It seems to be in the news all the time, and it is evident on streets across the country. America is getting bigger, and not in a good way.

Obesity rates are climbing. According to a study released in July by the Trust for America’s Health and the Robert Wood Johnson Foundation, in 31 states, obesity rates exceed 25 percent. In 49 states, the rates are above 20 percent. Overall, the report found that two-thirds of all Americans are now obese or overweight. Go back less than 20 years ago, and no state had an adult obesity rate higher than 20 percent.

People are considered obese if they have a Body Mass Index (BMI) higher than 40. There are three criteria to know if one is morbidly obese:

• If a person is more than 100 pounds overweight.

• If BMI is over 40.

• If they have complications including high blood pressure, edema, high blood sugar and shortness of breath, among many others.

This higher rate of obesity is turning into a boon for weight loss surgeries. As more insurance companies pay for weight loss surgery — to avoid expensive medicines and surgeries due to complications from obesity — no weight loss center is busier than Federal Way’s St. Francis Weight Loss Surgery Clinic.

Surgery options

There are more and more options for weight loss surgery. In Federal Way, St. Francis performs the most weight loss surgeries in the state, and offers four types of surgery.

• Adjustable Gastric Band (also known as Lap Band) is a less invasive option. In this surgery, the stomach is not opened or stapled. Instead, a band is placed on the outside of the upper stomach, making a small pouch. This surgery does not offer as much weight loss as some of the others. However, it does have the shortest recovery time.

• Roux En Y Gastric Bypass is the typical weight loss surgery. This operation creates a small thumb-sized pouch, which becomes the new stomach. The small intestine is cut and rearranged to provide an outlet to the small stomach. When a patient eats following surgery, the food is sent to the second part of the small bowel within 10 minutes of starting to eat. This reduces intake and quickly triggers the patient to feel full. This surgery often offers weight loss of 80-100 percent of excess weight.

• Duodenal Switch is a less often performed surgery, where 85 percent of the stomach is permanently removed, leaving a small pouch of about 6 ounces. However, this surgery provides weight loss through restriction and malabsorption, so patients must carefully watch their nutrition to avoid anemia, protein deficiency and metabolic bone disease. This procedure is generally limited to those patients with a BMI of over 55.

• Sleeve Gastrectomy is fairly new. This procedure restricts food intake, and is usually for highly obese or at-risk patients to provide enough weight loss in order to have a second surgery, usually a gastric bypass or duodenal switch, to be performed later. In this surgery, a little more than half the stomach is removed laparoscopically, leaving the remaining stomach in the shape of a sleeve. Patients can lose 30-50 percent of their excess weight in under a year.

4,000 surgeries and counting

Over the years, Dr. Ki Oh has performed more than 4,000 weight loss surgeries.

Dr. Oh is one of two weight loss surgeons at St. Francis in Federal Way. He said candidates for surgery at their center usually have a BMI above 35.

“People who come to my office have gone through zillions of diets in the past,” Dr. Oh said. “This is the last resort.”

The surgeries can range from one hour for the Lap Band surgery to four hours for the Duodenal.

There are complications for weight loss surgeries, including death in about 1 percent of patients. Other complications frequently include nausea, vomiting, sometimes wound infections and ulcers.

And while insurance companies are more frequently approving weight loss surgery, there are still plenty of patients who are turned down or only receive partial coverage for the surgery. Without insurance, surgeries can cost anywhere from about $15,000 for the Sleeve Gastrectomy to $26,000 for the Duodenal.

Dr. Oh said most of his patients are in their 30s and 40s, although he does go as low as age 15 and up to 69 years old.

Patients begin losing weight even before their surgery, he said. For two weeks prior to surgery, the patients are put on a clear liquid diet, which continues for a month following surgery. There are permanent diet restrictions following the surgery, including no sugar or milk as well as the need for a high-protein, low-carb diet.

Weight loss varies from surgery to surgery but the average, Dr. Oh said is 100 pounds over 10-12 months.

“When I started in 1985, a lot of doctors didn’t agree with me. They thought it was unnecessary,” Dr. Oh said. “People now are educated through information.”

Weight loss surgery is meant to be permanent. Dr. Oh estimates that one in 1,000 patients want to remove their Lap Band after reaching their weight loss goals. However, that usually results in the patients gaining weight back.

“If you reverse the surgery, you gain the weight back,” Dr. Oh said. “The gene has the memory. One patient had his removed and he gained 43 pounds in one month. Weight loss surgery is permanent.”