Obesity in the United States is a common, serious, and deadly disease. Estimates of the medical cost of adult obesity in the United States range from a staggering $147 billion to nearly $210 billion per year. Still, anyone who has ever dieted knows that losing weight can be hard. And the more you weigh, the harder it can be to shed excess pounds. For some people, diet, exercise, and lifestyle changes aren’t enough; bariatric surgery offers another path to achieving and maintaining a healthy weight.
Learn more about the Bariatrics Weight Loss Program at UM Charles Regional Medical Center
Learn about other University of Maryland Medical System Bariatric Programs
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Are You a Good Candidate for Bariatric Surgery?
Featured Speaker:
Learn more about Dr. Nzara
Rumbi Nzara, MD
Rumbi Nzara, MD, a surgeon at UM Charles Regional Medical Group—Surgical Care, graduated from the University of Minnesota Medical School in 2014, and completed her medical residency at Boston Medical Center in 2019. She also completed a fellowship at the University of Maryland Medical Center in Minimally Invasive Surgery in 2019, and holds certification from the American Board of Surgery. Her treatment philosophy puts the patient at the center of the treatment team, and her goal is to listen and truly understand a patient’s concerns so that together she can identify appropriate treatment options that align with the patient's goals. Dr. Nzara is committed to safe and cost-effective care that minimizes unnecessary testing and procedures.Learn more about Dr. Nzara
Transcription:
Are You a Good Candidate for Bariatric Surgery?
Evo Terra: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by the UM Charles Regional Medical Center. And I'm your host Evo Terra. My guest today is Dr. Rumbi Nzara, a surgeon at UM Charles Regional Medical Group. Welcome to the show doctor.
Dr. Rumbi Nzara: Well, thank you so much for having me. I'm very excited to talk about an issue that is very near and dear to my heart.
Evo Terra: I would love to get more information, but let's start at the beginning. We're talking about bariatric surgery. What kind of goals are patients looking for when they seek out this procedure?
Dr. Rumbi Nzara: So bariatric surgery is any surgery that has a goal of achieving weight, loss and healthy weight. While each patient has individualized goals for why they undergo the surgery. The main goal for the surgeon is to treat any obesity related conditions and prevent the development of other obesity related health conditions.
Evo Terra: That's great. And so when we're doing this with our patients, we obviously know about bariatric surgery for weight loss, but what are some other medical complications that this surgery can address?
Dr. Rumbi Nzara: So the main related conditions that patients are looking to treat are things like diabetes, high blood pressure. Osteoarthritis sleep apnea and even pulmonary conditions. Other complications from obesity that can be treated are emotional disorders such as depression or any problems with body image. And that can be addressed with the surgery too.
Evo Terra: Okay, great. So maybe lots of people that are thinking about is this surgery for me. So I'll ask the question of what makes someone a good candidate for bariatric surgery?
Dr. Rumbi Nzara: Bariatric surgery is a good option for patients who are suffering from severe obesity. And we define this based on BMI, which is a body mass index. So patients with a BMI over 35. Or who have a BMI over 40 would be good candidates to think about bariatric surgery. Now, obviously we wanna make sure that other medical conditions are well controlled to make it safe for the patient to undergo surgery. And we want to make sure that patients are in good mental health so that they have a good outcome right after the surgery, as well as long-term.
Evo Terra: Yeah, long term care is certainly important. So let's say that I am the patient and I'm considering getting this surgery done, there's a question. What should I be considering? How do I know this is the right decision for me?
Dr. Rumbi Nzara: So the first step for any patient who is thinking about surgery is to make an appointment with a reputable bariatric surgeon to really sit down with them and talk about an individualized plan, about the goals that the patient has, and which surgery might be a good fit. That way the patient also would get more information about the, each of the surgeries to be able to make an informed decision.
Evo Terra: Yeah. Informed decisions are certainly key. And I know that the field of bariatric surgery has certainly changed over the years. So let's talk about that for a moment. What types of different bariatric surgeries are there?
Dr. Rumbi Nzara: So you're absolutely right. There's been a lot of changes in the different procedures that are offered for the treatment of obesity. The bariatric surgeries that are available, the sleeve gastrectomy is the most common procedure that is offered. And in that procedure, we use a stapler to divide the stomach and remove about 80% of the stomach.
The next most popular procedure is the roux en Y gastric bypass. That procedure's been around for a long time, over 50 years. And about 30% of all bariatric procedures are the gastric bypass. Some of the less common procedures are the gastric band and the duodenal switch. And some of that has to do with complexity of those procedures as well as potential complications.
Evo Terra: Lots of decisions to be made, obviously with your doctor in tow. I have a few acquaintances of mine. Who've gone through the surgery and I know that they've had to do some ahead of time work. So let's talk about that. How do patients prepare for surgery? What do they need to do?
Dr. Rumbi Nzara: Absolutely. So preparation is key to ensure that patients do well during the time of the surgery, as well as long term. And most programs will have a very robust support system for patients to go through, dietary training and counseling, to make sure that they understand the changes that will be needed after the surgery. We also try and make sure that patients have all their medical conditions well controlled before surgery and have them work with a cardiologist, a psychiatrist. So we can address everything that will make the surgery safe.
Evo Terra: Earlier, you talked about the goals that the surgeon has with the surgery. Let's talk about success. What defines a successful surgery? And I guess the other question is what is the success rate of these types of surgeries?
Dr. Rumbi Nzara: So I define the success of the surgery based on the patient's initial goals. But I would say, as the field the main thing we look for is weight loss of at least 50% of the patient's excess body weight. And that's the weight that the patient is above an ideal body weight for their height. In terms of the success rate of the surgery, patients tend to see pretty fantastic results. About 80 to 85% of patients will meet that threshold of losing at least 50% of their excess weight.
Evo Terra: That's very successful. 80% is great. So what happens after their surgery? I mean, clearly you don't lose 50% of your body mass. As soon as the surgery is done, it takes some time. But what does happen after their surgery and thinking about recovery time more than I am full weight loss time, what's it like?
Dr. Rumbi Nzara: So bariatric surgery has really moved to being minimally invasive, meaning using small incisions and laparoscopic surgery. And that means that the recovery is much easier for most patients. After surgery, most patients go home one day after surgery. We expect them to be up to be moving around pretty much right after they get out of the operating room from surgery. Most patients go home on day one, and most patients are returning to work at about two weeks after the surgery. Immediately after the biggest change is in terms of the diet. So patients will start out on a liquid diet and gradually progress to pick a liquids and eventually solids over the first few weeks after surgery.
Evo Terra: And so when we are back to eating solid foods after all of this, and we're ready for, to be part of that 80% success factor, you mentioned, when does it happen? How long until someone starts seeing results?
Dr. Rumbi Nzara: I think that's the most amazing part about the surgery. Patients are pretty surprised that they start to see weight loss, even in the first few weeks after surgery. About half of all the weight that we are talking about is lost in the first three months after the surgery. But patients continue to lose weight even up to 12 to 18 months after surgery.
Evo Terra: That's really fantastic. So, you mentioned previously that it takes some time to build up to your solid food once again, the foods you are normally eating with, but when you're there, how is the diet restricted? Do you recommend a restricted diet, either from calories or types of foods or certain perhaps diets they should be on?
Dr. Rumbi Nzara: Once patients are past the initial stage where they're eating liquids and thicker liquids, they do go back to a fairly normal diet. But as you pointed out, we are aiming to help patients make better decisions about their food. And additionally, because these surgeries decrease the size of the stomach, patients are usually not able to eat the same amounts or portion sizes that they were eating before the surgery.
So our goal is actually to get them to a point where patients have. A lot of information, to be able to make better choices about foods, avoiding any empty calories and getting all the nutrients that they need in order to continue to achieve a healthy weight.
Evo Terra: Which is obviously what someone wants, take off the weight, but also keep off the
Dr. Rumbi Nzara: Absolutely.
Evo Terra: Let's talk about, side effects, complications, reason to not get the surgery.
Dr. Rumbi Nzara: So absolutely. Any procedure that we do in medicine comes with the risk of potential complications. So things like bleeding, infection, injuring something in the course of the surgery. But these surgeries have actually been around for a long time. So the sleeve gastrectomy for over 20 years and the gastric bypass for over 50 years. As a result, there's been a lot of advancements in the field to decrease any potential complications and increase the safety of these procedures. Thus, the complication rates are actually comparable to other common procedures. So things like gall bladder removal and removal of the appendix as well.
Evo Terra: And is this an elective surgery or is some, or all of this covered by most insurance plans?
Dr. Rumbi Nzara: So most insurance companies realize that the impact on health is pretty profound, if patients are able to get better control of diabetes, better control of osteo arthritis and hypertension. As a result, most of them will provide some coverage. For this procedure. I always advise patients to obviously speak to their bariatric surgeon or facility to ensure that they have all the information about the insurance coverage.
Evo Terra: This all sounds fascinating. Any final thoughts to leave with the listeners?
Dr. Rumbi Nzara: So the reason I ended up doing bariatric surgery is because I saw. Just how life changing this procedure is for patients. It's pretty remarkable to see patients do things that they never thought they'd be able to do. So thanks from running a marathon or even just as simple as running around and playing with their kids. And so I really encourage any patient, anyone who's suffering from obesity to at least sit down with someone, talk about the procedure and see if this may be an option that may be life changing for you.
Evo Terra: Yeah, I agree. Get back to the life that you need to live. Dr. Nzara, thank you very much for being with us today.
Dr. Rumbi Nzara: Thank you so much for having me I've really enjoyed chatting about this.
Evo Terra: And once again, that was Dr. Rumbi Nzara, a surgeon at UM Charles Regional Medical Group. You can find more episodes just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I have been your host Evo Terra, and we look forward to you joining us again.
Are You a Good Candidate for Bariatric Surgery?
Evo Terra: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by the UM Charles Regional Medical Center. And I'm your host Evo Terra. My guest today is Dr. Rumbi Nzara, a surgeon at UM Charles Regional Medical Group. Welcome to the show doctor.
Dr. Rumbi Nzara: Well, thank you so much for having me. I'm very excited to talk about an issue that is very near and dear to my heart.
Evo Terra: I would love to get more information, but let's start at the beginning. We're talking about bariatric surgery. What kind of goals are patients looking for when they seek out this procedure?
Dr. Rumbi Nzara: So bariatric surgery is any surgery that has a goal of achieving weight, loss and healthy weight. While each patient has individualized goals for why they undergo the surgery. The main goal for the surgeon is to treat any obesity related conditions and prevent the development of other obesity related health conditions.
Evo Terra: That's great. And so when we're doing this with our patients, we obviously know about bariatric surgery for weight loss, but what are some other medical complications that this surgery can address?
Dr. Rumbi Nzara: So the main related conditions that patients are looking to treat are things like diabetes, high blood pressure. Osteoarthritis sleep apnea and even pulmonary conditions. Other complications from obesity that can be treated are emotional disorders such as depression or any problems with body image. And that can be addressed with the surgery too.
Evo Terra: Okay, great. So maybe lots of people that are thinking about is this surgery for me. So I'll ask the question of what makes someone a good candidate for bariatric surgery?
Dr. Rumbi Nzara: Bariatric surgery is a good option for patients who are suffering from severe obesity. And we define this based on BMI, which is a body mass index. So patients with a BMI over 35. Or who have a BMI over 40 would be good candidates to think about bariatric surgery. Now, obviously we wanna make sure that other medical conditions are well controlled to make it safe for the patient to undergo surgery. And we want to make sure that patients are in good mental health so that they have a good outcome right after the surgery, as well as long-term.
Evo Terra: Yeah, long term care is certainly important. So let's say that I am the patient and I'm considering getting this surgery done, there's a question. What should I be considering? How do I know this is the right decision for me?
Dr. Rumbi Nzara: So the first step for any patient who is thinking about surgery is to make an appointment with a reputable bariatric surgeon to really sit down with them and talk about an individualized plan, about the goals that the patient has, and which surgery might be a good fit. That way the patient also would get more information about the, each of the surgeries to be able to make an informed decision.
Evo Terra: Yeah. Informed decisions are certainly key. And I know that the field of bariatric surgery has certainly changed over the years. So let's talk about that for a moment. What types of different bariatric surgeries are there?
Dr. Rumbi Nzara: So you're absolutely right. There's been a lot of changes in the different procedures that are offered for the treatment of obesity. The bariatric surgeries that are available, the sleeve gastrectomy is the most common procedure that is offered. And in that procedure, we use a stapler to divide the stomach and remove about 80% of the stomach.
The next most popular procedure is the roux en Y gastric bypass. That procedure's been around for a long time, over 50 years. And about 30% of all bariatric procedures are the gastric bypass. Some of the less common procedures are the gastric band and the duodenal switch. And some of that has to do with complexity of those procedures as well as potential complications.
Evo Terra: Lots of decisions to be made, obviously with your doctor in tow. I have a few acquaintances of mine. Who've gone through the surgery and I know that they've had to do some ahead of time work. So let's talk about that. How do patients prepare for surgery? What do they need to do?
Dr. Rumbi Nzara: Absolutely. So preparation is key to ensure that patients do well during the time of the surgery, as well as long term. And most programs will have a very robust support system for patients to go through, dietary training and counseling, to make sure that they understand the changes that will be needed after the surgery. We also try and make sure that patients have all their medical conditions well controlled before surgery and have them work with a cardiologist, a psychiatrist. So we can address everything that will make the surgery safe.
Evo Terra: Earlier, you talked about the goals that the surgeon has with the surgery. Let's talk about success. What defines a successful surgery? And I guess the other question is what is the success rate of these types of surgeries?
Dr. Rumbi Nzara: So I define the success of the surgery based on the patient's initial goals. But I would say, as the field the main thing we look for is weight loss of at least 50% of the patient's excess body weight. And that's the weight that the patient is above an ideal body weight for their height. In terms of the success rate of the surgery, patients tend to see pretty fantastic results. About 80 to 85% of patients will meet that threshold of losing at least 50% of their excess weight.
Evo Terra: That's very successful. 80% is great. So what happens after their surgery? I mean, clearly you don't lose 50% of your body mass. As soon as the surgery is done, it takes some time. But what does happen after their surgery and thinking about recovery time more than I am full weight loss time, what's it like?
Dr. Rumbi Nzara: So bariatric surgery has really moved to being minimally invasive, meaning using small incisions and laparoscopic surgery. And that means that the recovery is much easier for most patients. After surgery, most patients go home one day after surgery. We expect them to be up to be moving around pretty much right after they get out of the operating room from surgery. Most patients go home on day one, and most patients are returning to work at about two weeks after the surgery. Immediately after the biggest change is in terms of the diet. So patients will start out on a liquid diet and gradually progress to pick a liquids and eventually solids over the first few weeks after surgery.
Evo Terra: And so when we are back to eating solid foods after all of this, and we're ready for, to be part of that 80% success factor, you mentioned, when does it happen? How long until someone starts seeing results?
Dr. Rumbi Nzara: I think that's the most amazing part about the surgery. Patients are pretty surprised that they start to see weight loss, even in the first few weeks after surgery. About half of all the weight that we are talking about is lost in the first three months after the surgery. But patients continue to lose weight even up to 12 to 18 months after surgery.
Evo Terra: That's really fantastic. So, you mentioned previously that it takes some time to build up to your solid food once again, the foods you are normally eating with, but when you're there, how is the diet restricted? Do you recommend a restricted diet, either from calories or types of foods or certain perhaps diets they should be on?
Dr. Rumbi Nzara: Once patients are past the initial stage where they're eating liquids and thicker liquids, they do go back to a fairly normal diet. But as you pointed out, we are aiming to help patients make better decisions about their food. And additionally, because these surgeries decrease the size of the stomach, patients are usually not able to eat the same amounts or portion sizes that they were eating before the surgery.
So our goal is actually to get them to a point where patients have. A lot of information, to be able to make better choices about foods, avoiding any empty calories and getting all the nutrients that they need in order to continue to achieve a healthy weight.
Evo Terra: Which is obviously what someone wants, take off the weight, but also keep off the
Dr. Rumbi Nzara: Absolutely.
Evo Terra: Let's talk about, side effects, complications, reason to not get the surgery.
Dr. Rumbi Nzara: So absolutely. Any procedure that we do in medicine comes with the risk of potential complications. So things like bleeding, infection, injuring something in the course of the surgery. But these surgeries have actually been around for a long time. So the sleeve gastrectomy for over 20 years and the gastric bypass for over 50 years. As a result, there's been a lot of advancements in the field to decrease any potential complications and increase the safety of these procedures. Thus, the complication rates are actually comparable to other common procedures. So things like gall bladder removal and removal of the appendix as well.
Evo Terra: And is this an elective surgery or is some, or all of this covered by most insurance plans?
Dr. Rumbi Nzara: So most insurance companies realize that the impact on health is pretty profound, if patients are able to get better control of diabetes, better control of osteo arthritis and hypertension. As a result, most of them will provide some coverage. For this procedure. I always advise patients to obviously speak to their bariatric surgeon or facility to ensure that they have all the information about the insurance coverage.
Evo Terra: This all sounds fascinating. Any final thoughts to leave with the listeners?
Dr. Rumbi Nzara: So the reason I ended up doing bariatric surgery is because I saw. Just how life changing this procedure is for patients. It's pretty remarkable to see patients do things that they never thought they'd be able to do. So thanks from running a marathon or even just as simple as running around and playing with their kids. And so I really encourage any patient, anyone who's suffering from obesity to at least sit down with someone, talk about the procedure and see if this may be an option that may be life changing for you.
Evo Terra: Yeah, I agree. Get back to the life that you need to live. Dr. Nzara, thank you very much for being with us today.
Dr. Rumbi Nzara: Thank you so much for having me I've really enjoyed chatting about this.
Evo Terra: And once again, that was Dr. Rumbi Nzara, a surgeon at UM Charles Regional Medical Group. You can find more episodes just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I have been your host Evo Terra, and we look forward to you joining us again.