy pregnancies, and in fact, they say that their pregnancy was easier than when they were heavy.

COHEN: We have a phone call now from Michelle in Ohio.

Michelle, welcome to WEEKEND HOUSE CALL and go ahead with your question for Dr. Schauer.

MICHELLE, OHIO: Thanks Elizabeth, Yes, Dr. Schauer, my aunt is approximately five feet tall and weighs about, I would say, 400 pounds, and she certainly has considered this surgery, but she's in her 60's and I think she's concerned because of her age. Could you tell me how old is too old to have this surgery?

SCHAUER: Yes. There's no age limit, per se, for patients to have this surgery, in fact, we've operated on patients in their 70's, but the older patients do require a very extensive evaluation prior to surgery to make sure that their heart and lungs and so forth are in good condition to withstand the operation. But, there's no age limit, per se, for weight loss surgery.

COHEN: We have an e-mail now from Adena in Alabama. She wants to know:

"I had gastric bypass surgery in July of this year. I have already lost more than 100 pounds and am concerned about the inevitable plastic surgery that will be required. Is there an accepted time limit or guideline for when you should have plastic surgery after weight loss?"

Doctor, is it inevitable when you lose that much weight, do you need to have plastic surgery for the -- all that sagging skin afterwards?

SCHAUER: Not always, Elizabeth. It depends on how large the patient is prior to surgery. Patients that have only 100 pounds to lose often will have just a minimal amount of loose skin. Folks that lose 200 or 300 pounds from surgery, yes, they usually will have a lot of loose skin. We counsel our patients to have the plastic surgery when they've reached a stable weight. And this is usually two, maybe three years after the operation. They'll get the best results when their weight is stable.

COHEN: We have a phone now from Betty in the Virgin Islands.

Betty, go ahead with your question for Dr. Schauer.

BETTY, VIRGIN ISLANDS: Yes. I have a friend's daughter who weighs 377 pounds and she had extensive invasive gastric bypass, and she has only lost 67 pounds. She's still able to eat everything and large amounts. What happened?

SCHAUER: Yes. Well, there are number of factors that will predict weight loss. The average weight loss for this operation is about 70 percent of the excess weight. So, 70 pounds, if someone's 100 pounds overweight, but there's quite a variation. A lot depends on how the patient adapts to the surgery, how they're counseled before and after the operation, there are many factors involved with the ultimate weight loss.

COHEN: We have on the phone now, Linda in Minnesota.

Linda, welcome to WEEKEND HOUSE CALL and go ahead with your question.

LINDA, MINNESOTA: Thank you, Elizabeth. Dr. Schauer, why aren't there any support groups for us? I'm in Minnesota, and I have over two -- oh, about an hour and a half to drive to where I had my surgery two years ago. It seems like there should be something, some place we can go where we can talk with other who have had the surgery to find out if we have problems instead of having to go back to the doctor or go to a dietitian that costs us extra money our insurance doesn't pay for. Help!

SCHAUER: Yes, ma'am, that's a very good question and we believe strongly that most programs should have support groups. In our program in Pittsburgh, for example, we have a monthly meeting where we invite all of our patients to come and it gives them the chance to talk to other patients, as well as, health care professionals about the surgery, about problems they're having and it's very healthy. There are support groups now being developed over the internet, and if you have a home computer, you can get on the internet and, for example, our program we broadcast our support group over the internet and you can even e-mail questions in. So, I think that is a developing process. Support groups are very helpful. COHEN: And, we'll -- actually we'll be giving your -- the website later for your hospital so that people can do that virtual support group. It sounds like a great idea. So, grab a pen, we'll give that you website and some others to check out on more information on weight loss surgeries. First, take a look at some of this week's medical news in today's "For Your Health."

(BEGIN VIDEO CLIP)

COHEN (voice-over): A new study in the "New England Journal of Medicine" this week, suggests that a virtual colonoscopy may be just as effective as a normal, more invasive colonoscopy at detecting colon cancer. The procedure using a spiral CAT scan to create a virtual image of the patient's colon.

Also, Echinacea may not be Mother Nature's answer to curing colds, after all. A study released this week in the "Journal of the Medical Association" found the herbal supplement did not relieve cold systems in the children studied and in some cases it caused mild skin rashes.

(END VIDEO CLIP)

COHEN: For more information on weight loss surgery go to www.mayoclinic.com where you can find all kinds of information on the risks and rewards. Also try going to Dr. Schauer's hospital website at www.upmc.edu/obesitysurgery.com, there you'll be able to find information on all of these procedures, or if surgery isn't the right choice for you, there are links to weight management sites, as well.

Thanks so much for joining us this morning where we've been talking about obesity surgery with Dr. Schauer from the University of Pittsburgh.

Doctor, can you give us an example -- obviously after the surgery you can't eat the way you used to, give me an example of what a typical meal would be after the surgery?

SCHAUER: Yes, it would be really normal food; a patient can eat meat, vegetables, but probably about a quarter of what they could eat before. An example would be a kid's meal instead of -- you know, a full adult meal.

COHEN: Well we're out of time for today. Thanks to all of you for your great phone calls and e-mails.

And, Dr. Schauer, thank you for being with us this morning.

SCHAUER: You're very welcome, Elizabeth.

COHEN: Make sure to watch next weekend when we're talking about new outbreaks of antibiotic resisted infections. Is misuse of antibiotics to blame? Tune in next weekend at 8:30 a.m. Thanks for watching. I'm Elizabeth Cohen, "CNN Sunday Morning" continues right now.

END

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