Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity.
Dr. DiBenedetto discusses weight loss surgery and how the team at Rochester Regional use guidelines set by the National Institutes of Health (NIH) to determine if you are a candidate for bariatric surgery.
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Bariatric Surgery 101
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Learn more about Dr. Anthony DiBenedetto
Anthony DiBenedetto, MD
Anthony DiBenedetto, MD, FACS is board certified in general surgery and is the Medical Director of Bariatric Surgery at Rochester Regional Health. He earned his medical degree and completed an internship and residency at State University of Buffalo, NY.Learn more about Dr. Anthony DiBenedetto
Transcription:
Bariatric Surgery 101
Bill Klaproth (Host): Obesity is a major problem. According to the most recent from the NIH, more than 1 in 20 adults are considered to have extreme obesity and bariatric surgery is one of the most effective ways of dealing with obesity. Here to talk with us is Dr. Anthony DiBenedetto, the Medical Director of Bariatric Services at Rochester Regional Health. Dr. DiBenedetto will be discussing weight loss surgery and whether it is right for you. Dr. DiBenedetto, thank you for your time today. So, let's start at the beginning. What is bariatrics?
Dr. Anthony DiBenedetto (Guest): Well bariatric surgery is surgery which alters the GI tract so that people can eat a smaller amount of food, lose weight, and yet be satisfied with the amount of food that they're eating. In addition to that, it also cures a lot of the co-morbidities or illness that are associated with the obesity or, more importantly, the morbid obesity.
Bill: So, what is the definition of morbid obesity, then?
Dr. DiBenedetto: Morbid obesity is being 100 pounds above your ideal body weight or having a body mass index of 40 or above.
Bill: Okay, so when we talk about extreme obesity, that's what you're talking about. And, what contributes to morbid obesity?
Dr. DiBenedetto: The most important thing that contributes to morbid obesity is genetics. We know that 80% of this disease is genetically-related. In addition to that, there are a lot of environmental factors that take place such as the amount of food and the amount of calories that are available, the ability for people to burn up those calories, and the amount of exercise that people do to burn up those calories; but, by far, the most important component is genetics.
Bill: Well, that's interesting. So, lifestyle does contribute, but genetics is the number one factor, then?
Dr. DiBenedetto: Genetics is very important, but lifestyle modifications are also part of bariatric surgery and we try to achieve both.
Bill: You touched on this already. Besides quality of life issues, obesity can cause many other health problems, like heart disease, stroke, Type II Diabetes, certain types of cancer, so bariatric surgery really can be a lifesaver for some people?
Dr. DiBenedetto: Absolutely and one of the most important things we concentrate on is diabetes and there are operations that can actually help someone who is morbidly obese who has Type II diabetes get rid of that disease, Type II diabetes, over 80% of the time.
Bill: Okay, so that's really good. So, let's talk about who would be a good candidate for this surgery. What do you look for and what would that person have to show you to be a good candidate for bariatric surgery?
Dr. DiBenedetto: Alright. So, let's start with their weight. Let's talk about the body mass index. If they have a body mass index of 35-40, which means they are obese, but they have significant comorbidities such as high blood pressure, diabetes, sleep apnea, they're a great candidate for bariatric surgery. Or, if their body mass index is 40 or above, then they're an excellent candidate for bariatric surgery.
Bill: And, this type of surgery, now, with advances in technology, are these surgeries considered minimally-invasive at this point?
Dr. DiBenedetto: Yes. I would say that over 95% of these operations are done laparoscopically, meaning they have 5 or 6 little, tiny incisions. We actually do this entire operation looking at a monitor and which makes the operation a lot easier to undergo and most people are out of the hospital in two days.
Bill: That is amazing. So, what are the risk factors involved, then?
Dr. DiBenedetto: Well, the risk factors for bariatric surgery are, of course, being morbidly obese, or having a BMI of 35 or above with significant comorbidities. When we talks about the risks of surgery, the risk of surgery right now, if you have your operation done in a center of excellence, in a bariatric center of excellence, your risks of dying from this operation is the same as having your gallbladder out.
Bill: Okay. So, that's good news for somebody thinking about having this procedure. And for someone who may be considering this or wants to learn more, do you offer any informational classes at all where people can really research this and understand it, you know in depth?
Dr. DiBenedetto: Yes. So, actually two times a month, I have informational sessions in here and Lockport, New York, and my partner, Dr. Gandhi has them in Rochester and in Newark Wayne, and if they're interested in an informational session, they just call the hospital and ask to have an appointment. We have a very informal session where people can ask questions. They last for about 1-2 hours, and what we really talk about is the disease of morbid obesity and its treatment. And, once people come to these informational sessions, it becomes very clear whether they want to proceed with bariatric surgery or not.
Bill: So, then, they would follow up and come in for a consultation and then you would probably discuss the different treatment types. Could you quickly tell us what are the treatments that are available and what the most popular ones are?
Dr. DiBenedetto: Yes. So, as of 2014, the most popular bariatric operation is called a “gastric sleeve” and in that operation, we laparoscopically go in and take out approximately 2/3 of the stomach, leaving you with a very small tube so that what people do when they eat, they eat a lot less, but the most important thing is when they eat a lot less food, they still maintain that satisfaction so they're not looking to eat massive amounts of food. The weight loss is excellent, approximately 60% of their excess body weight is lost and there are also a lot of metabolic effects, like on diseases of diabetes and hypertension, so on and so forth. The second operation which is really the gold standard is a gastric bypass and in that operation, what we do is take the stomach, which is the size of a football, and we make a little tiny pouch, and then we bypass the intestines, so people are eating a little bit of food, and then that little bit of food that they are eating has some malabsorption, so they don't absorb it, and then there's a tremendous caloric loss. There's also a tremendous amount of metabolic effects and the release of intestinal hormones with gastric bypass which also help in the treatment of these comorbidities or diseases. Another operation is a duodenal switch, which we do a gastric sleeve and then we attach a bypass onto that. That has the best weight loss, but we reserve that for people who are very, very heavy.
Bill: So, the main three types, then, the gastric sleeve, the gastric bypass, and the duodenal switch. So, let me ask you this. I imagine then diet and exercise then, would still play a big part in the ongoing management of one's weight after the surgery?
Dr. DiBenedetto: Absolutely. Absolutely and I will tell you that we have patients that come back who have put on weight and it's because they haven't maintained those lifestyle changes and the first thing we tend to do is we want to get them back right into the swing of things with watching their diet and exercising on a daily basis. That is a key component. I mean, what people really need to do before they have bariatric surgery is to have a dedication to a lifestyle change and follow up. You know, this is not just an operation that we do here. We follow patients for the rest of their lives on at least a yearly basis to make sure they're doing well and if they're not doing well, we try to get them back on track.
Bill: And, if someone does follow those lifestyle changes after the surgery, is this then a long-term or you have found long-term success rates with this? 20 years or so or longer? Does it work that long?
Dr. DiBenedetto: Absolutely. After about 3 years, people will put on about 5% of their excess body weight, but this has been studied up to 14 years and patients have been shown to keep this weight off long-term with bariatric surgery. The most important thing that you have to realize is that when we get into the disease of morbid obesity, there's really no other treatment of this disease. You can go on a diet and exercise program and be morbidly obese, you will lose weight, but 95% of the time, people will put on all that weight within 5 years.
Bill: Okay. Well, Dr. DiBenedetto, thank you for your time today. If you could wrap it up for us, why should someone choose Rochester for their bariatric surgery and weight loss needs?
Dr. DiBenedetto: A couple of reasons. We are a center of excellence. We care about our patients. We follow our patients for the rest of their lives and Rochester General has made a tremendous commitment to bariatric surgery and I think for all those reasons, people will do well here.
Bill: Dr. DiBenedetto, thank you again, so much for your time. You're listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to www.Rochesterregional.org. That's www.rochesterregional.org. I'm Bill Klaproth. Thanks for listening.
Bariatric Surgery 101
Bill Klaproth (Host): Obesity is a major problem. According to the most recent from the NIH, more than 1 in 20 adults are considered to have extreme obesity and bariatric surgery is one of the most effective ways of dealing with obesity. Here to talk with us is Dr. Anthony DiBenedetto, the Medical Director of Bariatric Services at Rochester Regional Health. Dr. DiBenedetto will be discussing weight loss surgery and whether it is right for you. Dr. DiBenedetto, thank you for your time today. So, let's start at the beginning. What is bariatrics?
Dr. Anthony DiBenedetto (Guest): Well bariatric surgery is surgery which alters the GI tract so that people can eat a smaller amount of food, lose weight, and yet be satisfied with the amount of food that they're eating. In addition to that, it also cures a lot of the co-morbidities or illness that are associated with the obesity or, more importantly, the morbid obesity.
Bill: So, what is the definition of morbid obesity, then?
Dr. DiBenedetto: Morbid obesity is being 100 pounds above your ideal body weight or having a body mass index of 40 or above.
Bill: Okay, so when we talk about extreme obesity, that's what you're talking about. And, what contributes to morbid obesity?
Dr. DiBenedetto: The most important thing that contributes to morbid obesity is genetics. We know that 80% of this disease is genetically-related. In addition to that, there are a lot of environmental factors that take place such as the amount of food and the amount of calories that are available, the ability for people to burn up those calories, and the amount of exercise that people do to burn up those calories; but, by far, the most important component is genetics.
Bill: Well, that's interesting. So, lifestyle does contribute, but genetics is the number one factor, then?
Dr. DiBenedetto: Genetics is very important, but lifestyle modifications are also part of bariatric surgery and we try to achieve both.
Bill: You touched on this already. Besides quality of life issues, obesity can cause many other health problems, like heart disease, stroke, Type II Diabetes, certain types of cancer, so bariatric surgery really can be a lifesaver for some people?
Dr. DiBenedetto: Absolutely and one of the most important things we concentrate on is diabetes and there are operations that can actually help someone who is morbidly obese who has Type II diabetes get rid of that disease, Type II diabetes, over 80% of the time.
Bill: Okay, so that's really good. So, let's talk about who would be a good candidate for this surgery. What do you look for and what would that person have to show you to be a good candidate for bariatric surgery?
Dr. DiBenedetto: Alright. So, let's start with their weight. Let's talk about the body mass index. If they have a body mass index of 35-40, which means they are obese, but they have significant comorbidities such as high blood pressure, diabetes, sleep apnea, they're a great candidate for bariatric surgery. Or, if their body mass index is 40 or above, then they're an excellent candidate for bariatric surgery.
Bill: And, this type of surgery, now, with advances in technology, are these surgeries considered minimally-invasive at this point?
Dr. DiBenedetto: Yes. I would say that over 95% of these operations are done laparoscopically, meaning they have 5 or 6 little, tiny incisions. We actually do this entire operation looking at a monitor and which makes the operation a lot easier to undergo and most people are out of the hospital in two days.
Bill: That is amazing. So, what are the risk factors involved, then?
Dr. DiBenedetto: Well, the risk factors for bariatric surgery are, of course, being morbidly obese, or having a BMI of 35 or above with significant comorbidities. When we talks about the risks of surgery, the risk of surgery right now, if you have your operation done in a center of excellence, in a bariatric center of excellence, your risks of dying from this operation is the same as having your gallbladder out.
Bill: Okay. So, that's good news for somebody thinking about having this procedure. And for someone who may be considering this or wants to learn more, do you offer any informational classes at all where people can really research this and understand it, you know in depth?
Dr. DiBenedetto: Yes. So, actually two times a month, I have informational sessions in here and Lockport, New York, and my partner, Dr. Gandhi has them in Rochester and in Newark Wayne, and if they're interested in an informational session, they just call the hospital and ask to have an appointment. We have a very informal session where people can ask questions. They last for about 1-2 hours, and what we really talk about is the disease of morbid obesity and its treatment. And, once people come to these informational sessions, it becomes very clear whether they want to proceed with bariatric surgery or not.
Bill: So, then, they would follow up and come in for a consultation and then you would probably discuss the different treatment types. Could you quickly tell us what are the treatments that are available and what the most popular ones are?
Dr. DiBenedetto: Yes. So, as of 2014, the most popular bariatric operation is called a “gastric sleeve” and in that operation, we laparoscopically go in and take out approximately 2/3 of the stomach, leaving you with a very small tube so that what people do when they eat, they eat a lot less, but the most important thing is when they eat a lot less food, they still maintain that satisfaction so they're not looking to eat massive amounts of food. The weight loss is excellent, approximately 60% of their excess body weight is lost and there are also a lot of metabolic effects, like on diseases of diabetes and hypertension, so on and so forth. The second operation which is really the gold standard is a gastric bypass and in that operation, what we do is take the stomach, which is the size of a football, and we make a little tiny pouch, and then we bypass the intestines, so people are eating a little bit of food, and then that little bit of food that they are eating has some malabsorption, so they don't absorb it, and then there's a tremendous caloric loss. There's also a tremendous amount of metabolic effects and the release of intestinal hormones with gastric bypass which also help in the treatment of these comorbidities or diseases. Another operation is a duodenal switch, which we do a gastric sleeve and then we attach a bypass onto that. That has the best weight loss, but we reserve that for people who are very, very heavy.
Bill: So, the main three types, then, the gastric sleeve, the gastric bypass, and the duodenal switch. So, let me ask you this. I imagine then diet and exercise then, would still play a big part in the ongoing management of one's weight after the surgery?
Dr. DiBenedetto: Absolutely. Absolutely and I will tell you that we have patients that come back who have put on weight and it's because they haven't maintained those lifestyle changes and the first thing we tend to do is we want to get them back right into the swing of things with watching their diet and exercising on a daily basis. That is a key component. I mean, what people really need to do before they have bariatric surgery is to have a dedication to a lifestyle change and follow up. You know, this is not just an operation that we do here. We follow patients for the rest of their lives on at least a yearly basis to make sure they're doing well and if they're not doing well, we try to get them back on track.
Bill: And, if someone does follow those lifestyle changes after the surgery, is this then a long-term or you have found long-term success rates with this? 20 years or so or longer? Does it work that long?
Dr. DiBenedetto: Absolutely. After about 3 years, people will put on about 5% of their excess body weight, but this has been studied up to 14 years and patients have been shown to keep this weight off long-term with bariatric surgery. The most important thing that you have to realize is that when we get into the disease of morbid obesity, there's really no other treatment of this disease. You can go on a diet and exercise program and be morbidly obese, you will lose weight, but 95% of the time, people will put on all that weight within 5 years.
Bill: Okay. Well, Dr. DiBenedetto, thank you for your time today. If you could wrap it up for us, why should someone choose Rochester for their bariatric surgery and weight loss needs?
Dr. DiBenedetto: A couple of reasons. We are a center of excellence. We care about our patients. We follow our patients for the rest of their lives and Rochester General has made a tremendous commitment to bariatric surgery and I think for all those reasons, people will do well here.
Bill: Dr. DiBenedetto, thank you again, so much for your time. You're listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to www.Rochesterregional.org. That's www.rochesterregional.org. I'm Bill Klaproth. Thanks for listening.