Considering bariatric surgery?
Obesity can cause a number of conditions, including diabetes, high blood pressure, sleep apnea and joint problems.
Weight-loss surgery, combined with exercise and a sensible diet, has controlled obesity and its effects for thousands.
Learn from Dr. Peter Hallowell, the director of UVA’s bariatric surgery program, who may be a candidate for the weight-loss surgery as well as some of the potential benefits.
Selected Podcast
Is Bariatric Surgery Right for You?
Featured Speaker:
Peter Hallowell, MD
Dr. Peter Hallowell is a board-certified surgeon and director of bariatric surgery at UVA Health System. Transcription:
Is Bariatric Surgery Right for You?
Melanie Cole (Host): Are you severely overweight? Have you ever considered bariatric surgery? Who is really a candidate for this weight loss surgery and what does it involve? My guest today is Dr. Peter Hallowell. He is a board certified surgeon and Director of Bariatric Surgery at the UVA Health System. Welcome to the show, Dr. Hallowell. Tell us a little bit about bariatric surgery. What does it involve?
Dr. Peter Hallowell (Guest): Bariatric surgery involves an operation on the patient and it describes a field of surgery where there are multiple different procedures that we do, all with the goal to help the patient lose a significant amount of weight and to improve the medical problems that are associated with carrying a significant amount of weight.
Melanie: What are the different kinds of bariatric surgery out there now? Some of them are permanent and some of them are not, correct?
Dr. Hallowell: Yes. In a general sense, what we found is that even the procedures that are somewhat temporary, once that procedure is withdrawn, there is a tendency to regain weight. So there tends to need to be a procedure, in effect, to maintain this weight loss. The procedures that are commonly done in the United States include the gastric bypass, the sleeve gastrectomy, and the lap-band, as far as common surgical procedures.
Melanie: Who are candidates? Who really should be considering any of these types of bariatric surgery?
Dr. Hallowell: Excellent question. Patients who are severely overweight and in medical terms, we measure that by a tool called the body mass index. This is essentially a ratio of your height and weight, so that taller people can carry a lot more weight. Think of a person like Shaquille O’Neal, who is nearly 7 feet tall versus somebody who is 5’ 4”. Shaquille O’Neal can carry a lot more weight on his frame and not be unhealthy. The body mass index is something that you can easily calculate in your head. Most places have a calculator on a website and we use that in our own clinic. What we are looking to see is if your body mass index is greater than 40, you would be a candidate for surgery, or if your body mass index was greater than 35 and you have a significant medical problem like hypertension, diabetes, obstructive sleep apnea. The body mass index in those ranges translates to roughly 80 to 100 pounds over your ideal weight.
Melanie: Dr. Hallowell, explain a little bit about these types of surgeries. People think of a stomach getting smaller and limiting the amount of solid food, but does that also make it like malabsorptive? Does it make it so that you cannot retain that food? Explain a little bit about it.
Dr. Hallowell: Each of the main procedures that we do works in a slightly different way. I’ll take them kind of each in and of itself. In a gastric bypass, we will take the upper part of your stomach and staple that off and make it into what we call a small pouch. It is generally about the size of an egg or smaller and holds pretty much up to about an ounce to an ounce-and-a-half of food or fluid. We then take part of your small intestine and attach it to that pouch. The food you eat will go into the stomach and then into a part of the small intestine that is usually further down. Then we make another connection, even farther down the small bowel, where the rest of the body’s juices from the liver and pancreas, and the rest of the stomach come in to help you digest. In a traditional sense, we think of that operation as sometimes limiting the amount of food that you can eat because of the size of the pouch and also inducing a little bit of malabsorption because of where the digestive enzymes come into the system and shortening your intestines a little bit. Some of the newer research into bariatric surgery indicates that some of the effects that we are having may be more hormonal or biochemical than pure restriction of food or malabsorption, and that while it hasn’t been fully fleshed out, it’s one of the most interesting areas in the field. The next procedure that is commonly done in the United States and, in fact, the most common operation performed these days, is called the sleeve gastrectomy. Simply put, that is taking the stomach and turning it into a thin tube, about the size of your esophagus. If you think of your stomach as a big reservoir that can stretch out, especially around Thanksgiving time when you may overindulge in food and it becomes a big reservoir, the sleeve gastrectomy turns that into a much smaller reservoir, much smaller tube, and you cannot hold as much food. Then the last procedure that is commonly done in the United States, the lap band, we take basically a plastic belt with a balloon on the inside and put that around the upper part of the stomach, right by the entrance to the stomach, and by inflating the balloon, we cause that area to narrow down and allow patients to feel hungry earlier than they would when eating food, so it gives a lot more restriction.
Melanie: What questions would you advise patients to ask their doctors when they are considering these types of surgery?
Dr. Hallowell: They need to ask their doctor, if they are considering this surgery, which operation may be best for them. They should ask their doctor how much experience have they had in the various operations that they propose. It would be very prudent to ask what the risks of the surgery that they are thinking about entail, what the potential benefits for them are, and if the surgeon is a member of an organization that specializes in bariatric surgery, if the hospital and center they are going to is recognized as the center that performs this and a high volume with good outcomes.
Melanie: Tell us a little bit about the recovery. We don’t have much time left, but what can patients expect afterward?
Dr. Hallowell: Again, it depends on the procedure that they have, but in general, it is about a two-day hospital stay. Most of the procedures in the United States are performed in a minimally invasive surgery fashion or what we call laparoscopic surgery. There will be multiple small incisions on the patient’s abdomen. This allows it to have a lot less pain than a traditional open surgical incision. The patients will generally recover pretty quickly from the surgical side of the equation. However, they begin losing weight, especially with the gastric bypass or sleeve, sometimes up to a pound a day, so they may feel a lot of fatigue up until six weeks after surgery. Those should be some of the expectations going in that they may be out of work for a week or two after the surgery and then they may feel tired for up to a month to a month and a half.
Melanie: Dr. Hallowell, why should patients come to UVA for their bariatric surgery?
Dr. Hallowell: UVA has been doing bariatric surgery for the longest period of time in Central Virginia and we have the most experienced team taking care of our patients. We are a recognized center of excellence for bariatric surgery and we’ve held that designation since the beginning of the program to designate hospitals as centers of excellence. It is really our experience, our knowledge, and our skill at doing these operations that should drive patients to come and see us.
Melanie: Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Is Bariatric Surgery Right for You?
Melanie Cole (Host): Are you severely overweight? Have you ever considered bariatric surgery? Who is really a candidate for this weight loss surgery and what does it involve? My guest today is Dr. Peter Hallowell. He is a board certified surgeon and Director of Bariatric Surgery at the UVA Health System. Welcome to the show, Dr. Hallowell. Tell us a little bit about bariatric surgery. What does it involve?
Dr. Peter Hallowell (Guest): Bariatric surgery involves an operation on the patient and it describes a field of surgery where there are multiple different procedures that we do, all with the goal to help the patient lose a significant amount of weight and to improve the medical problems that are associated with carrying a significant amount of weight.
Melanie: What are the different kinds of bariatric surgery out there now? Some of them are permanent and some of them are not, correct?
Dr. Hallowell: Yes. In a general sense, what we found is that even the procedures that are somewhat temporary, once that procedure is withdrawn, there is a tendency to regain weight. So there tends to need to be a procedure, in effect, to maintain this weight loss. The procedures that are commonly done in the United States include the gastric bypass, the sleeve gastrectomy, and the lap-band, as far as common surgical procedures.
Melanie: Who are candidates? Who really should be considering any of these types of bariatric surgery?
Dr. Hallowell: Excellent question. Patients who are severely overweight and in medical terms, we measure that by a tool called the body mass index. This is essentially a ratio of your height and weight, so that taller people can carry a lot more weight. Think of a person like Shaquille O’Neal, who is nearly 7 feet tall versus somebody who is 5’ 4”. Shaquille O’Neal can carry a lot more weight on his frame and not be unhealthy. The body mass index is something that you can easily calculate in your head. Most places have a calculator on a website and we use that in our own clinic. What we are looking to see is if your body mass index is greater than 40, you would be a candidate for surgery, or if your body mass index was greater than 35 and you have a significant medical problem like hypertension, diabetes, obstructive sleep apnea. The body mass index in those ranges translates to roughly 80 to 100 pounds over your ideal weight.
Melanie: Dr. Hallowell, explain a little bit about these types of surgeries. People think of a stomach getting smaller and limiting the amount of solid food, but does that also make it like malabsorptive? Does it make it so that you cannot retain that food? Explain a little bit about it.
Dr. Hallowell: Each of the main procedures that we do works in a slightly different way. I’ll take them kind of each in and of itself. In a gastric bypass, we will take the upper part of your stomach and staple that off and make it into what we call a small pouch. It is generally about the size of an egg or smaller and holds pretty much up to about an ounce to an ounce-and-a-half of food or fluid. We then take part of your small intestine and attach it to that pouch. The food you eat will go into the stomach and then into a part of the small intestine that is usually further down. Then we make another connection, even farther down the small bowel, where the rest of the body’s juices from the liver and pancreas, and the rest of the stomach come in to help you digest. In a traditional sense, we think of that operation as sometimes limiting the amount of food that you can eat because of the size of the pouch and also inducing a little bit of malabsorption because of where the digestive enzymes come into the system and shortening your intestines a little bit. Some of the newer research into bariatric surgery indicates that some of the effects that we are having may be more hormonal or biochemical than pure restriction of food or malabsorption, and that while it hasn’t been fully fleshed out, it’s one of the most interesting areas in the field. The next procedure that is commonly done in the United States and, in fact, the most common operation performed these days, is called the sleeve gastrectomy. Simply put, that is taking the stomach and turning it into a thin tube, about the size of your esophagus. If you think of your stomach as a big reservoir that can stretch out, especially around Thanksgiving time when you may overindulge in food and it becomes a big reservoir, the sleeve gastrectomy turns that into a much smaller reservoir, much smaller tube, and you cannot hold as much food. Then the last procedure that is commonly done in the United States, the lap band, we take basically a plastic belt with a balloon on the inside and put that around the upper part of the stomach, right by the entrance to the stomach, and by inflating the balloon, we cause that area to narrow down and allow patients to feel hungry earlier than they would when eating food, so it gives a lot more restriction.
Melanie: What questions would you advise patients to ask their doctors when they are considering these types of surgery?
Dr. Hallowell: They need to ask their doctor, if they are considering this surgery, which operation may be best for them. They should ask their doctor how much experience have they had in the various operations that they propose. It would be very prudent to ask what the risks of the surgery that they are thinking about entail, what the potential benefits for them are, and if the surgeon is a member of an organization that specializes in bariatric surgery, if the hospital and center they are going to is recognized as the center that performs this and a high volume with good outcomes.
Melanie: Tell us a little bit about the recovery. We don’t have much time left, but what can patients expect afterward?
Dr. Hallowell: Again, it depends on the procedure that they have, but in general, it is about a two-day hospital stay. Most of the procedures in the United States are performed in a minimally invasive surgery fashion or what we call laparoscopic surgery. There will be multiple small incisions on the patient’s abdomen. This allows it to have a lot less pain than a traditional open surgical incision. The patients will generally recover pretty quickly from the surgical side of the equation. However, they begin losing weight, especially with the gastric bypass or sleeve, sometimes up to a pound a day, so they may feel a lot of fatigue up until six weeks after surgery. Those should be some of the expectations going in that they may be out of work for a week or two after the surgery and then they may feel tired for up to a month to a month and a half.
Melanie: Dr. Hallowell, why should patients come to UVA for their bariatric surgery?
Dr. Hallowell: UVA has been doing bariatric surgery for the longest period of time in Central Virginia and we have the most experienced team taking care of our patients. We are a recognized center of excellence for bariatric surgery and we’ve held that designation since the beginning of the program to designate hospitals as centers of excellence. It is really our experience, our knowledge, and our skill at doing these operations that should drive patients to come and see us.
Melanie: Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.