Considering weight-loss surgery inevitably results in a long list of questions and concerns.
Elizabeth Alexandra Zubowicz, MD, a bariatric surgeon at MedStar Washington Hospital Center, walks us through the patient journey, from initial consultation to recovery, and offers explanations for some critical questions along the way.
Selected Podcast
Weight-Loss Surgery: Your Questions Answered
Featured Speaker:
Learn more about Elizabeth Alexandra Zubowicz, MD
Elizabeth Alexandra Zubowicz, MD
Elizabeth Alexandra Zubowicz, MD, is a board-certified minimally invasive, general and bariatric surgeon at MedStar Washington Hospital Center. She is a member of the American College of Surgeons, the Society of Laparoendoscopic Surgeons and the American Society for Metabolic and Bariatric Surgery.Learn more about Elizabeth Alexandra Zubowicz, MD
Transcription:
Weight-Loss Surgery: Your Questions Answered
Melanie: (Host): Thinking about weight loss surgery? At the top of your "to do” list is choosing the very best hospital and an experienced medical team. My guest today is Dr. Elizabeth Zubowicz. She's a bariatric surgeon with Med Star Washington Hospital Center. Welcome to the show, Dr. Zubowicz. Who should consider bariatric surgery?
Dr. Elizabeth Zubowicz (Guest): I recommend anyone who's been trying their whole lives to lose weight and have been struggling and failed other attempts at weight loss to consider weight loss surgery. In terms of the specific, insurance requirement require in order to be covered require a BMI of 35 or more with medical problem, or simply a BMI of 40 or greater to be covered for the bariatric procedure.
Melanie: What kind of medical problems are considered?
Dr. Zubowicz: The medical problems include diabetes, high blood pressure, high cholesterol, sleep apnea, osteoarthritis and even if you may not necessarily be diagnosed with those, a lot of time people may have things like latent arthritis or sleep apnea and not even know it. I still recommend people to come in if they're in that 35-40 range. We usually do assess for all of those beforehand to see if they would be approved for surgery.
Melanie: Is there a psychological counseling involved in these parameters?
Dr. Zubowicz: There is a psychological counseling and it's actually something that is required by insurance companies and required by our program as well as any other program that you would attend. It requires at least one visit with the psychologist or psychiatrist. If the patient already has one that they see routinely, we could give them the guidelines that need to be addressed. As far as our Hospital Center goes, we have our own dedicated psychologist that the patients can go and see.
Melanie: What would you like them to do in advance before considering surgery? Should they still be trying to diet? This is a tool for them, yes? So, what do you like them to do in advance?
Dr. Zubowicz: There's a pretty rigorous pre-operative program that patients undergo in advance and the things you really recommend are learning healthy eating habits, learning portion control, making sure that they're medically optimized and safe to undergo surgery, and get them, at least in the beginning, in an exercise program. We actually, at the Hospital Center, have a program at the gym that's nearby to the hospital where they go do an exercise evaluation. There are no strict requirements in terms of whether or not they need to lose a certain about of weight but mostly, we want to see that they are actively trying to make those lifestyle changes because bariatric surgery can be very successful but it's only successful if you do it in conjunction with healthy lifestyle changes.
Melanie: Tell us about the types of bariatric surgery available?
Dr. Zubowicz: There are three primary types of bariatric surgery that is most commonly performed. We use the gastric band, the sleeve gastrectomy, and the gastric bypass. The majority of the time it can be performed laparoscopically which means you make 4-5 small 3mm to 5 mm incisions and that helps decrease hospital stay, recovery time and pain.
Melanie: Are any of these reversible?
Dr. Zubowicz: None of them are truly reversible. The first one, the lap band, this involves placing a band around the stomach as a way to cause restriction and decrease the amount of food you can eat. There is no actual change to the patient's anatomy. So, theoretically that's reversible but I do warn people that it does require another major surgery in order to take the band out and oftentimes the reversal surgery isn't covered by insurance unless there are actually complications from the band. So, even though the anatomy is not being altered you can, in theory, take out the band making it reversible, I caution people not to make that their number one reason why they would choose the band.
Melanie: Tell us about gastric bypass surgery, what's involved in that?
Dr. Zubowicz: The gastric bypass surgery has been performed the longest amount of time for weight loss and so that is the most data regarding effectiveness and complications, etc., are out there for the gastric bypass. The bypass involves both the restriction where we make the stomach smaller as well as bypassing a significant amount of small intestine. So, even what does goes down is not absorbed in the same way that it would in a normal person. It's very effective for weight loss and the weight loss tends to be the fastest with the bypass. It's also probably the best for resolution of diabetes. I will say the third surgery is the sleeve gastrectomy and that is also very effective for weight loss as well as resolution of medical problems like diabetes, high blood pressure, high cholesterol. The sleeve involve actually stapling up the side of the stomach and we take out about 70% of the stomach. It's called a purely restrictive procedure, slightly less involved than the bypass, with a slightly lower complication rate, but the weight loss is just as good as and as well as the resolution of the medical problems.
Melanie: What can the patient expect after these surgeries? Can they still go out and eat at restaurants? What do you tell them about eating in that first couple of weeks?
Dr. Zubowicz: So, obviously, there are going to be huge changes in eating after getting a bariatric procedure. For the first couple days, patients should expect to be nauseous, expect to have some abdominal pain. That's normal. The important thing is making sure you're keeping up liquids to stay hydrated. For the first two to three days, patients should remain on clear liquids, then we transition them to full liquids like yogurt and thicker soup and things like that. Around the two week point is when we transition them to actual solid food. In terms of going out to eat, we actually have cards that we give to patients so when they do go out to eat, they can order from the children's menu just because there's no point in, obviously, getting large portions when you can't eat them all. But, again, it's also important to remember that usually when people go out to eat, you're not able to track just how many calories, how much fat is in what you're eating. It's still important to pick the healthier option.
Melanie: Are there certain foods that they should now stay away from or try to avoid?
Dr. Zubowicz: Nothing specifically. People tend to have a harder time with certain foods like thicker tougher meat and things like that but, over time, people usually end up being able to tolerate pretty much anything. I do hear that a lot of times peoples’ taste buds significantly change, so something they may have really liked beforehand they no longer like after or vice versa, something they didn't like before the surgery and now they do. It's more kind of a trial and error. At the beginning, you'll have to see what your body can tolerate and what your body doesn't.
Melanie: We said near the beginning, Dr. Zubowicz, that this is a tool to help them lose weight. What do you tell them about what they need to change after the surgery in lifestyle modifications that are so important?
Dr. Zubowicz: Just like pre-operatively where we recommend the healthy eating habits, the portion control and the exercises, obviously, need to be continued after the surgery. The surgery itself helps with the initial weight loss and can help magnify the effects of healthy eating and exercise but to consistently keep that weight off for the long term, you've got to keep those healthy eating habits. I recommend, in general, at least three to four times a week of cardio, thirty minutes per session; to try to add in strength training; in addition to always be mindful of portion control and eating three to four small meals as opposed to snacking throughout the day. If people use all these tools together, they could be extremely successful with their weight loss.
Melanie: If they follow all of these guidelines after surgery, how much weight can they expect to lose?
Dr. Zubowicz: On an average, people that receive the lap band lose about 50% of their excess weight, and people who undergo the sleeve gasectromy of the gastric bypass lose about 60-70% of their excess weight which means that, let's say that they're 100 pounds overweight, with the band, they lose about 50 pounds and with the bypass or the sleeve, they lose about 60-70 pounds.
Melanie: In the last few minutes, Dr. Zubowicz, please give us your best advice for people considering bariatric surgery, and what you really want them to know?
Dr. Zubowicz: People considering bariatric surgery, obviously, being able to make your lifestyle changes to lose the weight is the best in being able to avoid a surgery but by the time someone that is considering bariatric surgery, I'm sure they've already tried the dieting, tried the exercise, and it's just not working. It's because, I think, a series of genetic changes and basic changes to your metabolism that really makes it extremely difficult to, even by doing the right things, lose that weight. That's where the bariatric surgery can be extremely successful. It helps fundamentally change the body's metabolism and make the lifestyle changes like exercising and eating healthy more effective.
Melanie: Thank you so much for being with us today. You're listening to Medical Intel with Med Star Washington Hospital Center. For more information you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie, Thanks so much for listening.
Weight-Loss Surgery: Your Questions Answered
Melanie: (Host): Thinking about weight loss surgery? At the top of your "to do” list is choosing the very best hospital and an experienced medical team. My guest today is Dr. Elizabeth Zubowicz. She's a bariatric surgeon with Med Star Washington Hospital Center. Welcome to the show, Dr. Zubowicz. Who should consider bariatric surgery?
Dr. Elizabeth Zubowicz (Guest): I recommend anyone who's been trying their whole lives to lose weight and have been struggling and failed other attempts at weight loss to consider weight loss surgery. In terms of the specific, insurance requirement require in order to be covered require a BMI of 35 or more with medical problem, or simply a BMI of 40 or greater to be covered for the bariatric procedure.
Melanie: What kind of medical problems are considered?
Dr. Zubowicz: The medical problems include diabetes, high blood pressure, high cholesterol, sleep apnea, osteoarthritis and even if you may not necessarily be diagnosed with those, a lot of time people may have things like latent arthritis or sleep apnea and not even know it. I still recommend people to come in if they're in that 35-40 range. We usually do assess for all of those beforehand to see if they would be approved for surgery.
Melanie: Is there a psychological counseling involved in these parameters?
Dr. Zubowicz: There is a psychological counseling and it's actually something that is required by insurance companies and required by our program as well as any other program that you would attend. It requires at least one visit with the psychologist or psychiatrist. If the patient already has one that they see routinely, we could give them the guidelines that need to be addressed. As far as our Hospital Center goes, we have our own dedicated psychologist that the patients can go and see.
Melanie: What would you like them to do in advance before considering surgery? Should they still be trying to diet? This is a tool for them, yes? So, what do you like them to do in advance?
Dr. Zubowicz: There's a pretty rigorous pre-operative program that patients undergo in advance and the things you really recommend are learning healthy eating habits, learning portion control, making sure that they're medically optimized and safe to undergo surgery, and get them, at least in the beginning, in an exercise program. We actually, at the Hospital Center, have a program at the gym that's nearby to the hospital where they go do an exercise evaluation. There are no strict requirements in terms of whether or not they need to lose a certain about of weight but mostly, we want to see that they are actively trying to make those lifestyle changes because bariatric surgery can be very successful but it's only successful if you do it in conjunction with healthy lifestyle changes.
Melanie: Tell us about the types of bariatric surgery available?
Dr. Zubowicz: There are three primary types of bariatric surgery that is most commonly performed. We use the gastric band, the sleeve gastrectomy, and the gastric bypass. The majority of the time it can be performed laparoscopically which means you make 4-5 small 3mm to 5 mm incisions and that helps decrease hospital stay, recovery time and pain.
Melanie: Are any of these reversible?
Dr. Zubowicz: None of them are truly reversible. The first one, the lap band, this involves placing a band around the stomach as a way to cause restriction and decrease the amount of food you can eat. There is no actual change to the patient's anatomy. So, theoretically that's reversible but I do warn people that it does require another major surgery in order to take the band out and oftentimes the reversal surgery isn't covered by insurance unless there are actually complications from the band. So, even though the anatomy is not being altered you can, in theory, take out the band making it reversible, I caution people not to make that their number one reason why they would choose the band.
Melanie: Tell us about gastric bypass surgery, what's involved in that?
Dr. Zubowicz: The gastric bypass surgery has been performed the longest amount of time for weight loss and so that is the most data regarding effectiveness and complications, etc., are out there for the gastric bypass. The bypass involves both the restriction where we make the stomach smaller as well as bypassing a significant amount of small intestine. So, even what does goes down is not absorbed in the same way that it would in a normal person. It's very effective for weight loss and the weight loss tends to be the fastest with the bypass. It's also probably the best for resolution of diabetes. I will say the third surgery is the sleeve gastrectomy and that is also very effective for weight loss as well as resolution of medical problems like diabetes, high blood pressure, high cholesterol. The sleeve involve actually stapling up the side of the stomach and we take out about 70% of the stomach. It's called a purely restrictive procedure, slightly less involved than the bypass, with a slightly lower complication rate, but the weight loss is just as good as and as well as the resolution of the medical problems.
Melanie: What can the patient expect after these surgeries? Can they still go out and eat at restaurants? What do you tell them about eating in that first couple of weeks?
Dr. Zubowicz: So, obviously, there are going to be huge changes in eating after getting a bariatric procedure. For the first couple days, patients should expect to be nauseous, expect to have some abdominal pain. That's normal. The important thing is making sure you're keeping up liquids to stay hydrated. For the first two to three days, patients should remain on clear liquids, then we transition them to full liquids like yogurt and thicker soup and things like that. Around the two week point is when we transition them to actual solid food. In terms of going out to eat, we actually have cards that we give to patients so when they do go out to eat, they can order from the children's menu just because there's no point in, obviously, getting large portions when you can't eat them all. But, again, it's also important to remember that usually when people go out to eat, you're not able to track just how many calories, how much fat is in what you're eating. It's still important to pick the healthier option.
Melanie: Are there certain foods that they should now stay away from or try to avoid?
Dr. Zubowicz: Nothing specifically. People tend to have a harder time with certain foods like thicker tougher meat and things like that but, over time, people usually end up being able to tolerate pretty much anything. I do hear that a lot of times peoples’ taste buds significantly change, so something they may have really liked beforehand they no longer like after or vice versa, something they didn't like before the surgery and now they do. It's more kind of a trial and error. At the beginning, you'll have to see what your body can tolerate and what your body doesn't.
Melanie: We said near the beginning, Dr. Zubowicz, that this is a tool to help them lose weight. What do you tell them about what they need to change after the surgery in lifestyle modifications that are so important?
Dr. Zubowicz: Just like pre-operatively where we recommend the healthy eating habits, the portion control and the exercises, obviously, need to be continued after the surgery. The surgery itself helps with the initial weight loss and can help magnify the effects of healthy eating and exercise but to consistently keep that weight off for the long term, you've got to keep those healthy eating habits. I recommend, in general, at least three to four times a week of cardio, thirty minutes per session; to try to add in strength training; in addition to always be mindful of portion control and eating three to four small meals as opposed to snacking throughout the day. If people use all these tools together, they could be extremely successful with their weight loss.
Melanie: If they follow all of these guidelines after surgery, how much weight can they expect to lose?
Dr. Zubowicz: On an average, people that receive the lap band lose about 50% of their excess weight, and people who undergo the sleeve gasectromy of the gastric bypass lose about 60-70% of their excess weight which means that, let's say that they're 100 pounds overweight, with the band, they lose about 50 pounds and with the bypass or the sleeve, they lose about 60-70 pounds.
Melanie: In the last few minutes, Dr. Zubowicz, please give us your best advice for people considering bariatric surgery, and what you really want them to know?
Dr. Zubowicz: People considering bariatric surgery, obviously, being able to make your lifestyle changes to lose the weight is the best in being able to avoid a surgery but by the time someone that is considering bariatric surgery, I'm sure they've already tried the dieting, tried the exercise, and it's just not working. It's because, I think, a series of genetic changes and basic changes to your metabolism that really makes it extremely difficult to, even by doing the right things, lose that weight. That's where the bariatric surgery can be extremely successful. It helps fundamentally change the body's metabolism and make the lifestyle changes like exercising and eating healthy more effective.
Melanie: Thank you so much for being with us today. You're listening to Medical Intel with Med Star Washington Hospital Center. For more information you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie, Thanks so much for listening.