Weighty matters

Clinic specializes in bariatric surgery

By COLIN M. STEWART

Tribune-Herald staff writer

As anyone who has tried to lose a few pounds at the New Year can attest, success is rarely assured. Motivation can wane, and the undertaking can quickly be forgotten amid the daily challenges posed by a busy work life and family life.

But for the 26 percent of the Big Isle’s population who are considered obese, and the 4 percent who are morbidly obese, the subject of weight loss can be a life-or-death proposition. While medical science has developed a number of ways to make weight loss easier, it still requires a person to make a total commitment to changing his or her life, and that can often be too much to tackle alone.

Since 2004, The Queen’s Medical Center Comprehensive Weight Management Program in Honolulu has been working to provide that support along with its bariatric surgeries, any of three different procedures which endeavor to shrink the stomach so that patients feel fuller after eating less food. Importantly, that approach is multidisciplinary, including evaluation by physicians, nutritionists and psychological and emotional therapists. Since the program’s launch, about 80 patients from the Big Island have participated.

But, said program Medical Director Cedric Lorenzo, patients on the Big Isle have long been at a disadvantage because they have had to fly to Oahu to attend the necessary meetings. A patient’s large size, combined with the high cost of travel and hotel stays, means that many people may not choose to pursue the surgery, he said. The state’s QUEST insurance program will cover flight costs, he added, but often private insurers do not, making tickets an out-of-pocket expense for many participants.

In an effort to expand its program to better serve Neighbor Island residents, Queen’s Medical Center on Saturday celebrated the opening of a clinic in Hilo that will provide all of the pre- and post-operative care needed to participate in the program.

“It means they no longer have to travel to Honolulu for the important pre-surgery and post-care,” Lorenzo said. “We’re coming to them, instead.”

According to Lorenzo, patients must be seen a total of about 10 times during their first year and a half on the program.

“We’ll see them an average of three to four times before the surgery for the education and evaluation process,” he said, “and after the surgery we’ll see them about six times to check on the progress of their diet, and making sure there are no nutritional problems.”

Located at 670 Ponahawai St., Suite 122, the Hilo clinic will host the program’s entire weight management team one day a month to meet with Hawaii Island residents, and may expand its hours if necessary, depending on volume, said Program Coordinator Valerie Kauhane.

“There are so many benefits to patients, and not just the weight loss,” Kauhane said. “There are also the illnesses they’re dealing with attributed to their weight, such as Type II diabetes, high blood pressure, obstructive sleep apnea, acid reflux. Some females have increased menstrual bleeding or back and joint pain. A lot of these illnesses resolve after the first month after the operation, killing many birds with one stone.”

For instance, she said, the Big Island has a very high rate of diabetes at 7.3 percent. It also has the highest diabetes mortality rate in the state, at 73.2 percent. In many cases, bariatric surgery can be considered a cure for diabetes, she said, with some people’s symptoms clearing up in a matter of weeks or months.

Participation in the program and surgery is certainly not cheap, Kauhane admitted, boasting a total price tag of $30,000. Depending on what kind of insurance someone has, he or she can be responsible for out-of-pocket expenses from as low as $26 to as high as $5,000. Additionally, patients must pay for a dietitian, which isn’t covered by most insurance plans and can run about $400, as well as supplementary vitamins and minerals they must take for the rest of their lives, totaling $30-$40 a month.

But, she said, the money a patient can save by not paying for insulin and other medications to battle weight-related illnesses can more than make up the difference.

“We had a patient who had to poke himself nine or 10 times a day for diabetes,” she said. “The insurance company estimated that they would have recouped the cost of his surgery in three years for all the money they were spending on medication. His diabetes has fully resolved after the surgery.”

Not every surgery results in permanent weight loss, she admitted, with the program’s success rate resting at between 75 and 80 percent. But many of those who don’t succeed do so because they “haven’t changed their lifestyle,” she said. “It’s meant to be a tool for people to get a kickstart.”

For more information on the program, visit www.queensmedicalcenter.net and click on “Comprehensive Weight Management” under the “Services” tab. Or, call (808) 691-7546.

Email Colin M. Stewart at cstewart@hawaiitribune-herald.com.