More than 60 million Americans are considered obese. When diet and exercise does not work, surgery may become an option.
Weight loss surgery, otherwise known as, bariatric surgery has become a viable treatment option these days, especially to those individuals that are considered morbidly obese.
The goal of bariatric surgery is to limit the caloric intake and can sometimes have hormonal benefits to help decrease appetite.
This form of surgery is not intended to be an "easy way out." Find out if you or a loved one may be a candidate for weight loss surgery and what you can expect before, during and after surgery.
Selected Podcast
Is Bariatric Surgery for You?
Featured Speaker:
Before joining Summit Medical Group, Dr. Bell was Founder and Medical Director of the Yale - New Haven Hospital Bariatric Surgery Program and Medical Director of the Yale - New Haven Hospital Minimally Invasive Surgery Program. To his credit, Dr. Bell also established and has been Director of the Yale Minimally Invasive Surgery Fellowship Program.
Robert Bell, MD
Robert Bell, MD, MA, FACS, has expertise in bariatric surgery for morbid obesity. Dr. Bell also specializes in minimally invasive laparoscopic and endoscopic surgery for gastroesophageal reflux disease, gallbladder disease, esophageal motility problems, abdominal wall hernia repairs, and other gastrointestinal (GI) problems. A leader in bariatric surgery and minimally invasive surgery, he is among few surgeons in the New York metropolitan area who perform revisionary (corrective) obesity surgeries. In addition to his position at Summit Medical Group, Dr. Bell is Associate Professor of Surgery at Yale University School of Medicine in New Haven, Connecticut.Before joining Summit Medical Group, Dr. Bell was Founder and Medical Director of the Yale - New Haven Hospital Bariatric Surgery Program and Medical Director of the Yale - New Haven Hospital Minimally Invasive Surgery Program. To his credit, Dr. Bell also established and has been Director of the Yale Minimally Invasive Surgery Fellowship Program.
Transcription:
Is Bariatric Surgery for You?
Melanie Cole (Host): As a treatment for severe obesity, weight loss surgery’s popularity is growing. When diet and exercise fail the more than 60 million Americans that are considered obese, surgery for some of them can literally be lifesaving. My guest is Dr. Robert Bell. He’s a bariatric surgeon with Summit Medical Group. Welcome to the show, Dr. Bell. Tell us a little bit about bariatric surgery, what’s involved, and really, who is a candidate for this type of surgery.
Dr. Robert Bell (Guest): Well, thank you very much. Bariatric surgery is also known as weight loss surgery. What weight loss surgery tries to accomplish is limiting the caloric intake of a patient over the course of the day, and hopefully over the course of a lifetime. There’s a variety of different weight loss surgical procedures that do a variety of different things. They all are aimed towards limiting caloric intake. But some of the operations additionally have hormonal benefits that actually make the person not hungry in spite of taking in very few calories over the course of the day. As far as who the candidates for surgery, really, as Americans, we’ve always fought off the metric system. Unfortunately, you need to know a little bit of metric system to see who the candidates for weight loss surgery. What you need to know is one’s body mass index, and that’s something that the rest of the world is entirely familiar with. It’s essentially a weight divided by height ratio in kilograms per meter squared. So you need to be able to put your height and your weight into typically a website calculator that can be found on certain websites like the asmbs.org or the CDC or the NIH website. Who is a candidate for surgery? It’s somebody that has a body mass index of greater than 35 with medical problems such as diabetes, sleep apnea, hypertension, high cholesterol, or any patient with a body mass index of greater than 40. Just from a frame of reference, a body mass index of greater than 40 is typically being 80 to 100 pounds overweight.
Melanie: Okay, so people can calculate their BMI. They can Google it, and then the calculators do pop up everywhere. So 80 to 100 pounds overweight. You know, this is a really severe problem in this country. What’s involved in the surgery? Because Dr. Bell, my sister had it, so I know what you have to go through. It is not—and I want the listeners to understand that—the easy way out. So explain what all the process is—the counseling that you have to go through—really, the very long process. But, boy, it sure can be a life-saving thing for some people.
Dr. Bell: Well, I really appreciate what you said in that that it’s not the easy way out, because it really peeves me when I overhear somebody say that or when a patient says that a family member, or even a caregiver, says that surgery is the easy way out. Because if all you had to do was have surgery, well, then in fact, it would be the easy way out. But it is much more than involved than that. Really, surgery only limits the calories in, and it’s never too soon to think about long-term success after weight loss surgery. If you want to be successful on the long term after weight loss surgery, you have to pay careful attention to what you put in your mouth as well as careful attention to your calorie expenditure, i.e., exercise. Patients have to exercise after weight loss surgery in order to be successful in the long run. Additionally, something you touched on is something that is hopefully not overlooked, and that is the behavioral and psychological components to one’s obesity. Just because one is full doesn't mean they’re not going to eat. These types of eating behaviors—eating when you’re not hungry and continuing to eat once you’re full—there’s really not a surgery for that as well, so you need to make sure that those behaviors are being addressed along the way. We try to capture those behaviors before surgery and also work on them after surgery. Again, these are behaviors that have taken a lifetime to develop, and it takes a little while to get over those behaviors. So, in order to be successful after surgery, you have to be willing and able to participate in an exercise program, and then you need to address any and all behavioral factors that might be contributing to your obesity.
Melanie: Dr. Bell, tell us. For Summit Medical Group, if someone were to come and have bariatric surgery with you, before, during and then after, is there program support? Because I know that there’s a lot of support needed afterwards because it’s frustrating and scary, the whole thing. But it sure can work. So tell us about a little about the before, during and after and what goes on with your group.
Dr. Bell: Before surgery, everybody needs to visit with a dietician. What the dietician will go over is basically assessing one’s level of education regarding what they put in their mouth. Just because you and I may know what a carbohydrate, protein, and a fat is doesn’t mean that everybody knows—so some basic education that the patients need going into surgery. But the dietician also helps patients understand what the diet is going to be like immediately after surgery, and you will also touch on what the diet is supposed to be in the long term. And long term, I really don't know that I like the word “diet,” but really, long term, it has to be with good eating behaviors and portion control. As far as the additional evaluations before surgery, of course everybody meets with the psychologist just to basically see what the support structure is at home and also address any maladaptive eating behaviors that patients may acquire over the years. Again, make sure that those are addressed ahead of time and just being aware of it so that post-operatively, the patients do well. Additionally, patients come to an educational seminar given by myself, and then I meet with them one on one to discuss their own personal medical histories and what they’ve tried in the past in terms of diet and exercise to treat their obesity.
Melanie: And then, after the surgery, how long until they can start to resume some exercise and get going? Because it can be scarring or painful. How long until they can start being active?
Dr. Bell: Well, that’s the beauty of the laparoscopic surgery. The first laparoscopic gastric bypass was done in 1994, so we’ve really had getting close to 20 years’ experience with laparoscopic weight loss surgery. The vast majority, let’s say 95-98 percent of weight loss surgeries being performed in the United States these days, are done laparoscopically, through a small incision. And when you perform an operation through small incisions, that really enables the patient to get back on their feet very, very quickly. So, if the patients are discharged home, which is typically one day or two days after surgery, I encourage the patient to go for a walk. Now, that’s not exactly getting into the gym with a personal trainer, but it’s being up and active. So I really expect that the patient’s level of activity to be as good as it was before surgery within days after surgery. Then hopefully, within weeks after surgery, the activity level is actually much better than it was before surgery, because of course there’ll be some tremendous weight loss over those first couple of weeks.
Melanie: So, wrap it up for us, Dr. Bell. Give us your best advice for people out there considering bariatric surgery, gastric bypass surgery, anything that you’re doing that can help them lose the myriad of extra pounds.
Dr. Bell: Well, I think the best thing is to be educated, and there’s a variety of ways to be educated. You can attend seminars such as the one that I give, but you can also do some reading on the Internet, whether it’s through reputable websites—again, like the American Study of Metabolic and Bariatric Surgery or the NIH website, the National Institute of Health or the CDC, the Centers for Disease Control. I would look for those type of reputable websites. I wouldn’t look for advertisement-based websites. So I would go to really more of your organizational websites. Then lastly, I think it’s really nice to go to a support group and talk to patients that have had the surgery, because it’s one thing to hear what it’s going to be like from me, but it’s another thing to hear what it’s going to be like from not one patient but 20, 30, 40 patients that are attending support group meetings. Those are a good group of people to pick their brains about what it was like with surgery in the hospital, what it was like after surgery, what they’re doing to be successful. The vast majority of times, what patients will say is, the support group patients, “I should have done this years ago.” It’s a very common thing that people will say. But they can provide excellent scores of insight for preoperative bariatric surgery patients, these postoperative bariatric surgery patients that you’ll find at support groups.
Melanie: That’s really great advice and great information for those people listening that are really considering something that you really need to help you lose that weight. But as Dr. Bell said, you have to consider all of your options carefully. It is not for everyone, but it is also not the easy way out. It’s something that you do with counseling and a dietician and exercise, and you have to change your life and change your behaviors. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Is Bariatric Surgery for You?
Melanie Cole (Host): As a treatment for severe obesity, weight loss surgery’s popularity is growing. When diet and exercise fail the more than 60 million Americans that are considered obese, surgery for some of them can literally be lifesaving. My guest is Dr. Robert Bell. He’s a bariatric surgeon with Summit Medical Group. Welcome to the show, Dr. Bell. Tell us a little bit about bariatric surgery, what’s involved, and really, who is a candidate for this type of surgery.
Dr. Robert Bell (Guest): Well, thank you very much. Bariatric surgery is also known as weight loss surgery. What weight loss surgery tries to accomplish is limiting the caloric intake of a patient over the course of the day, and hopefully over the course of a lifetime. There’s a variety of different weight loss surgical procedures that do a variety of different things. They all are aimed towards limiting caloric intake. But some of the operations additionally have hormonal benefits that actually make the person not hungry in spite of taking in very few calories over the course of the day. As far as who the candidates for surgery, really, as Americans, we’ve always fought off the metric system. Unfortunately, you need to know a little bit of metric system to see who the candidates for weight loss surgery. What you need to know is one’s body mass index, and that’s something that the rest of the world is entirely familiar with. It’s essentially a weight divided by height ratio in kilograms per meter squared. So you need to be able to put your height and your weight into typically a website calculator that can be found on certain websites like the asmbs.org or the CDC or the NIH website. Who is a candidate for surgery? It’s somebody that has a body mass index of greater than 35 with medical problems such as diabetes, sleep apnea, hypertension, high cholesterol, or any patient with a body mass index of greater than 40. Just from a frame of reference, a body mass index of greater than 40 is typically being 80 to 100 pounds overweight.
Melanie: Okay, so people can calculate their BMI. They can Google it, and then the calculators do pop up everywhere. So 80 to 100 pounds overweight. You know, this is a really severe problem in this country. What’s involved in the surgery? Because Dr. Bell, my sister had it, so I know what you have to go through. It is not—and I want the listeners to understand that—the easy way out. So explain what all the process is—the counseling that you have to go through—really, the very long process. But, boy, it sure can be a life-saving thing for some people.
Dr. Bell: Well, I really appreciate what you said in that that it’s not the easy way out, because it really peeves me when I overhear somebody say that or when a patient says that a family member, or even a caregiver, says that surgery is the easy way out. Because if all you had to do was have surgery, well, then in fact, it would be the easy way out. But it is much more than involved than that. Really, surgery only limits the calories in, and it’s never too soon to think about long-term success after weight loss surgery. If you want to be successful on the long term after weight loss surgery, you have to pay careful attention to what you put in your mouth as well as careful attention to your calorie expenditure, i.e., exercise. Patients have to exercise after weight loss surgery in order to be successful in the long run. Additionally, something you touched on is something that is hopefully not overlooked, and that is the behavioral and psychological components to one’s obesity. Just because one is full doesn't mean they’re not going to eat. These types of eating behaviors—eating when you’re not hungry and continuing to eat once you’re full—there’s really not a surgery for that as well, so you need to make sure that those behaviors are being addressed along the way. We try to capture those behaviors before surgery and also work on them after surgery. Again, these are behaviors that have taken a lifetime to develop, and it takes a little while to get over those behaviors. So, in order to be successful after surgery, you have to be willing and able to participate in an exercise program, and then you need to address any and all behavioral factors that might be contributing to your obesity.
Melanie: Dr. Bell, tell us. For Summit Medical Group, if someone were to come and have bariatric surgery with you, before, during and then after, is there program support? Because I know that there’s a lot of support needed afterwards because it’s frustrating and scary, the whole thing. But it sure can work. So tell us about a little about the before, during and after and what goes on with your group.
Dr. Bell: Before surgery, everybody needs to visit with a dietician. What the dietician will go over is basically assessing one’s level of education regarding what they put in their mouth. Just because you and I may know what a carbohydrate, protein, and a fat is doesn’t mean that everybody knows—so some basic education that the patients need going into surgery. But the dietician also helps patients understand what the diet is going to be like immediately after surgery, and you will also touch on what the diet is supposed to be in the long term. And long term, I really don't know that I like the word “diet,” but really, long term, it has to be with good eating behaviors and portion control. As far as the additional evaluations before surgery, of course everybody meets with the psychologist just to basically see what the support structure is at home and also address any maladaptive eating behaviors that patients may acquire over the years. Again, make sure that those are addressed ahead of time and just being aware of it so that post-operatively, the patients do well. Additionally, patients come to an educational seminar given by myself, and then I meet with them one on one to discuss their own personal medical histories and what they’ve tried in the past in terms of diet and exercise to treat their obesity.
Melanie: And then, after the surgery, how long until they can start to resume some exercise and get going? Because it can be scarring or painful. How long until they can start being active?
Dr. Bell: Well, that’s the beauty of the laparoscopic surgery. The first laparoscopic gastric bypass was done in 1994, so we’ve really had getting close to 20 years’ experience with laparoscopic weight loss surgery. The vast majority, let’s say 95-98 percent of weight loss surgeries being performed in the United States these days, are done laparoscopically, through a small incision. And when you perform an operation through small incisions, that really enables the patient to get back on their feet very, very quickly. So, if the patients are discharged home, which is typically one day or two days after surgery, I encourage the patient to go for a walk. Now, that’s not exactly getting into the gym with a personal trainer, but it’s being up and active. So I really expect that the patient’s level of activity to be as good as it was before surgery within days after surgery. Then hopefully, within weeks after surgery, the activity level is actually much better than it was before surgery, because of course there’ll be some tremendous weight loss over those first couple of weeks.
Melanie: So, wrap it up for us, Dr. Bell. Give us your best advice for people out there considering bariatric surgery, gastric bypass surgery, anything that you’re doing that can help them lose the myriad of extra pounds.
Dr. Bell: Well, I think the best thing is to be educated, and there’s a variety of ways to be educated. You can attend seminars such as the one that I give, but you can also do some reading on the Internet, whether it’s through reputable websites—again, like the American Study of Metabolic and Bariatric Surgery or the NIH website, the National Institute of Health or the CDC, the Centers for Disease Control. I would look for those type of reputable websites. I wouldn’t look for advertisement-based websites. So I would go to really more of your organizational websites. Then lastly, I think it’s really nice to go to a support group and talk to patients that have had the surgery, because it’s one thing to hear what it’s going to be like from me, but it’s another thing to hear what it’s going to be like from not one patient but 20, 30, 40 patients that are attending support group meetings. Those are a good group of people to pick their brains about what it was like with surgery in the hospital, what it was like after surgery, what they’re doing to be successful. The vast majority of times, what patients will say is, the support group patients, “I should have done this years ago.” It’s a very common thing that people will say. But they can provide excellent scores of insight for preoperative bariatric surgery patients, these postoperative bariatric surgery patients that you’ll find at support groups.
Melanie: That’s really great advice and great information for those people listening that are really considering something that you really need to help you lose that weight. But as Dr. Bell said, you have to consider all of your options carefully. It is not for everyone, but it is also not the easy way out. It’s something that you do with counseling and a dietician and exercise, and you have to change your life and change your behaviors. You’re listening to Summit Medical Group Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.