Obesity comes with health risks. Diabetes. High-blood pressure. Joint pain. Sleep apnea and more. That's why so many people have turned to us for help. MedStar Washington Hospital Center's Bariatric Surgery Program is one of the area's most experienced and comprehensive.
Join Dr. Timothy Shope, Director of Bariatric Surgery, to begin your journey to better health and if this is your first step in the bariatric surgical process, to think of this as a tool to aid in the long term weight loss that could improve the quality of the rest of your life.
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Bariatrics and Weight Management at Medstar Washington Hospital Center
Featured Speaker:
Learn more about Timothy R. Shope, MD
Timothy R. Shope, MD
Timothy Shope, MD, is a bariatric surgeon and Chief of the Section of Advanced Laparoscopic and Bariatric Surgery at MedStar Washington Hospital Center. He is a fellow of the American College of Surgeons and a member of the American Society for Metabolic and Bariatric Surgery (ASMBS) as well as the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).Learn more about Timothy R. Shope, MD
Transcription:
Bariatrics and Weight Management at Medstar Washington Hospital Center
Melanie Cole (Host): More than 12.5 million Americans are severely overweight according to the US Department of Health and Human Services. Obesity comes with health risks – diabetes, high blood pressure, joint pains, sleep apnea, and so much more. Many people who are seriously overweight have tried different diets and medications and professional weight loss services for years without long-term success. My guest today is Dr. Timothy Shope. He’s the Director of Bariatric Surgery at MedStar Washington Hospital Center. Welcome to the show, Dr. Shope. Who should consider bariatric surgery? Are there certain parameters to considering bariatrics, and who can qualify?
Dr. Timothy Shope (Guest): There are parameters, Melanie, and thanks for having me along. The patient that would be a good candidate for surgical weight loss or bariatric surgery would include anyone who has a body mass index or BMI greater than 40, or more than 35 with certain medical conditions such as – you already mentioned diabetes and sleep apnea. There are some carve-outs, which would include patients that have an excess weight of approximately 100 pounds over their ideal body weight, as well.
Melanie: If people have that, and they’ve determined by BMI that they are a candidate, what is the first step? What do they do, and how long does it take between deciding that this is something you’d like to pursue and actually having the surgery?
Dr. Shope: No patient comes through our doors until they’re definitely ready to proceed. Oftentimes patients will tell us that they’ve been thinking about this for five, seven years. Once they’ve made the decision, and they have their initial consultation with the surgeon to determine candidacy, they’re then put into a pretty well-defined program. This includes not only psychological evaluation and potentially counseling, but also, one of the most important components, which is nutritional counseling, which involves our registered dietician. Those patients will have monthly visits with the dietician. Mostly, that’s based on insurance needs, and it’s either three or usually six months of preoperative counseling with the dietician.
Once they’ve completed that program if they met the other program requirements – and that will vary minimally from program to program -- they would then come back to see the surgeon. If everything is in line, we will proceed with surgery.
Melanie: Based on insurance requirements, are there certain things like psychological counseling, and you mentioned the nutrition consulting – what else does insurance sometimes require that they do?
Dr. Shope: Some insurance programs – I’m sorry, some insurance companies will require visits with, for example, a cardiologist or, perhaps a pulmonologist. That’s pretty rare. More and more insurance companies are requiring an evaluation by an exercise physiologist, or some meaningful time spent with the physical side of things. The insurance company’s main requirements are dietician visits and that psychological or psychiatric evaluation.
Melanie: Tell us about the types, Dr. Shope, of bariatric surgery that you’re doing there at MedStar Washington Hospital Center.
Dr. Shope: Sure. We perform the gastric bypass surgery, which is still considered to be the gold standard in the United States. We perform the sleeve gastrectomy. All of those procedures, for the most part, are done laparoscopically these days. On occasion, we do some open procedures when it’s appropriate, and we also have the opportunity to use the robotic equipment as well.
Melanie: Let’s start with bypass. What’s involved, and explain whether this is a malabsorption type of procedure? What is it like for the patient?
Dr. Shope: The gastric bypass is actually a combination procedure where we provide pretty substantial restriction, which basically limits the amount of calories the patient can take in at any one time, as well as the malabsorption that you mentioned. The malabsorption makes it so that of the amount of calories that a patient takes in, only a certain percentage of them would then be actually absorbed appropriately and available by literal consumption by the patient.
As far as what it’s like to live with the operation, patients will have pretty substantially reduced plate sizes. Their portion sizes will be much smaller, and they’ll be eating less at any one time. It’s important that we make it possible for them to get enough calories in in a day, and that dietician counseling makes it certain that of those calories that they take in, a certain proportion of that should be proteins first, perhaps some fats and some carbohydrates, as well. There’s a very significant stress that we place on fluid intake. It’s very easy to become dehydrated after these procedures, and if patients aren’t aware of that, and constantly practicing their fluid intake, it can be a little bit of trouble for them.
Melanie: What’s the difference with the gastric sleeve?
Dr. Shope: The gastric sleeve is a truly restrictive operation. With it, we only reduce the amount of fluid or food that the patient can take in at any one time. The sleeve – with that operation, we create essentially a long, narrow tube of stomach. That long, narrow tube is what provides that rather substantial restriction and limits the amount that they can get in at any one time.
Melanie: Can either of these be reversed?
Dr. Shope: The sleeve gastrectomy cannot be reversed. We actually remove a fair portion of the stomach – somewhere around three-quarters or 80% of the stomach is actually, physically taken out of the patient and cannot be replaced. Reversing the gastric bypass is technically possible, but there has to be a very, very good reason for anyone even to consider it. If it’s considered and subsequently performed, some of the risks that the patient accepted at the initial procedure may even be more so with the reversal of the procedure. The patient may well then regain their weight and their medical troubles that they had.
Melanie: What is life like afterward – after having – whether they’ve had the sleeve or the bypass – as far as nutrition, going to restaurants, supplementation, and exercise? Tell us about some of those things.
Dr. Shope: Sure. Life after the surgery, my patients tell me it’s a little bit to get used to in the early going. They do have to understand that they can only take in a certain amount at a time. There will be times, not only early on, but throughout the rest of their life where – perhaps, they eat a little bit too fast, maybe they haven’t chewed their food, as well as they thought they did, or maybe they’re at a meal with their family, and they’re not consciously aware of what they’re doing where they may actually have some trouble with food feeling like it’s stuck, or perhaps even – needing to excuse themselves to run to the bathroom. This is something that they learn to accommodate with over time, and after months or certainly, after years, they can go out to dinner with the family. They can go to social events. They can live their lives like they otherwise would be able to. They just have to pay a bit more attention to the pace of eating and the types of food they’re eating, and the quantity, certainly.
With regard to lifestyle choices afterward, they can and certainly should be physically active. As far as the nutritional supplements that these patients should be on – all patients should be on a standard multivitamin. Many of our patients should also be on calcium supplementation. That’s particularly important if the patient is an early- or middle-aged woman, for example, for bone health. Any time where there is an identified nutritional deficiency, which is a bit more common in the gastric bypass, but certainly, possible in the other procedures, those patients should then be then supplemented for that then identified the nutritional deficiency.
Our program, we monitor nutritional labs – vitamin levels, calcium levels, copper levels, zinc levels, some micronutrients that we know that they can become deficient in on at least a yearly basis. Anytime that we evaluate the patient and consider that they might have a nutritional deficiency, we’re going to look for that. If it’s present, then it should be supplemented.
Melanie: And what about medications for things such as high blood pressure and diabetes? Have you seen, Dr. Shope, these things maybe not go away, but at least get a little bit better as far as comorbidities with obesity are concerned?
Dr. Shope: That’s certainly the goal of the surgery. I always tell my patients that I care what the scale says, but I case so much more what’s happening with their overall health. These operations should not be done just for weight loss purposes. The patients have, in many cases, resolved or improved some of those medical troubles we discussed earlier – diabetes, high blood pressure, sleep apnea, for example. Some of those medical troubles can go away rather quickly. For example, I’ve seen with as little as 20 to 30 pounds of weight loss patients that have sleep apnea will tell me that they find that they’re lowering the settings on the machine or they’re actually waking up fighting the machine. Some will even admit that they’d forgotten to use the machine and not had a headache the next morning, the slept well, their partner didn’t tell them that they snored that night, for example.
Equally important with diabetes, for example, and particularly with a gastric bypass operation, patients that are diabetic that have had a gastric bypass can see their diabetes improve in some cases even before they leave the hospital, which is only a few days after surgery. And then, in the following weeks and months, those medications are being lessened, their blood sugars are being much more well-maintained. They are essentially resolving or improving substantially, their diabetes.
Blood pressure is a little bit different. Blood pressure can be simply because your parents had high blood pressure – your age, your gender, your race. It’s not just about the weight, but certainly, we have seen blood pressure improve substantially simply with weight loss. The truth is, there are some downright skinny people who have high blood pressure, so we may not be able to resolve that for all patients completely, but it should be much better managed, and in some cases, the patients will come off of one or maybe more of their medications, as well.
Melanie: Wrap it up for us, Dr. Shope, with your best advice for people that are considering bariatric surgery, what you would like them to know about this tool to aid in lifelong weight loss?
Dr. Shope: I think that these operations should be thought of as a tool and nothing else. There’s no operation that’s going to make them achieve their goals in life. The operation can be used to help them get to those goals, but in and of itself, it’s not going to make them do anything. If they combine the tool that they’re provided with with their new lifestyle of healthy eating, more appropriate choices, exercise, they ought to see a rapid improvement in their medical troubles, certainly weight loss and just a better life in general.
I would also suggest that they should only consider this if they’ve truly exhausted other means. This is not the first thing that they should think, and they should be fully committed to it before they even come through the door.
Melanie: Tell us about your team at MedStar Washington Hospital Center.
Dr. Shope: I could not ask for a better team. Our front office staff is wonderful with the patients. Many times, they get to know their personal lives more than I do. We have a nurse; we have a nurse practitioner that is dedicated to bariatric surgery. We’ve got two full-time dieticians. We’ve got four surgeons now. We’ve got a GI doctor that’s part of our team. We have a psychologist and a psychiatrist that will see patients in our offices. We have a fully comprehensive surgical weight loss program here, and again, the people are really what drives it. The surgeons always get the accolades, but the reality is if I didn’t have the rest of this team in place, there’s no chance I could do what I do.
Melanie: Thank you, so much, Doctor, for such great information. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.
Bariatrics and Weight Management at Medstar Washington Hospital Center
Melanie Cole (Host): More than 12.5 million Americans are severely overweight according to the US Department of Health and Human Services. Obesity comes with health risks – diabetes, high blood pressure, joint pains, sleep apnea, and so much more. Many people who are seriously overweight have tried different diets and medications and professional weight loss services for years without long-term success. My guest today is Dr. Timothy Shope. He’s the Director of Bariatric Surgery at MedStar Washington Hospital Center. Welcome to the show, Dr. Shope. Who should consider bariatric surgery? Are there certain parameters to considering bariatrics, and who can qualify?
Dr. Timothy Shope (Guest): There are parameters, Melanie, and thanks for having me along. The patient that would be a good candidate for surgical weight loss or bariatric surgery would include anyone who has a body mass index or BMI greater than 40, or more than 35 with certain medical conditions such as – you already mentioned diabetes and sleep apnea. There are some carve-outs, which would include patients that have an excess weight of approximately 100 pounds over their ideal body weight, as well.
Melanie: If people have that, and they’ve determined by BMI that they are a candidate, what is the first step? What do they do, and how long does it take between deciding that this is something you’d like to pursue and actually having the surgery?
Dr. Shope: No patient comes through our doors until they’re definitely ready to proceed. Oftentimes patients will tell us that they’ve been thinking about this for five, seven years. Once they’ve made the decision, and they have their initial consultation with the surgeon to determine candidacy, they’re then put into a pretty well-defined program. This includes not only psychological evaluation and potentially counseling, but also, one of the most important components, which is nutritional counseling, which involves our registered dietician. Those patients will have monthly visits with the dietician. Mostly, that’s based on insurance needs, and it’s either three or usually six months of preoperative counseling with the dietician.
Once they’ve completed that program if they met the other program requirements – and that will vary minimally from program to program -- they would then come back to see the surgeon. If everything is in line, we will proceed with surgery.
Melanie: Based on insurance requirements, are there certain things like psychological counseling, and you mentioned the nutrition consulting – what else does insurance sometimes require that they do?
Dr. Shope: Some insurance programs – I’m sorry, some insurance companies will require visits with, for example, a cardiologist or, perhaps a pulmonologist. That’s pretty rare. More and more insurance companies are requiring an evaluation by an exercise physiologist, or some meaningful time spent with the physical side of things. The insurance company’s main requirements are dietician visits and that psychological or psychiatric evaluation.
Melanie: Tell us about the types, Dr. Shope, of bariatric surgery that you’re doing there at MedStar Washington Hospital Center.
Dr. Shope: Sure. We perform the gastric bypass surgery, which is still considered to be the gold standard in the United States. We perform the sleeve gastrectomy. All of those procedures, for the most part, are done laparoscopically these days. On occasion, we do some open procedures when it’s appropriate, and we also have the opportunity to use the robotic equipment as well.
Melanie: Let’s start with bypass. What’s involved, and explain whether this is a malabsorption type of procedure? What is it like for the patient?
Dr. Shope: The gastric bypass is actually a combination procedure where we provide pretty substantial restriction, which basically limits the amount of calories the patient can take in at any one time, as well as the malabsorption that you mentioned. The malabsorption makes it so that of the amount of calories that a patient takes in, only a certain percentage of them would then be actually absorbed appropriately and available by literal consumption by the patient.
As far as what it’s like to live with the operation, patients will have pretty substantially reduced plate sizes. Their portion sizes will be much smaller, and they’ll be eating less at any one time. It’s important that we make it possible for them to get enough calories in in a day, and that dietician counseling makes it certain that of those calories that they take in, a certain proportion of that should be proteins first, perhaps some fats and some carbohydrates, as well. There’s a very significant stress that we place on fluid intake. It’s very easy to become dehydrated after these procedures, and if patients aren’t aware of that, and constantly practicing their fluid intake, it can be a little bit of trouble for them.
Melanie: What’s the difference with the gastric sleeve?
Dr. Shope: The gastric sleeve is a truly restrictive operation. With it, we only reduce the amount of fluid or food that the patient can take in at any one time. The sleeve – with that operation, we create essentially a long, narrow tube of stomach. That long, narrow tube is what provides that rather substantial restriction and limits the amount that they can get in at any one time.
Melanie: Can either of these be reversed?
Dr. Shope: The sleeve gastrectomy cannot be reversed. We actually remove a fair portion of the stomach – somewhere around three-quarters or 80% of the stomach is actually, physically taken out of the patient and cannot be replaced. Reversing the gastric bypass is technically possible, but there has to be a very, very good reason for anyone even to consider it. If it’s considered and subsequently performed, some of the risks that the patient accepted at the initial procedure may even be more so with the reversal of the procedure. The patient may well then regain their weight and their medical troubles that they had.
Melanie: What is life like afterward – after having – whether they’ve had the sleeve or the bypass – as far as nutrition, going to restaurants, supplementation, and exercise? Tell us about some of those things.
Dr. Shope: Sure. Life after the surgery, my patients tell me it’s a little bit to get used to in the early going. They do have to understand that they can only take in a certain amount at a time. There will be times, not only early on, but throughout the rest of their life where – perhaps, they eat a little bit too fast, maybe they haven’t chewed their food, as well as they thought they did, or maybe they’re at a meal with their family, and they’re not consciously aware of what they’re doing where they may actually have some trouble with food feeling like it’s stuck, or perhaps even – needing to excuse themselves to run to the bathroom. This is something that they learn to accommodate with over time, and after months or certainly, after years, they can go out to dinner with the family. They can go to social events. They can live their lives like they otherwise would be able to. They just have to pay a bit more attention to the pace of eating and the types of food they’re eating, and the quantity, certainly.
With regard to lifestyle choices afterward, they can and certainly should be physically active. As far as the nutritional supplements that these patients should be on – all patients should be on a standard multivitamin. Many of our patients should also be on calcium supplementation. That’s particularly important if the patient is an early- or middle-aged woman, for example, for bone health. Any time where there is an identified nutritional deficiency, which is a bit more common in the gastric bypass, but certainly, possible in the other procedures, those patients should then be then supplemented for that then identified the nutritional deficiency.
Our program, we monitor nutritional labs – vitamin levels, calcium levels, copper levels, zinc levels, some micronutrients that we know that they can become deficient in on at least a yearly basis. Anytime that we evaluate the patient and consider that they might have a nutritional deficiency, we’re going to look for that. If it’s present, then it should be supplemented.
Melanie: And what about medications for things such as high blood pressure and diabetes? Have you seen, Dr. Shope, these things maybe not go away, but at least get a little bit better as far as comorbidities with obesity are concerned?
Dr. Shope: That’s certainly the goal of the surgery. I always tell my patients that I care what the scale says, but I case so much more what’s happening with their overall health. These operations should not be done just for weight loss purposes. The patients have, in many cases, resolved or improved some of those medical troubles we discussed earlier – diabetes, high blood pressure, sleep apnea, for example. Some of those medical troubles can go away rather quickly. For example, I’ve seen with as little as 20 to 30 pounds of weight loss patients that have sleep apnea will tell me that they find that they’re lowering the settings on the machine or they’re actually waking up fighting the machine. Some will even admit that they’d forgotten to use the machine and not had a headache the next morning, the slept well, their partner didn’t tell them that they snored that night, for example.
Equally important with diabetes, for example, and particularly with a gastric bypass operation, patients that are diabetic that have had a gastric bypass can see their diabetes improve in some cases even before they leave the hospital, which is only a few days after surgery. And then, in the following weeks and months, those medications are being lessened, their blood sugars are being much more well-maintained. They are essentially resolving or improving substantially, their diabetes.
Blood pressure is a little bit different. Blood pressure can be simply because your parents had high blood pressure – your age, your gender, your race. It’s not just about the weight, but certainly, we have seen blood pressure improve substantially simply with weight loss. The truth is, there are some downright skinny people who have high blood pressure, so we may not be able to resolve that for all patients completely, but it should be much better managed, and in some cases, the patients will come off of one or maybe more of their medications, as well.
Melanie: Wrap it up for us, Dr. Shope, with your best advice for people that are considering bariatric surgery, what you would like them to know about this tool to aid in lifelong weight loss?
Dr. Shope: I think that these operations should be thought of as a tool and nothing else. There’s no operation that’s going to make them achieve their goals in life. The operation can be used to help them get to those goals, but in and of itself, it’s not going to make them do anything. If they combine the tool that they’re provided with with their new lifestyle of healthy eating, more appropriate choices, exercise, they ought to see a rapid improvement in their medical troubles, certainly weight loss and just a better life in general.
I would also suggest that they should only consider this if they’ve truly exhausted other means. This is not the first thing that they should think, and they should be fully committed to it before they even come through the door.
Melanie: Tell us about your team at MedStar Washington Hospital Center.
Dr. Shope: I could not ask for a better team. Our front office staff is wonderful with the patients. Many times, they get to know their personal lives more than I do. We have a nurse; we have a nurse practitioner that is dedicated to bariatric surgery. We’ve got two full-time dieticians. We’ve got four surgeons now. We’ve got a GI doctor that’s part of our team. We have a psychologist and a psychiatrist that will see patients in our offices. We have a fully comprehensive surgical weight loss program here, and again, the people are really what drives it. The surgeons always get the accolades, but the reality is if I didn’t have the rest of this team in place, there’s no chance I could do what I do.
Melanie: Thank you, so much, Doctor, for such great information. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.