Gastric Bypass for Polio Survivors

A Bruno Byte from Richard L. Bruno, HD, PhD
Director, International Centre for Polio Education

Question:

I am 5 feet tall and 100 pounds overweight. My doctor says if I lost weight, my weakness and fatigue would go away. I have tried to diet and just can't lose weight. Is it safe for polio survivors to have their stomachs stapled?

Dr. Bruno’s Response:

Before we get out the Swingline and have at your belly, let's discuss the basics. First, two studies have shown that weight is not related to PPS symptoms. Second, our research has found that you can feel stronger and less fatigued -- and lose about a pound a week -- by eating more low fat and low cholesterol protein and decreasing carbohydrates

However, some folk can't stick to this "diet" or are so heavy that their health is at risk, e.g., those with diabetes, high cholesterol and blood pressure, and sleep apnea. Since polio survivors can't exercise to lose weight, could stomach stapling be an option for those who must lose more than 100 pounds?

To be a candidate for stomach stapling, which is technically called gastric bypass, your body mass index (BMI) must be 40 or more. (BMI = weight in pounds times 703, divided by two times your height in inches.) A "normal" BMI is up to 25. "Overweight" is 25 to 30 and "obese" is 30 and above. At 5 feet tall and 210 pounds, your BMI is 41, which means you are a candidate for gastric bypass.

There are a couple of gastric bypass procedures. In one, staples are used to divide your stomach into two compartments, a small egg-sized upper "pouch" to hold food and a larger unused bottom section. Your small intestine is connected to the small pouch, which limits how much you can eat at a sitting and thereby enforces a "diet."

In a less common procedure called gastric banding, the "pouch" is created using bands or staples. A narrow passage is left so that food can still pass through the remainder of the stomach and into the small intestine. This procedure is not as successful for weight loss but is better when it comes to maintaining the ability absorb vitamins and minerals.

Surgeries are performed under anesthesia either laparoscopically or the old-fashioned way, which is more painful and can cause stomach muscle weakness. (If you weigh more than 350 pounds or if you have had abdominal surgery in the past, you are probably not a good candidate for laparoscopy.)

Both procedures carry with them all of the post-polio surgical and anesthesia concerns (see the "Preventing Surgical Complications" article). And there are also side effects: infection, bleeding, diarrhea, bloating, vomiting, and iron and calcium deficiencies causing anemia or osteoporosis.

What's more, if you couldn't stick to the post-polio "diet," it may be hard to eat only a few ounces of food many times a day, a requirement since your new mini-stomach will only hold about a tablespoonful at first. But all this said, the procedures typically result in a weight loss of about 10 pounds per month for up to two years –– an average loss of 60% of the excess weight -- with most weight lost before surgery went your on all liquid diet and then right after surgery when you're only taking liquids.

In addition, a recent review of 136 studies of 22,000 obese gastric bypass patients found that dangerous medical conditions could be eliminated by the surgery. High blood pressure was reduced in 62% of patients, diabetes disappeared in 77%, and sleep apnea vanished in 86%. Cholesterol improved in at least 70%.

But is gastric bypass safe for polio survivors? A medical journal article found that gastric bypass was safe and effective in two post-polio patients and in a few with multiple sclerosis, cerebral palsy and post-stroke. Two Post-Polio Institute patients have had gastric bypass, stuck to their diets, lost weight without exercise, and now feel, function and look great. So, although gastric bypass is the last resort for the treatment of severe and dangerous obesity -- and should never be done to treat post-polio muscle weakness or fatigue -- polio survivors can do well after having their stomachs stapled.

However, for those not interested in snipping and cutting, newer techniques of gastric banding -- where a strap is placed around the stomach to reduce its size -- can be alternative to gastric bypass. If surgery is of interest to you please contact a surgeon who is familiar with all techniques.