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Bariatric Weight Loss Surgery for Severe Obesity

Being seriously overweight can lead to life-threatening medical conditions such as severe diabetes, high blood pressure, sleep apnea, gastroesophageal reflux and heart disease. As the pounds come off, health problems can dramatically improve or disappear entirely.

Patients seek bariatric surgery to reduce the number of obesity-related complications like heart disease, stroke, sleep apnea and diabetes.

The Bariatric Center at Inland Valley Medical Center has been designated a Bariatric Surgery Comprehensive Center by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Listen as Dr. David Suh, the Medical Director of the Bariatric Weight-loss program at Southwest Health Care System, discusses Bariatric surgery as a tool to aid in the long term weight loss that could improve the quality of the rest of your life.
Bariatric Weight Loss Surgery for Severe Obesity
Featured Speaker:
David Suh, MD
David Suh, MD, is the Medical Director of Bariatric Surgery at Southwest Healthcare System.

Melanie Cole (Host): Being seriously overweight can lead to life-threatening medical conditions such as diabetes, high blood pressure, sleep apnea, and more. When combined with a comprehensive treatment plan, bariatric surgery may often act as an effective tool to provide you with long-term weight loss and help you improve your quality of life. My guest today is Dr. David Suh. He’s the medical director of bariatric weight loss at Southwest Healthcare System. Welcome to the show Dr. Suh. Who should consider bariatric surgery and are there certain parameters to consider bariatrics, who can qualify?

Dr. David Suh, MD (Guest): Yes, thank you for having me on. Basically there are certain criteria that are set aside by national entities such as American College of Surgeons that determine patients who have BMI or body mass index which is calculated by your weight over your height (kg over meters square), if it’s over BMI of 40 then individuals are considered to be morbidly obese and those individuals who then can undergo different evaluations to see if they qualify for surgery or patients who have diabetes, high blood pressure, severe sleep apnea or severe reflux disease can have BMI over 35 and be a candidate for surgery.

Melanie: So if somebody is determined to have that BMI and they’re a candidate for surgery, what then are the steps that they would consider taking before they can actually have the surgery? Is there psychological counseling involved, what would you like them to know about what they should do?

Dr. Suh: Yes, I think it’s important that individuals consult their primary doctors first to determine whether they would be a good candidate for this type of surgical procedure. Before considering surgery, they should certainly try other methods of weight loss, certainly diet, exercise, and even some medications can be effective. If these fail, then consulting with their primary doctors then they would ask for referral or find a qualified bariatric program and inquire about possible surgical options. Now once patients are introduced to the program, we have the patients go through a variety of evaluations including psychological evaluation, there are many steps in terms of nutritional counseling and nutritional classes that patients must also attend. Patients may need to demonstrate some weight loss prior to being a candidate for surgery. Certainly they may undergo medical evaluation to make sure that their hearts and their lungs and there are no other medical issues that would preclude them from having surgery.

Melanie: Does insurance typically cover bariatric surgery? Or are there certain requirements?

Dr. Suh: All insurance including PPO and HMOs and Medicare do cover bariatric surgery, however different insurances have different requirements before patients can be a candidate. Certain insurances require nutritional counseling for a certain period of time, sometimes it can be 3 months, sometimes it can be 6 months. They also require psychological evaluations; they also require different insurances have different criteria that may vary from the national standards.

Melanie: So then let’s speak about the types of bariatric surgery that you perform at Southwest HealthCare System. And start with the bypass, the gastric bypass, please explain a little bit about what this procedure is and give the listeners just a little walk through about what they can expect.

Dr. Suh: Gastric bypass is a procedure that has been around for quite a bit long time. It’s been around since the 60s, late 50s and the procedure involves separating the upper 20% from the rest of the 80% of the stomach. Then rearranging the small intestine so that the upper part of the separated stomach empties directly into the small intestine, thus bypassing the majority of the stomach itself. So this certainly limits the amount of food that patients can intake. It also helps them control their appetite because of the separation of the majority of the stomach reducing the appetite hormone ghrelin. This surgery is effective in achieving weight loss by a small part of malabsorption of calories that helps them lose weight. The surgery again has been around for a long time and has a good track record when performed in competent hands. The surgery is very safe. It has been shown to be very effective in treating diseases such as diabetes aside from achieving weight loss. So in patients who are severely diabetic who are on multiple medications can actually achieve great benefit sometimes achieving what we call permanent remission from diabetes. So there are some concerns in the long term which involve ulcers that can form and so the patients who undergo gastric bypass have a precaution not to ever smoke or take any aspirin, Motrin type of medications.

Melanie: And what about the gastric sleeve, what’s the difference, you mentioned malabsorption so gastric bypass creates the pouch and the gastric sleeve is a little bit different, explain about that.

Dr. Suh: So gastric sleeve is a simpler procedure. It involves resecting approximately 75% of the stomach, the outer part of it, so that rather than having a bag-like stomach you end up with a very narrow, slim, elongated stomach that is in the shape of a banana or a sleeve. So it’s called gastric sleeve or it’s called vertical gastrectomy. Now when you do that you result with a smaller stomach so your intakes are reduced as well as also separating or removing the outer part of the stomach loses a significant amount of ghrelin or appetite hormone so your appetites decreased as well. Weight loss primarily is because of the reduction in portion size and your portion size reduction can be achieved because your appetite is so reduced so the weight loss is achieved. It is more of a recent procedure; it’s been around for about maybe 10 years. We do have some tenure outcome data out now but this procedure so that is does achieve very good outcomes in terms of weight loss, in terms of achieving resolution of some of the comorbid conditions such as diabetes though might not be as effective as gastric bypass but achieving weight loss can be as effective. Now the precautions about the gastric sleeve are that the patients with severe reflux may actually experience continued reflux or maybe even slight worsening of it in the long run in a small percentage of patients so that’s a precaution.

Melanie: And what is life like after bariatric surgery for these patients? As far as going to restaurants and group support and supplementation, do they have to take supplements? Speak a little bit about life after surgery.

Dr. Suh: So whether its gastric bypass or gastric sleeve, patients who undergo surgery they require to adapt the same lifestyle changes in terms of modifying their diet, they have to certainty along with a reduction in their portion sizes they have to actually exclude certain type of food from their diet, patients who are morbidly obese they have difficulty controlling some sugar intake, certain food can trigger their hunger and cravings long after the surgeries done so that their same behaviors that existed can return. Therefore, certain snacks, soda, and sweets need to be avoided after surgery, however aside from that their food intake as far as the variety of food that they can have is not much changed in terms of fruits, vegetables, dairy products, meat, these are slowly reintroduced to their diet so eventually patients are able to have all these variety of foods. However, certainly portion sizes will be reduced for the rest of their lives therefore they have to adhere by paying attention to how much they intake. When they go to restaurants they can certainly order food off the menu, however their portion sizes will be smaller so usually they end up sharing a meal with their family or their partners. We do give small cards that they can present at the restaurants, sometimes they do honor these cards so they can order even off the kids menu. Both gastric bypass and gastric sleeve patients have to take supplements; multivitamin, vitamin B12, calcium, and sometimes in addition B1 or B complex and keratein, vitamin D. These supplements must be taken by both patients because it’s really do to the reduction in portion sizes rather than actually the malabsorption part that they require vitamins. Certainly gastric sleeve patients because we’re removing part of the stomach, the B12 supplement is actually very essential.

Melanie: And how much weight can someone expect to lose?

Dr. Suh: Well it varies depending on how much weight they need to lose. Some patients are 100 pounds over their ideal body weight, some patients are 200 pounds over. Both procedures we can expect to lose a significant amount of weight, however in my experience, gastric sleeve you can achieve up to about 100-120 pounds weight loss effectively. So if patients need to lose about 120 pounds they can expect to lose somewhere close to that amount or 85-90% of it with the gastric sleeve. However, when you go over 120 pounds then the effectiveness of gastric sleeve may be challenged in losing beyond 150 pounds of weight loss may be difficult. In gastric bypass patients the upper limit of weight loss can be extended up to 250 pounds of weight loss so patients that are over 150-200 pounds of weight loss in terms of their weight they may benefit from gastric bypass versus gastric sleeve.

Melanie: In just the last minutes doctor, what should people who are severely overweight think about when considering bariatric surgery?

Dr. Suh: Well I think it’s important that you have to think that you’re doing this for your health and that your health is what’s important. Sometimes patients think about bariatric surgery because they’ve been diagnosed with hypertension or diabetes recently or patients have been required joint replacement such as knee or hip and their surgeon requires them to have weight loss. So again because of the criteria that exists we certainly make sure that the patients who qualify for surgery are patients who actually can certainly greatly benefit from the reduction of weight loss but it’s really more for the benefit of achieving a healthier lifestyle. Now aside from that they need to remember that surgery in itself may result in weight loss initially but after beyond a year to a year and a half not everyone keeps the weight off. So it does require commitment to make lifestyle changes and that is essential in achieving long term weight loss otherwise even gastric bypass or gastric sleeve may result in only temporary weight loss that may give you weight loss for a brief beyond time of just 2-5 years.

Melanie: And why should they come to Southwest Healthcare System for their care?

Dr. Suh: Well Southwest Healthcare System has been a center of excellence for bariatric surgery for the last over 11 years. That means that they have a track record in terms of overall quality of care that we’ve provided that’s been overseen by national entities. We’ve done over 7500 procedures at Southwest Healthcare System and patients ask me which or what are the safe bariatric procedures whether it’s gastric bypass or sleeve or any other procedure. My answer is safe bariatric procedure is bariatric procedure performed by an experienced bariatric surgeon and an experienced comprehensive center. We make sure that we provide safe and effective care. So I think Southwest Healthcare System has demonstrated to be such a center.

Melanie: Thank you so much for being with us today. You’re listening to Southwest Health Talk with Southwest Healthcare System. For more information, go to This is Melanie Cole, thanks so much for listening.