Bariatric surgery is an option for many who cannot lose weight through diet and exercise alone. Weight loss surgery may improve co-morbidities like high blood pressure and diabetes.
Dr. Joseph Caruana, ECMC Synergy Bariatrics Director of Metabolic and Bariatric Surgery, discusses Synergy Bariatrics and the care available for those who need a surgical weight loss solution.
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Bariatric Surgery: Is It For You?
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Learn more about Joseph Caruana, MD
Joseph Caruana, MD
Founder of Synergy Bariatrics, Dr. Joseph Caruana performs laparoscopic vertical sleeve gastrectomy and laparoscopic revisional bariatric surgery. After leaving full time academics for private practice in 1991, he specialized in surgery of the liver, biliary tract, stomach, and intestine. From there, because of increasing evidence that weight loss surgery is beneficial to patients facing serious obesity, he began to specialize in gastric bypass.Learn more about Joseph Caruana, MD
Transcription:
Bill Klaproth (Host): There are more obese adults in the US than those who are just overweight, according to a study in the Journal of the American Medical Association, and many are turning to bariatric surgery to lose the weight and regain their life. Here to talk with us about bariatric services and procedures at Erie County Medical Center is Dr. Joseph Caruana, Director of Metabolic and Bariatric Surgery and a bariatric surgeon at Erie County Medical Center. Dr. Caruana, thanks for your time. So what is bariatric weight loss surgery?
Dr. Joseph Caruana, MD (Guest): Yes, good morning, Bill. Thank you for giving me this opportunity. Bariatric weight loss surgery is something that has been perfected, you might say, over the past forty years, and is done throughout the world. Patients who are candidates are those who are at least 100 pounds over ideal body weight, or those who are less severely overweight but have diabetes, or sleep apnea, other serious conditions related to the heart such as hypertension and cardiovascular disease.
Bill: So this really has become a life saver for many people.
Dr. Caruana: Yes, it really has. Candidates for surgery also have had to demonstrate that they cannot lose weight on their own and keep it off for a long time. Most people are very successful. Most of our patients have tremendous willpower, can lose twenty, forty, even 100 pounds, but their body just fights them. The body doesn't like to lose weight through just diet and exercise, cutting back calories. Bariatric surgery alters the signals that come from the stomach and intestine and go to the brain, and actually change people's metabolism.
Bill: Really kind of a last resort for a lot of people, like you said, that have struggled, and struggled, and struggled to lose that weight, or they've lost it and it comes right back. So this really is their final option, is that right?
Dr. Caruana: I think so. The data shows that it is successful. We feel we'd like to have people consider this option, especially those with diabetes, probably long before they have gone through a course of multiple medications, which you may know for diabetes has to usually involve progression of multiple oral agents followed by insulin. So it may be a last resort, but we'd like to think that clinicians as well as patients maybe think of it sooner in the course of these kinds of diseases.
Bill: Right, before type II diabetes and other health problems arise. Better to attack the problem sooner than later. So what are the different types of bariatric surgery options are there?
Dr. Caruana: Yes, the most commonly done procedure around the world these days is called the sleeve gastrectomy. Actually nothing is placed around the stomach, it's not like you're putting a sleeve around the stomach to make it smaller, but we remove a good portion of the stomach so that it looks- the upper part looks like a sleeve of your coat or your jacket. And removing this part of the stomach is what affects the hormone signals that are coming from that area, going to the brain, and triggering hunger, and eating, and other things. There are other signals that occur as food moves down quicker through the intestines.
About 10% to 15% of patients will have gastric bypass, which is involved with a little bit more technique, more surgical manipulation, if you will, more connection. And then there are some surgeons who are doing just a small number of procedures that are even more drastic or newer techniques. But the sleeve gastrectomy is the most popular because of its simplicity and effectiveness.
Bill: So with the different options available, Dr. Caruana, how do you consult with potential candidates to line up the right option for them?
Dr. Caruana: That's an extremely important question. I think it's important for any bariatric surgeon to meet the patient on his or her own terms. Many people bring to the consultation a long history of not only trial and failure, but sometimes our patients are subjected to discrimination, or even many of them have had bullying as children and adults that adds to the stress, and makes them more vulnerable. So surgeons really have to meet the patients on that level and understand all that in order to get an appropriate consent and inform the patient for surgery.
So we'll present the various options, we'll try to understand all of the complex causes which may be contributing to the obesity, recognizing that it's really not just a lack of willpower. That's the least thing these folks have. So we have to understand where they're coming from, and then try to address all of the medical as well as the social dynamics that each patient is bringing to the discussion.
Bill: Well they're certainly more involved than just the surgery, but speaking of the surgery, does this surgery require a hospital stay? And then what about recovery and long-term success?
Dr. Caruana: Yes, well let's talk about the sleeve gastrectomy, since that's the most often done. Patients usually come into the hospital in the morning, it's done in the operating suite, and then patients are up to the floor and to their hospital room, walking around, walking to the bathrooms, starting liquids and oral medications the same day. Most patients will stay one or two days. We like to keep patients with diabetes a couple days to really see how their medications will change even that quickly after surgery, but most people are quite active and able to get around. We like to keep people pretty much thinking only of themselves and what they need to see for the first week to ten days. There are adjustments that need to be made in terms of eating on schedule and drinking on schedule, but most recover quickly in terms of physical ability.
Bill: And I imagine diet and exercise still play a part in the ongoing management of one's weight after the surgery, so can you talk about that, and the subsequent follow-up?
Dr. Caruana: Yeah, I'm happy to. We think follow-up is extremely important. We want people to understand from the get-go that surgery is just a tool, but I mentioned earlier the complex social dynamics that many people bring, they need continuing support, and we offer that with a regularly scheduled visit program. We also have dietary services, so we offer some exercise, we have a clinical pharmacist. So we're very in tune to appropriate follow-up.
I don't like to use the word 'diet' anymore after surgery, I like to use a word like 'menu' because dieting has such bad connotations. But certainly learning what to eat and how to eat is different. Many of the changes that are made in people's metabolism after the surgery actually affect their perceptions of food, so they choose healthier food, and certainly exercise is important. Primarily I would say afterwards for dealing with the everyday stresses and anxieties that people have, and giving them an outlet rather than food for relief of that stress.
Bill: I like that, 'menu' over 'diet.' That's good. And also, could you talk about the program at Erie County Medical Center and what makes it unique?
Dr. Caruana: Obviously I'm very proud of the program. We have multiple contributors in the office, as I mentioned several of them, and of course the folks at the hospital have done a marvelous job for us. The nurses are excellent, the administration is extremely supportive. We actually- I'm very proud to say we were awarded a Women’s Choice Award for 2017 as one of America's best hospitals for bariatric surgery. We're in the top 9% of the country for that. We've also had some other awards through the American College of Surgeons.
So we have a program that we're proud of and that has been recognized by others as well, and I think it's because as our name implies, we're called Synergy Bariatrics. We realize that there are many factors that have to come together for successful care of these very special people.
Bill: And if you could wrap it up for us, Dr. Caruana, for someone who is considering bariatric weight loss surgery, what is your message to them?
Dr. Caruana: My message is that we welcome them to come and explore us on our website, find out who we are. When they're ready to meet with us, we're happy to meet with them in person, and accept them for what they bring, and try to work with them in a very unique way to achieve a long-lasting success.
Bill: Dr. Caruana, thank you so much for your time today, and talking with us about bariatric surgery. For more information, please visit www.ECMC.edu. That's www.ECMC.edu. This is the True Care Health Cast from Erie County Medical Center. I'm Bill Klaproth, thanks for listening.
Bill Klaproth (Host): There are more obese adults in the US than those who are just overweight, according to a study in the Journal of the American Medical Association, and many are turning to bariatric surgery to lose the weight and regain their life. Here to talk with us about bariatric services and procedures at Erie County Medical Center is Dr. Joseph Caruana, Director of Metabolic and Bariatric Surgery and a bariatric surgeon at Erie County Medical Center. Dr. Caruana, thanks for your time. So what is bariatric weight loss surgery?
Dr. Joseph Caruana, MD (Guest): Yes, good morning, Bill. Thank you for giving me this opportunity. Bariatric weight loss surgery is something that has been perfected, you might say, over the past forty years, and is done throughout the world. Patients who are candidates are those who are at least 100 pounds over ideal body weight, or those who are less severely overweight but have diabetes, or sleep apnea, other serious conditions related to the heart such as hypertension and cardiovascular disease.
Bill: So this really has become a life saver for many people.
Dr. Caruana: Yes, it really has. Candidates for surgery also have had to demonstrate that they cannot lose weight on their own and keep it off for a long time. Most people are very successful. Most of our patients have tremendous willpower, can lose twenty, forty, even 100 pounds, but their body just fights them. The body doesn't like to lose weight through just diet and exercise, cutting back calories. Bariatric surgery alters the signals that come from the stomach and intestine and go to the brain, and actually change people's metabolism.
Bill: Really kind of a last resort for a lot of people, like you said, that have struggled, and struggled, and struggled to lose that weight, or they've lost it and it comes right back. So this really is their final option, is that right?
Dr. Caruana: I think so. The data shows that it is successful. We feel we'd like to have people consider this option, especially those with diabetes, probably long before they have gone through a course of multiple medications, which you may know for diabetes has to usually involve progression of multiple oral agents followed by insulin. So it may be a last resort, but we'd like to think that clinicians as well as patients maybe think of it sooner in the course of these kinds of diseases.
Bill: Right, before type II diabetes and other health problems arise. Better to attack the problem sooner than later. So what are the different types of bariatric surgery options are there?
Dr. Caruana: Yes, the most commonly done procedure around the world these days is called the sleeve gastrectomy. Actually nothing is placed around the stomach, it's not like you're putting a sleeve around the stomach to make it smaller, but we remove a good portion of the stomach so that it looks- the upper part looks like a sleeve of your coat or your jacket. And removing this part of the stomach is what affects the hormone signals that are coming from that area, going to the brain, and triggering hunger, and eating, and other things. There are other signals that occur as food moves down quicker through the intestines.
About 10% to 15% of patients will have gastric bypass, which is involved with a little bit more technique, more surgical manipulation, if you will, more connection. And then there are some surgeons who are doing just a small number of procedures that are even more drastic or newer techniques. But the sleeve gastrectomy is the most popular because of its simplicity and effectiveness.
Bill: So with the different options available, Dr. Caruana, how do you consult with potential candidates to line up the right option for them?
Dr. Caruana: That's an extremely important question. I think it's important for any bariatric surgeon to meet the patient on his or her own terms. Many people bring to the consultation a long history of not only trial and failure, but sometimes our patients are subjected to discrimination, or even many of them have had bullying as children and adults that adds to the stress, and makes them more vulnerable. So surgeons really have to meet the patients on that level and understand all that in order to get an appropriate consent and inform the patient for surgery.
So we'll present the various options, we'll try to understand all of the complex causes which may be contributing to the obesity, recognizing that it's really not just a lack of willpower. That's the least thing these folks have. So we have to understand where they're coming from, and then try to address all of the medical as well as the social dynamics that each patient is bringing to the discussion.
Bill: Well they're certainly more involved than just the surgery, but speaking of the surgery, does this surgery require a hospital stay? And then what about recovery and long-term success?
Dr. Caruana: Yes, well let's talk about the sleeve gastrectomy, since that's the most often done. Patients usually come into the hospital in the morning, it's done in the operating suite, and then patients are up to the floor and to their hospital room, walking around, walking to the bathrooms, starting liquids and oral medications the same day. Most patients will stay one or two days. We like to keep patients with diabetes a couple days to really see how their medications will change even that quickly after surgery, but most people are quite active and able to get around. We like to keep people pretty much thinking only of themselves and what they need to see for the first week to ten days. There are adjustments that need to be made in terms of eating on schedule and drinking on schedule, but most recover quickly in terms of physical ability.
Bill: And I imagine diet and exercise still play a part in the ongoing management of one's weight after the surgery, so can you talk about that, and the subsequent follow-up?
Dr. Caruana: Yeah, I'm happy to. We think follow-up is extremely important. We want people to understand from the get-go that surgery is just a tool, but I mentioned earlier the complex social dynamics that many people bring, they need continuing support, and we offer that with a regularly scheduled visit program. We also have dietary services, so we offer some exercise, we have a clinical pharmacist. So we're very in tune to appropriate follow-up.
I don't like to use the word 'diet' anymore after surgery, I like to use a word like 'menu' because dieting has such bad connotations. But certainly learning what to eat and how to eat is different. Many of the changes that are made in people's metabolism after the surgery actually affect their perceptions of food, so they choose healthier food, and certainly exercise is important. Primarily I would say afterwards for dealing with the everyday stresses and anxieties that people have, and giving them an outlet rather than food for relief of that stress.
Bill: I like that, 'menu' over 'diet.' That's good. And also, could you talk about the program at Erie County Medical Center and what makes it unique?
Dr. Caruana: Obviously I'm very proud of the program. We have multiple contributors in the office, as I mentioned several of them, and of course the folks at the hospital have done a marvelous job for us. The nurses are excellent, the administration is extremely supportive. We actually- I'm very proud to say we were awarded a Women’s Choice Award for 2017 as one of America's best hospitals for bariatric surgery. We're in the top 9% of the country for that. We've also had some other awards through the American College of Surgeons.
So we have a program that we're proud of and that has been recognized by others as well, and I think it's because as our name implies, we're called Synergy Bariatrics. We realize that there are many factors that have to come together for successful care of these very special people.
Bill: And if you could wrap it up for us, Dr. Caruana, for someone who is considering bariatric weight loss surgery, what is your message to them?
Dr. Caruana: My message is that we welcome them to come and explore us on our website, find out who we are. When they're ready to meet with us, we're happy to meet with them in person, and accept them for what they bring, and try to work with them in a very unique way to achieve a long-lasting success.
Bill: Dr. Caruana, thank you so much for your time today, and talking with us about bariatric surgery. For more information, please visit www.ECMC.edu. That's www.ECMC.edu. This is the True Care Health Cast from Erie County Medical Center. I'm Bill Klaproth, thanks for listening.