Transcription:
Is Bariatric Surgery An Option for You?

Melanie Cole (Host): According to the US Department of Health and Human Services, more than twelve and a half million Americans are severely overweight. Obesity can cause many health problems and put you at higher risk for diseases such as high blood pressure, diabetes, heart disease, stroke, sleep apnea, and more. Bariatric surgery is a life-changing event that requires a team approach for long-term success. Here to speak with us today about the benefits bariatric surgery can offer the severely obese is Dr. Wayne Weiss. He’s a board certified surgeon specializing in general surgery and bariatric surgery procedures at St. Luke’s Cornwall Hospital. Welcome to the show, Dr. Weiss. Who should consider bariatric surgery? Are there certain parameters to consider bariatrics and who can qualify?

Dr. Wayne Weiss, MD, FACS (Guest): Well, thank you for having me today Melanie. Absolutely, there are definitely certain parameters. We are a Center of Excellence, so verified by the American College of Surgeons, and so we will follow the strict guidelines for weight loss surgery that are dictated by the professional organizations that oversee bariatric surgery. Specifically, an individual should be of a certain, well, weight and size. We use what's called the body mass index, and a body mass index is a calculation that we can do, or you can actually do for yourself looking at online calculators. It basically looks at your height and your weight, and you plug the numbers in, and you come up with a number. A number of 35 is considered the minimum weight for bariatric surgery, usually in conjunction with certain medical problems, like things like sleep apnea or diabetes, or a body mass index of 40 irrespective of certain health problems. Just based on that size alone, just as a matter of reference, a normal body mass index is 25.

Melanie: How much weight can someone expect to lose? I'm sure you get this question quite often, and I know it’s sort of a ball park and patient dependent, but how much weight can they expect to lose?

Dr. Weiss: Yeah. Well we actually, you know, obviously someone who’s 500 pounds is probably going to lose more total, you know, weight in pounds than someone who weighs 250 pounds. But more importantly, it's based on your BMI and your excess weight. So, for instance, if someone weighs 300 pounds, and their ideal weight would be 150 pounds based on their height, they are considered 150 pounds overweight. If they lose 150 pounds, that would be 100% of their excess weight. Well, it turns out that bariatric surgery isn’t quite that good, but the surgeries that we perform, in general, will achieve long-term success with about a 55 to 60% excess weight loss. So, you can expect in that example that I just gave you, an individual to lose almost 100 pounds. Certainly if they were 300 pounds overweight, a much larger person, then they would be losing 175 or so pounds. So, it's based on percentages of your excess weight.

Melanie: So, before they can consider the surgery, there's a certain process that they have to go through. Speak about that. Is their psychological counseling involved? Do they have to check with insurance? What do they do beforehand?

Dr. Weiss: Yeah, actually, we actually streamline it and make it a very, very pleasant and easy experience. In fact, you know, our program which is in conjunction with St. Luke’s Cornwall Hospital utilizes Tri-State Bariatrics, which actually has almost 50 employees, and so we actually have two psychiatrists, five nutritionists, a billing specialist, nurse practitioners, and patient navigators that essentially review patient insurances and help all of our patients go through the process. It’s no question that having weight loss surgery is very comprehensive and requires a lot of preparation and attention to detail. It can be overwhelming for a lot of patients. So, we basically do what's called a navigation. We basically look at your insurance. We look at you as an individual, and we go over all of the steps and actually help you make the appointments, or even make them for you within our offices, which in fact, can accomplish most of what’s required.

Melanie: And what would you like them to do while this process is ongoing? Should they be trying to lose weight or exercise? What would you like them to be doing?

Dr. Weiss: Absolutely. I mean, you know, it's a lifestyle. You know, there’s no surgery that can solve everything. We emphasize that the surgical procedure is just one aspect of many aspects that an individual will need to undergo and basically transform themselves. So, we do assist them with exercise, recommendations. We assist them with dieting. We make recommendations. Certain individuals, we do refer for physical therapy evaluations to help with mobility depending upon their needs. We have also affiliations with certain gyms that give our patients preferential membership rates to help them out and have special types of classes for our patients. So, we approach an individual from all facets and all aspects, and we emphasize that, yes, surgery will help you quite a bit, but it is not the only thing that’s going to help you, and the better prepared you are, even before the surgery, the better the experience will be. The better your ultimate result will be, and it will also result in a better outcome. More weight loss with less risk.

Melanie: Well, it certainly is a tool to aid in that weight loss. So, what types of bariatric surgery are offered at St. Luke’s Cornwall Hospital?

Dr. Weiss: Well, we, you know, like most of the bariatric centers in the country and, in fact, in the world at this time, the majority of the operations now are the sleeve gastrectomy. They are done almost exclusively with laparoscopic technique. That means small incisions. We also do perform gastric bypass. Historically, we have done lap bands, but we're actually not doing very many of those anymore as a result of the decrease in the number of lap bands totally throughout the country, but mostly sleeves and gastric bypass.

Melanie: So then let's talk about bypass first. Is this a reversible procedure? Just speak a little bit about the procedure itself.

Dr. Weiss: Well, historically, the gastric bypass has been around the longest of the weight-loss operations that are presently being done. It was actually started back in the 1960’s. Initially, it was an open, big operation. Now, it's all done laparoscopically. It ought not be thought of as a reversible operation. Certainly, the concept of dividing the stomach and rerouting things is a very aggressive thing, and although you can kind of undo it, it’s very difficult to do. So, we emphasize, it's really not a reversible operation, and it would only be reversed in the setting of problems or complications. So, that’s our approach to the gastric bypass. It’s an excellent operation, but it definitely does have some side effects, and individuals choosing it really do need to consider those in great detail before undergoing it. In general, it is best recommended for patients who have an extraordinary amount of weight to lose as well as people with diabetes and severe gastroesophageal reflux disease.

Melanie: So then, what's the difference with the sleeve gastrectomy versus the bypass?

Dr. Weiss: Yeah. Well, you know, that’s kind of why the sleeve has become the more popular operation at this time. A lot of people are intimidated by the concept of a bypass. They just feel it's a bit too aggressive, you know, kind of rerouting. It’s not physiologic, truth be told. It really does change things for people. It changes the way you absorb vitamins and the way you respond to certain foods. We actually take advantage of those to help you lose weight, but it’s no question there’s some side effects related to it. The sleeve on the other hand, we basically are reducing the size of an individual’s stomach on the order of about 60 to 65% of the stomach is removed, essentially turning the stomach into a tube. That tube of stomach severely constricts the appetite actually, more interestingly. People visualize a small stomach and say, well, my stomach is small. So, therefore, I can’t eat. Well, truth be told, you can eat. You know, it's just a matter of timing. If you eat slowly enough you can certainly eat, or if you eat things of the right consistency. But more importantly, I believe the sleeve gastrectomy affects hormones, and the hormones such as appetite stimulating hormones are dramatically reduced as a result of this operation, and so what in essence occurs is people just don’t have an appetite. They just don’t have desire, and as a result, they eat less. Now, the benefit is you're not really rerouting. It’s just a smaller stomach. So, vitamin deficiencies, although possible and certainly we do need to supplement vitamins, are much less worrisome than we would usually see with the gastric bypass. So, I think it has some less side effects when it comes to vitamin deficiencies and certain unique problems that can occur with respect to the gastric bypass, but on the other hand, it is also a major operation that does carry some risk, and so an individual does need to carefully consider those risks before undergoing the procedure.

Melanie: And when you're talking about nutrients and malabsorption in these types of surgery, what’s life like for the patient after the surgery, after the procedure, as far as vitamin supplementation or what they are able to digest and eat and pretty much what their life is like?

Dr. Weiss: Yeah. Well, you know, to be honest, I believe our patients feel – they're coming to us because they have a lot of issues, a lot of restrictions in their lives. So, life isn’t necessarily very good in our preoperative patients or the patients who are entertaining surgery. They have issues related to their size and weight. Most of them feel trapped in their bodies. So they do understand that, you know, there's no surgery that’s not going to come without a price, so to speak. But that being said, it kind of does depend on the surgery you choose. But even so, most people can eat most things – most things – not everything, but most things, most types of things after the surgery. There are usually certain intolerances. For instance, people with gastric bypasses generally do not do well with very sweet things. They can have reactions to that. Certainly, things like ice cream or candies are certainly not recommended, and it wouldn’t be recommended for anyone on a diet, really, anyway. But most healthy foods, to be honest with you, either a gastric bypass or a sleeve, most people can do pretty well. We recommend our patients eat poultry, fish, dairy products, fruits, vegetables, a fairly well-balanced diet. So, most people really, except for the fact they’re eating less, you know, certainly not right away, but within several months of the surgery, they're eating less. They can go out – you can go out to restaurants. We give them our little special card so they can order smaller portions. Maybe they can save some money that way because they're certainly not going to get their money’s worth if they go to a place that gives them a very large portion, unless they're just going to take it home, and then they have meals maybe for a week. But that’s pretty much the way it is. Most patients by and large are ecstatic somewhat to some degree. They’re much happier, even though they can’t eat some things, they can eat most things, and they feel better.

Melanie: And do they use supplements to help avoid long-term problems, vitamin supplements?

Dr. Weiss: Absolutely. Yeah. We’re very, very strict on those. I mean, we make very strict recommendations. We actually have a lot of publications, and as mentioned, we have dieticians that routinely meet with the patients both before and after the surgery. We actually review all our recommendations. There are choices. It’s not like this is it and nothing else. There are definite options, and we actually measure vitamin levels on our patients after the surgery, periodically, just to make sure that things are going well, depending upon which vitamins they're taking. Sometimes we do need to make adjustments depending upon the individual and their surgery.

Melanie: So, in just the last few minutes, Dr. Weiss, what should people that are severely overweight think about when considering bariatric surgery?

Dr. Weiss: Well, it's a major undertaking. I think they’d have to realize it's not simple. I think, you know, the concept that surgery is the easy way out is really not correct. I believe, it's not the easy way out, but it is a viable solution to a very, very difficult problem. We want our patients to look at this as a life-changing event to really improve their health, improve their longevity and their quality of life. That’s the most important thing, that this is a critical thing, that you should go to a place where they don’t just do surgery. They do everything that’s required to get your through the surgery. You know, as I've mentioned, all the preoperative preparations, the expertise in the surgery itself, both with the physicians doing the surgery as well as the hospital staff as well as all of the post-operative follow-up. Probably the most important thing, in my opinion, is to go to a reputable bariatric surgery program that has expertise and a history and a track record of excellence which we believe that we have at St. Luke’s.

Melanie: Thank you so much. It's great information. This is Doc Talk, presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. I’m Melanie Cole. Thanks so much for listening.