Surgical Weight Loss Options
Dr. Jonathan Arad discusses the surgical weight loss options available to patients at Montefiore Nyack Hospital, including bariatric surgery.
Featured Speaker:
Jonathan Arad, MD
Jonathan K. Arad, MD, FACS is a board-certified surgeon and expert in the field of Bariatric Surgery with membership in the American Society of Bariatric Surgeons. A graduate of Cornell University, Dr. Arad has many years of experience in all aspects of primary and revisional Bariatric Surgery. He specializes in laparoscopic, robotic-assisted and endoscopic surgery, including Gastric Sleeve, Lap Band and OverStitch™, a newer procedure used in gastric bypass revisions to help patients who have regained weight. Transcription:
Surgical Weight Loss Options
Prakash Chandran (Host): Bariatric surgery is a term for a surgery that is done to help you lose weight. While it's not recommended for everyone who's overweight or obese, it might be an option if you've tried everything and nothing seems to work. I'm Prakash Chandran, and in this episode of the Montefiore Nyack Hospital Podcast series, we'll talk about bariatric surgery and weight loss management. Here with us to discuss with us is Dr. Jonathan Arad, a Bariatric Surgeon at Montefiore Nyack Hospital. Dr. Arad, thank you so much for educating us today.
Dr. Jonathan Arad (Guest): Thank you for having me.
Host: I wanted to get started by understanding what exactly is bariatric surgery?
Dr. Arad: Bariatric surgery is weight loss surgery. It is a surgery that is used to help people lose weight and either reduce or eliminate comorbidities associated with weight loss, which include high blood pressure, diabetes, heart disease, sleep apnea, amongst others.
Host: Okay, that makes sense. I'm kind of curious to learn about when someone should consider bariatric surgery because I imagine that this is someone who has tried everything — who has tried exercise, has tried diet, and really is at their wit's end. Maybe you can give us some education around that.
Dr. Arad: Absolutely. Bariatric surgery is available for patients who are considered morbidly obese. These are patients who, just like you said, have tried everything, have been unsuccessful for various reasons. The criteria for bariatric surgery really is based on what's called BMI or body mass index. It's height, it's weight, there are calculators that are available readily. Anybody with a BMI of 40 or greater qualify for bariatric surgery. Anybody with a BMI of 35 to 39.9 qualifies if they have medical comorbidities associated with obesity, which are some of the ones that I mentioned before. These include high blood pressure, diabetes type II, heart disease, sleep apnea, amongst some other comorbidities as well.
Host: You mentioned BMI. For those of us that don't understand what that is can you explain?
Dr. Arad: BMI is a way of risk stratifying patients into categories of which they may develop or even worsen some of the comorbidities as mentioned before. It is kilograms over meters squared — and again, there are calculators readily available. It's basically a way of assessing what level of obesity that a person exists at.
Host: Got it. For the people that are candidates for this surgery, can you maybe talk about how much weight on average they can look at losing when they do this?
Dr. Arad: Sure. Everyone's different. Everyone comes in with different expectations, different starting weights, and so it is variable depending on the person who comes in. However, the average is approximately 65% of someone's excess weight. It's not what someone weighs, but how much more they weigh than would be considered as an average — or BMI within normal limits. Usually, bariatric surgery people will lose anywhere from 70 to 90 pounds. Sometimes it's even more. I've had people lose 150 pounds or more.
Host: That's quite a bit of weight. And like you said, it's that excess weight that they can look forward to losing there. I imagine that when someone is considering this, it's a big decision. If someone listening to this is going through that right now maybe talk a little bit about getting ready for the procedure, what the procedure is like, and then the recovery time afterward.
Dr. Arad: Sure. Obviously, it is a surgery. It's a very personal decision that each patient — each person has to decide whether it's right for them. There is a process that every person has to go through. They have to have gone through at least a six-month weight history — or a weight loss program and show that they have tried other conservative measures. They do see their primary care doctor and sometimes, even a cardiologist or pulmonologist to make sure that they are good candidates for the surgery.
They're also required to see a nutritionist to make sure that they understand the lifestyle changes that need to happen as well as a psychiatrist, psychologist, or social worker to make sure that they are mentally prepared for the surgery. It does take some time, but once patients are ready for surgery, there are two different main options I should say. The ones that I provide are what's called the Sleeve or the Vertical Sleeve Gastrectomy and the Band or Lap Band surgery.
They are two different types of surgeries, although they work similarly. The Sleeve surgery is a surgery where about 65% of the stomach is removed turning the stomach into a banana shape. The Band surgery works by putting an implant or the Band itself around the top part of the stomach that acts almost like a belt around the top of the stomach that gets inflated in the office. Both surgeries, in general, tend to get weight loss around like I said 65% of the excess weight.
Host: Okay, and after the surgery is done what about the recovery time? Can patients expect any side effects afterward?
Dr. Arad: Sure. For the Sleeve, the patients are in the hospital for one night overnight. We do one study the following morning to make sure that everything in the anatomy looks correct, and then they go home. With the Band surgery, they're not required to stay overnight, so they go home the same day. The return to work, the recovery time, most people — it obviously, is very patient-dependent as well — but most people are back to work within a week or two. Just like any other abdominal surgery, whether it's bariatric, gallbladder, anything else that's done in the abdomen or the belly, you shouldn't lift more than ten pounds for six weeks to avoid a possibility of a hernia. That's not specific to bariatrics, that's just in general for any abdominal surgery.
Host: One of the things that I really like about what you said is that there's a whole process in making sure that the patient is ready for the surgery. There's the nutrition plan. There's talking to people. There's making sure that they're prepared for the work that they have to do after. I'd love to talk a little bit about that. After a patient goes through the surgery, it sounds like the recovery time isn't that long, but what can they do to ensure that there's a long-term success following their surgery?
Dr. Arad: Sure. It's actually very important to stick to a bariatric or post-bariatric diet after the surgery. In essence, it's a high protein-low carbohydrate diet. However, there are obviously nuances to it. Patients who stick to the diet do extremely, extremely well, but it's a very important part of the procedure for patients to make sure that nutrition and exercise are part of their new lifestyle.
Host: That certainly does sound like they need to make it an integral part of recovery. One of the questions that I wanted to ask in wrapping up is you mentioned that someone can lose over 100 pounds. I imagine that there's a lot of excess skin after all of that excess fat is removed. Can you talk a little bit about that? Do you remove it at the time? Does that go away over time? Maybe add some clarification there.
Dr. Arad: Sure, absolutely. A very common question. It's actually very interesting because there is always a possibility depending on genetics, depending on the patients' skin tone, there is always a chance of loose, hanging skin. However, I will say that the majority of patients don't require anything. If patients are up and moving relatively early if patients get up and start exercising, go to the gym relatively early and really keep up with it, I would say that the majority of patients that we have don't really have to do anything at all. There are a small portion of patients who will require plastic surgery, and if that is the case, the plastic surgeons — which we have the referrals for — generally wait at least a year or so to get the best cosmetic results. I don't perform those cosmetic surgeries. Those are plastic surgeons.
Host: Okay, thanks. What it does sound like then is for a lot of patients, as long as they're moving and they're frequently moving, that the issue of the excess skin can go away on its own. It's really good to hear, and I really appreciate you educating us here today, Dr. Arad.
Dr. Arad: Absolutely.
Host: Is there anything else that you want to share with our audience before we wrap up?
Dr. Arad: I do. I want to make sure that people understand that there is a difference between bariatric surgery and plastic/cosmetic surgery. Bariatric surgery is meant to lose weight, gain confidence, and things of that nature. However, a very, very important part and the key part of bariatric surgery is really eliminating medical comorbidities and making people healthier and live longer. By getting rid of diabetes, high blood pressure, controlling heart disease, sleep apnea, other medical problems, infertility, the goal of this is to really give people a longer, healthier life.
Host: I am so glad that you said that, Dr. Arad, because there's going to be people listening to this that they feel like maybe this surgery isn't for me, maybe it's nutrition and diet that I need to turn to. Even though it hasn't been working, they may not see the need for this, but this is going to help them live a longer, happier, healthier life. A lot of the reasons why we're obese, even though nutrition is a major component, is genetics. Is that correct?
Dr. Arad: Absolutely. There are many, many factors that go into obesity. Genetics is a key one. Some of obesity is not controllable. Some are. Some are not. It's a very multi-factorial disease. Some people — it's really nothing that they can do. They're predisposed to it, but there are people who also can make changes and still find it difficult. That's why this is made available.
Host: Yeah, and what a wonderful option it is. For those of you listening that are struggling with this, just know that there's this wonderful option here. It sounds like the recovery time is minimal, and with some movement and activity, it sounds like you can get back to living a happier, healthier life and regain that confidence. For more information, please visit MontefioreNyack.org. Let me spell that out for you. That's M-O-N-T-E-F-I-O-R-E N-Y-A-C-K .org. My guest today has been Dr. Jonathan Arad. I'm Prakash Chandran. Thank you so much for listening.
Surgical Weight Loss Options
Prakash Chandran (Host): Bariatric surgery is a term for a surgery that is done to help you lose weight. While it's not recommended for everyone who's overweight or obese, it might be an option if you've tried everything and nothing seems to work. I'm Prakash Chandran, and in this episode of the Montefiore Nyack Hospital Podcast series, we'll talk about bariatric surgery and weight loss management. Here with us to discuss with us is Dr. Jonathan Arad, a Bariatric Surgeon at Montefiore Nyack Hospital. Dr. Arad, thank you so much for educating us today.
Dr. Jonathan Arad (Guest): Thank you for having me.
Host: I wanted to get started by understanding what exactly is bariatric surgery?
Dr. Arad: Bariatric surgery is weight loss surgery. It is a surgery that is used to help people lose weight and either reduce or eliminate comorbidities associated with weight loss, which include high blood pressure, diabetes, heart disease, sleep apnea, amongst others.
Host: Okay, that makes sense. I'm kind of curious to learn about when someone should consider bariatric surgery because I imagine that this is someone who has tried everything — who has tried exercise, has tried diet, and really is at their wit's end. Maybe you can give us some education around that.
Dr. Arad: Absolutely. Bariatric surgery is available for patients who are considered morbidly obese. These are patients who, just like you said, have tried everything, have been unsuccessful for various reasons. The criteria for bariatric surgery really is based on what's called BMI or body mass index. It's height, it's weight, there are calculators that are available readily. Anybody with a BMI of 40 or greater qualify for bariatric surgery. Anybody with a BMI of 35 to 39.9 qualifies if they have medical comorbidities associated with obesity, which are some of the ones that I mentioned before. These include high blood pressure, diabetes type II, heart disease, sleep apnea, amongst some other comorbidities as well.
Host: You mentioned BMI. For those of us that don't understand what that is can you explain?
Dr. Arad: BMI is a way of risk stratifying patients into categories of which they may develop or even worsen some of the comorbidities as mentioned before. It is kilograms over meters squared — and again, there are calculators readily available. It's basically a way of assessing what level of obesity that a person exists at.
Host: Got it. For the people that are candidates for this surgery, can you maybe talk about how much weight on average they can look at losing when they do this?
Dr. Arad: Sure. Everyone's different. Everyone comes in with different expectations, different starting weights, and so it is variable depending on the person who comes in. However, the average is approximately 65% of someone's excess weight. It's not what someone weighs, but how much more they weigh than would be considered as an average — or BMI within normal limits. Usually, bariatric surgery people will lose anywhere from 70 to 90 pounds. Sometimes it's even more. I've had people lose 150 pounds or more.
Host: That's quite a bit of weight. And like you said, it's that excess weight that they can look forward to losing there. I imagine that when someone is considering this, it's a big decision. If someone listening to this is going through that right now maybe talk a little bit about getting ready for the procedure, what the procedure is like, and then the recovery time afterward.
Dr. Arad: Sure. Obviously, it is a surgery. It's a very personal decision that each patient — each person has to decide whether it's right for them. There is a process that every person has to go through. They have to have gone through at least a six-month weight history — or a weight loss program and show that they have tried other conservative measures. They do see their primary care doctor and sometimes, even a cardiologist or pulmonologist to make sure that they are good candidates for the surgery.
They're also required to see a nutritionist to make sure that they understand the lifestyle changes that need to happen as well as a psychiatrist, psychologist, or social worker to make sure that they are mentally prepared for the surgery. It does take some time, but once patients are ready for surgery, there are two different main options I should say. The ones that I provide are what's called the Sleeve or the Vertical Sleeve Gastrectomy and the Band or Lap Band surgery.
They are two different types of surgeries, although they work similarly. The Sleeve surgery is a surgery where about 65% of the stomach is removed turning the stomach into a banana shape. The Band surgery works by putting an implant or the Band itself around the top part of the stomach that acts almost like a belt around the top of the stomach that gets inflated in the office. Both surgeries, in general, tend to get weight loss around like I said 65% of the excess weight.
Host: Okay, and after the surgery is done what about the recovery time? Can patients expect any side effects afterward?
Dr. Arad: Sure. For the Sleeve, the patients are in the hospital for one night overnight. We do one study the following morning to make sure that everything in the anatomy looks correct, and then they go home. With the Band surgery, they're not required to stay overnight, so they go home the same day. The return to work, the recovery time, most people — it obviously, is very patient-dependent as well — but most people are back to work within a week or two. Just like any other abdominal surgery, whether it's bariatric, gallbladder, anything else that's done in the abdomen or the belly, you shouldn't lift more than ten pounds for six weeks to avoid a possibility of a hernia. That's not specific to bariatrics, that's just in general for any abdominal surgery.
Host: One of the things that I really like about what you said is that there's a whole process in making sure that the patient is ready for the surgery. There's the nutrition plan. There's talking to people. There's making sure that they're prepared for the work that they have to do after. I'd love to talk a little bit about that. After a patient goes through the surgery, it sounds like the recovery time isn't that long, but what can they do to ensure that there's a long-term success following their surgery?
Dr. Arad: Sure. It's actually very important to stick to a bariatric or post-bariatric diet after the surgery. In essence, it's a high protein-low carbohydrate diet. However, there are obviously nuances to it. Patients who stick to the diet do extremely, extremely well, but it's a very important part of the procedure for patients to make sure that nutrition and exercise are part of their new lifestyle.
Host: That certainly does sound like they need to make it an integral part of recovery. One of the questions that I wanted to ask in wrapping up is you mentioned that someone can lose over 100 pounds. I imagine that there's a lot of excess skin after all of that excess fat is removed. Can you talk a little bit about that? Do you remove it at the time? Does that go away over time? Maybe add some clarification there.
Dr. Arad: Sure, absolutely. A very common question. It's actually very interesting because there is always a possibility depending on genetics, depending on the patients' skin tone, there is always a chance of loose, hanging skin. However, I will say that the majority of patients don't require anything. If patients are up and moving relatively early if patients get up and start exercising, go to the gym relatively early and really keep up with it, I would say that the majority of patients that we have don't really have to do anything at all. There are a small portion of patients who will require plastic surgery, and if that is the case, the plastic surgeons — which we have the referrals for — generally wait at least a year or so to get the best cosmetic results. I don't perform those cosmetic surgeries. Those are plastic surgeons.
Host: Okay, thanks. What it does sound like then is for a lot of patients, as long as they're moving and they're frequently moving, that the issue of the excess skin can go away on its own. It's really good to hear, and I really appreciate you educating us here today, Dr. Arad.
Dr. Arad: Absolutely.
Host: Is there anything else that you want to share with our audience before we wrap up?
Dr. Arad: I do. I want to make sure that people understand that there is a difference between bariatric surgery and plastic/cosmetic surgery. Bariatric surgery is meant to lose weight, gain confidence, and things of that nature. However, a very, very important part and the key part of bariatric surgery is really eliminating medical comorbidities and making people healthier and live longer. By getting rid of diabetes, high blood pressure, controlling heart disease, sleep apnea, other medical problems, infertility, the goal of this is to really give people a longer, healthier life.
Host: I am so glad that you said that, Dr. Arad, because there's going to be people listening to this that they feel like maybe this surgery isn't for me, maybe it's nutrition and diet that I need to turn to. Even though it hasn't been working, they may not see the need for this, but this is going to help them live a longer, happier, healthier life. A lot of the reasons why we're obese, even though nutrition is a major component, is genetics. Is that correct?
Dr. Arad: Absolutely. There are many, many factors that go into obesity. Genetics is a key one. Some of obesity is not controllable. Some are. Some are not. It's a very multi-factorial disease. Some people — it's really nothing that they can do. They're predisposed to it, but there are people who also can make changes and still find it difficult. That's why this is made available.
Host: Yeah, and what a wonderful option it is. For those of you listening that are struggling with this, just know that there's this wonderful option here. It sounds like the recovery time is minimal, and with some movement and activity, it sounds like you can get back to living a happier, healthier life and regain that confidence. For more information, please visit MontefioreNyack.org. Let me spell that out for you. That's M-O-N-T-E-F-I-O-R-E N-Y-A-C-K .org. My guest today has been Dr. Jonathan Arad. I'm Prakash Chandran. Thank you so much for listening.