Comprehensive Obesity Program Available at SIU Med School

A team of medical and surgical specialists at Southern Illinois University School of Medicine in Springfield is now offering a Comprehensive Obesity Management Program, or COMP, to treat obesity. Treatment options can include a combination of diet, exercise, behavior changes and weight-loss drugs. For severe obesity, gastric bypass surgery also is considered. About 100 patients have enrolled in the program since it began last fall.

"With more than 60 percent of adult Americans overweight or obese, we wanted to provide a team approach to deal with this growing public health problem," says Dr. Amit K. Gupta, assistant professor of internal medicine and medical director for the COMP program. "Those who can best be helped with a program like this are not only those who are overweight, but who have a high proportion of body fat and are therefore considered obese and have obesity-related health problems."

Physicians make recommendations to lose weight usually to patients who have a body mass index (BMI) of 25 or more and may have certain risk factors such as diabetes, high blood pressure, high cholesterol levels, heart disease, joint pain or family history of chronic diseases such as heart disease or diabetes.

Physicians on the SIU COMP team are Gupta, Dr. John P. Sutyak, associate professor of surgery and surgical director for COMP, and Dr. Elizabeth A. Peralta, assistant professor of surgery. Other team members are nurse coordinator, Cindy Wilham, R.N.; dietitian, Erin Paris, R.D.; and a behavioral health counselor, Sandy Vicari, Ph.D., assistant professor of psychiatry. The COMP staff also works closely with patients' primary care physicians and various SIU subspecialties such as pulmonary medicine and endocrinology.

"We want to help patients make long-term changes in eating and physical activity habits, so they can lose weight and keep it off," explains Gupta. "Our goal is a slow and steady weight loss of two to four pounds a month, rather than a rapid weight loss, which can mean loss of muscle rather than fat. Fast weight loss also increases the chances of problems such as gallstones, nutritional deficiencies and failure to maintain weight loss."

Gupta sees all patients initially for a complete medical evaluation and then discusses treatment options with them. Appointments are then scheduled with the dietitian and the behavior therapy counselor. All patients are encouraged to join a structured dietary and behavioral modification program, which includes group therapy meetings where they can deal with the possible developmental, cognitive and emotional issues of eating. Treatment can also include special diets and medications currently being used for treating weight loss such as Xenical and Meridia. Most patients are non-surgical patients and remain in the COMP program for at least six months.

For some patients, the most appropriate therapy may be bariatric surgery, an operation where the stomach capacity is decreased to approximately the volume of a large egg and a length of the small intestine is bypassed. The surgeon creates a small stomach pouch, divides the small bowel and then attaches a short section of the bowel to the stomach pouch. People lose weight because the small stomach restricts food intake and the bypass reduces the length of the bowel that can absorb calories. Gastric bypass surgery has been modified since its first use in the 1960s. SIU surgeons are using the Roux-en-Y procedure. There are some complications possible with surgery.

Bariatric surgery is considered for patients who are at least 100 pounds over ideal body weight and those with one or more severe obesity-related medical complications.

"Potential candidates are those who are unable to lose weight or maintain weight loss with conventional therapy, have acceptable operative risks, and are able to comply with long-term dietary and lifestyle changes as well as lifelong follow-up," says Sutyak. "It helps if a family member or friend comes to appointments and provides support."

If the COMP team determines an individual is a candidate for bariatric surgery, both medically and psychologically, they are referred to Sutyak or Peralta. Meetings continue with the dietician and counselor for several months to solidify the motivation and lifestyle changes that will be necessitated by surgery.

The cost of the medical care and counseling in the COMP program varies depending on the treatment prescribed. Cost for bariatric surgery, including hospitalization and physician and surgeon fees, is approximately $40,000. Not all insurance companies cover all services, but most cover a large portion of the costs.

For more information about the program, patients can be referred to the program by their family physician or contact Cindy Wilham, R.N., Department of Internal Medicine, SIU School of Medicine, 217-545-9479 weekdays or comp@siumed.edu .

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