The Meritus Weight Loss Center offers minimally invasive bariatric surgery procedures, like gastric bypass and adjustable gastric banding, and the most advanced laparoscopic surgical technique available—single-incision laparoscopic surgery (SILS).
This surgical program is offered through a comprehensive, patient-centered program.
In this segment, Cheryl Frushour, RD, discusses bariatric surgery to help those struggling with obesity get the long-term weight loss they need to lead a longer and healthier life.
Selected Podcast
Understanding the Bariatric Surgery Process
Featured Speaker:
Cheryl Frushour, RD
Cheryl Frushour, RD is a care specialist who works with bariatric surgery patients at the Meritus Weight Loss Center. She is a registered dietitian and has worked for the health system for the past 18 years. She graduated from West Virginia University with a B.S. degree in nutrition and dietetics. She completed her dietetic internship at the University of Maryland Medical Center. She has been working with bariatric surgery patients for the past 8 years and has a certificate in training in adult weight management. Transcription:
Understanding the Bariatric Surgery Process
Melanie Cole (Host): More than 12.5 million Americans are severely overweight according to the US Department Health and Human Services. For those struggling with obesity, bariatric surgery may be a way to get the long-term weight loss needed to lead a longer and healthier life. My guest today, is Cheryl Frushour. She’s a Registered Dietician and a Care Specialist who works with bariatric patients at the Meritus Weight Loss Center. Welcome to the show, Cheryl. Who should consider bariatric surgery, and are there certain parameters to consider bariatrics? Who can qualify?
Cheryl Frushour (Guest): People who suffer from severe obesity, they’ve been unsuccessful with conventional therapies for weight loss, like eating fewer calories, increasing exercise, following commercial weight loss programs, and those that are feeling trapped in that weight loss, weight gain cycle, can really benefit from bariatric surgery.
Melanie: There is that cycle, that weight loss cycle – tried every diet, every fad diet, so many different things. Explain a little bit about bariatric surgery as a tool, Cheryl, for these people to get that weight off once and for all.
Cheryl: Weight loss surgery is one of the most effective treatments available to help resolve obesity and maintain weight loss in the long-term. We use bariatric surgery for people who are struggling with diet and exercise alone to help provide them with the extra tool they need to help them been successful and to help maintain weight losses, which is what a lot of people struggle with is maintaining their weight loss after diet and exercise programs.
Melanie: What are some of the parameters, and what do they have to do in advance? Is there psychological counseling? Is there intense medical testing? What’s involved?
Cheryl: When you come in for bariatric surgery – we’re looking for people with BMIs of about 40 or more, which would be about 100 pounds overweight, or they have a BMI of over 35 with at least one – what we call obesity-related condition. That would be like type two diabetes, hypertension, sleep apnea, so you want to check your BMI to see if you qualify for surgery. Maybe an adult who is 240 pounds and about five foot five, they would have a BMI of about 40, so that’s about 100 pounds overweight. If you don’t know what your BMI is, you can always use the BMI calculator on the Meritus Health website, and you could also call your primary care doctor. They usually calculate a BMI when you come in for a visit, or you can always call the Meritus Weight Loss Center.
Melanie: How long does it take between the time that someone first comes in to see you until the time that they can actually get their surgery?
Cheryl: It really depends on their insurance requirements when they’re coming to us. We say it could be six to nine months before you even get a surgery date when you start coming in for weight loss surgery. Every insurance has their own different requirements, so it really depends on your preoperative requirements. Some of those requirements are three, maybe six months of nutritional counseling. Some insurances require a psychological evaluation. Some require a letter of medical necessity from your primary doctor or a medical clearance from your primary care doctor. Sometimes they look for clearances from a specialist like a cardiac evaluation, a pulmonology evaluation, sometimes a nutrition evaluation. They will also look at your weight history to see how long you’ve struggled with obesity. Sometimes they’re looking for a three or five-year weight history.
When you come into our office for your first visit, the insurance coordinator will help you look at those and understand your requirements for you specific insurance because they really do change depending on what kind of insurance you have. Also, the thing that keeps you – the length of time before you have surgery, is looking at your nutrition counseling and whether it’s three months, six months before surgery. Some of the insurances require even twelve months of counseling.
Melanie: Cheryl, before we talk about the types of surgery involved when somebody -- you mentioned psychological counseling, nutrition counseling, their life changes a lot after this surgery. What do you tell them in advance about preparing for that change, and how do you know that they are ready for it?
Cheryl: You try to get a feel for people’s readiness to change when they come in for all of their visits, whether they’re meeting with the surgeon, or they’re meeting with the dietician, or insurance coordinator, and see if they’re ready for a change. If someone can come on – we always have them do a few months of nutrition counseling. Everyone has to see the psychiatrist and making sure that they feel ready for the change because it is a big change. Lots of people have been on a diet after diet after diet, so they’re aware of good nutrition and what they should be doing to lose weight.
What we’re looking for their readiness to change, their ability to change, making sure if they have any type of psychological problems that are not noticed like depression that’s not well-managed or anxiety that’s not well-managed that might lead to overeating. We screen everyone for all of those. We get to know our patients really well here in the office and try to help filter through those who are ready and help get people who aren’t quite ready, to get them to the next step.
Melanie: Explain for the listeners, the types of bariatric surgery that you guys take care of at Meritus Health.
Cheryl: The number one surgery that we perform is the gastric sleeve surgery or the sleeve gastrectomy surgery. We also do the laparoscopic Roux-en-Y bypass surgery. Those are the two main surgeries that we do here. The sleeve gastrectomy is a restrictive surgery, and the bypass surgery is a restrictive and a malabsorption surgery. When you come in for your visits with the surgeon, they’ll explain the surgeries for you and what surgery might be best for you.
Melanie: Explain that – you mentioned the word malabsorption – for the listeners, explain the difference between the sleeve and the bypass, which leaves this little pouch that is definitely a difference from the way they had been living previously.
Cheryl: The sleeve surgery makes a smaller stomach. They remove a part of your stomach and leave a small, sleeve-looking area, so that makes it a restrictive surgery. The bypass surgery makes a very small stomach pouch but also bypasses the first part of your small intestine, so your map absorbing some nutrients in there as well. Both surgeries are very effective at weight loss, and some patients already know what type of surgery they want when they’re coming in. They’ve talked to friends. They’ve done research, and they know what surgery they want. And other times, the surgeon in the office can help them guide them what surgery might be best for them.
Melanie: And what about support groups both before and after? Who can attend those? Is it just for the patients themselves, or are their families invited to these as well?
Cheryl: Everyone is invited to support group whether you’re just thinking about surgery or you had surgery ten years ago. Everyone is invited, and you also can bring your support people with you, your family with you, so they’re open to anyone. We have lots of different topics of discuss at a support group. We have guest speakers that come and talk about stress management, getting better sleep, maybe doing some cooking demonstrations. We also have success story nights where a former patient will come in and talk a little bit about their story after bariatric surgery and let you ask them questions.
We always meet the third Tuesday of every month, and it’s from 6 to 7pm at the Robinwood Medical Center in Room 122. That’s a standard time every month, and everyone is welcome to join us.
Melanie: What about life after surgery, and what do you tell them about supplements, Vitamins, and minerals – specifically if they had the malabsorption bypass surgery – and what their eating life is like? When you go to these support groups, or when you’re working individually with patients, Cheryl, what do you tell them to expect if they go to a restaurant about ordering, and the amounts and – speak about life after surgery.
Cheryl: Especially the first year after surgery, you’re going to use a lot of supplements like liquid protein supplements to help enhance your nutrition intake because your meal size is very very small when you first have surgery. You really rely on the liquid protein supplements through that first year to help get you that nutrition that you need.
You’ll also take vitamin and mineral supplements for both the sleeve surgery and the bypass surgery because you’re not getting enough nutrition through the food, and with the bypass, you still have a little bit of malabsorption of nutrients. Usually, there are multivitamins that you’re taking, calcium supplements that you’re taking, iron supplements, and B12 supplements. People really enjoy getting off some of their medications after surgery, but there are vitamins and minerals that you need to continue to take with regular bloodwork to make sure that your levels are normal.
After surgery, going to restaurants can be challenging. In the beginning, when your meal sizes are smaller, lots of people will share meals or grab a little food off of their husband’s plate or kid’s plate and just make meals out of that, or maybe order an appetizer for their meal. Sometimes they have to ask for their meal to be made in a certain – prepped in a certain way, not having a lot of butter or oils or those kinds of things. It’s definitely doable. A lot of restaurants in our area are very open to our patients and help them find foods that they’re able to tolerate in smaller amounts. Sometimes they allow them to order off the senior menu, or the kid's menu, or the appetizer menu for their meal, so they don’t have large portions sitting in front of them.
Melanie: What about lifestyle changes such as exercise or drinking liquids with meals? When can they begin exercise again, and what do you tell them about lifestyle modifications to go along with this tool so that they really get true success.
Cheryl: We really encourage exercise after surgery, and it starts almost right away after you have surgery. We have you up, walking about the hallways after surgery. Most of our patients are walkers after surgery, some do biking, some get into more extreme sports like triathlons, and running marathons, and those types of things, but the majority of patients are walkers. We recommend that you walk 30 to 60 minutes doing moderate walking most days of the week. Once you’re up and able to after surgery. Probably about 4 to 6 weeks after surgery, you can start getting into a regular exercise program, and just light walking right after surgery. We also, as the time goes on after surgery, try to get people to do things like strength training programs and to help preserve some of their lean muscle mass after surgery.
Other lifestyle changes that might happen after a sleeve or bypass surgery is can no longer drink with your meals because the stomach size is so small and because liquids and push foods through the pouches too quickly, you can’t drink with your meals after your surgery. All your fluids come in between your meals only, and you can’t drink things that are carbonated.
Melanie: This is such great information for people to hear. Wrap it up with your best advice, Cheryl, for people that are considering bariatric surgery, and what you would really like them to know about the Weight Loss Center at Meritus Health.
Cheryl: Bariatric surgery can help prevent or improve or resolve so many obesity-related conditions like type two diabetes, reflux disease, high blood pressure, high cholesterol, and sleep apnea. If you’re struggling with one of those conditions, or you’re struggling with your weight, you really want to consider a surgical option to help you with your weight loss. I really encourage people to discuss this with their primary care physician, see if they’re a candidate for surgery. Sometimes they don’t know that there’s a surgical option to help them with weight loss, and the primary care doctor can help them decide what surgery may be right for them, and get them to us.
The best thing about our program is that we are an accredited MBSAQIP Accredited center, which means that we – there’s national standards for bariatric surgery centers, with the goal of advancing safe, and high-quality care for bariatric surgery patients. Meritus Medical Center is very proud to be an MBSAQIP Accredited Comprehensive Center. When you’re looking for a bariatric surgery program, you want to make sure it’s an accredited center. That way you’re getting the best, safe, quality surgery available.
Melanie: Thank you, so much, Cheryl, for being with us today. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much, for listening.
Understanding the Bariatric Surgery Process
Melanie Cole (Host): More than 12.5 million Americans are severely overweight according to the US Department Health and Human Services. For those struggling with obesity, bariatric surgery may be a way to get the long-term weight loss needed to lead a longer and healthier life. My guest today, is Cheryl Frushour. She’s a Registered Dietician and a Care Specialist who works with bariatric patients at the Meritus Weight Loss Center. Welcome to the show, Cheryl. Who should consider bariatric surgery, and are there certain parameters to consider bariatrics? Who can qualify?
Cheryl Frushour (Guest): People who suffer from severe obesity, they’ve been unsuccessful with conventional therapies for weight loss, like eating fewer calories, increasing exercise, following commercial weight loss programs, and those that are feeling trapped in that weight loss, weight gain cycle, can really benefit from bariatric surgery.
Melanie: There is that cycle, that weight loss cycle – tried every diet, every fad diet, so many different things. Explain a little bit about bariatric surgery as a tool, Cheryl, for these people to get that weight off once and for all.
Cheryl: Weight loss surgery is one of the most effective treatments available to help resolve obesity and maintain weight loss in the long-term. We use bariatric surgery for people who are struggling with diet and exercise alone to help provide them with the extra tool they need to help them been successful and to help maintain weight losses, which is what a lot of people struggle with is maintaining their weight loss after diet and exercise programs.
Melanie: What are some of the parameters, and what do they have to do in advance? Is there psychological counseling? Is there intense medical testing? What’s involved?
Cheryl: When you come in for bariatric surgery – we’re looking for people with BMIs of about 40 or more, which would be about 100 pounds overweight, or they have a BMI of over 35 with at least one – what we call obesity-related condition. That would be like type two diabetes, hypertension, sleep apnea, so you want to check your BMI to see if you qualify for surgery. Maybe an adult who is 240 pounds and about five foot five, they would have a BMI of about 40, so that’s about 100 pounds overweight. If you don’t know what your BMI is, you can always use the BMI calculator on the Meritus Health website, and you could also call your primary care doctor. They usually calculate a BMI when you come in for a visit, or you can always call the Meritus Weight Loss Center.
Melanie: How long does it take between the time that someone first comes in to see you until the time that they can actually get their surgery?
Cheryl: It really depends on their insurance requirements when they’re coming to us. We say it could be six to nine months before you even get a surgery date when you start coming in for weight loss surgery. Every insurance has their own different requirements, so it really depends on your preoperative requirements. Some of those requirements are three, maybe six months of nutritional counseling. Some insurances require a psychological evaluation. Some require a letter of medical necessity from your primary doctor or a medical clearance from your primary care doctor. Sometimes they look for clearances from a specialist like a cardiac evaluation, a pulmonology evaluation, sometimes a nutrition evaluation. They will also look at your weight history to see how long you’ve struggled with obesity. Sometimes they’re looking for a three or five-year weight history.
When you come into our office for your first visit, the insurance coordinator will help you look at those and understand your requirements for you specific insurance because they really do change depending on what kind of insurance you have. Also, the thing that keeps you – the length of time before you have surgery, is looking at your nutrition counseling and whether it’s three months, six months before surgery. Some of the insurances require even twelve months of counseling.
Melanie: Cheryl, before we talk about the types of surgery involved when somebody -- you mentioned psychological counseling, nutrition counseling, their life changes a lot after this surgery. What do you tell them in advance about preparing for that change, and how do you know that they are ready for it?
Cheryl: You try to get a feel for people’s readiness to change when they come in for all of their visits, whether they’re meeting with the surgeon, or they’re meeting with the dietician, or insurance coordinator, and see if they’re ready for a change. If someone can come on – we always have them do a few months of nutrition counseling. Everyone has to see the psychiatrist and making sure that they feel ready for the change because it is a big change. Lots of people have been on a diet after diet after diet, so they’re aware of good nutrition and what they should be doing to lose weight.
What we’re looking for their readiness to change, their ability to change, making sure if they have any type of psychological problems that are not noticed like depression that’s not well-managed or anxiety that’s not well-managed that might lead to overeating. We screen everyone for all of those. We get to know our patients really well here in the office and try to help filter through those who are ready and help get people who aren’t quite ready, to get them to the next step.
Melanie: Explain for the listeners, the types of bariatric surgery that you guys take care of at Meritus Health.
Cheryl: The number one surgery that we perform is the gastric sleeve surgery or the sleeve gastrectomy surgery. We also do the laparoscopic Roux-en-Y bypass surgery. Those are the two main surgeries that we do here. The sleeve gastrectomy is a restrictive surgery, and the bypass surgery is a restrictive and a malabsorption surgery. When you come in for your visits with the surgeon, they’ll explain the surgeries for you and what surgery might be best for you.
Melanie: Explain that – you mentioned the word malabsorption – for the listeners, explain the difference between the sleeve and the bypass, which leaves this little pouch that is definitely a difference from the way they had been living previously.
Cheryl: The sleeve surgery makes a smaller stomach. They remove a part of your stomach and leave a small, sleeve-looking area, so that makes it a restrictive surgery. The bypass surgery makes a very small stomach pouch but also bypasses the first part of your small intestine, so your map absorbing some nutrients in there as well. Both surgeries are very effective at weight loss, and some patients already know what type of surgery they want when they’re coming in. They’ve talked to friends. They’ve done research, and they know what surgery they want. And other times, the surgeon in the office can help them guide them what surgery might be best for them.
Melanie: And what about support groups both before and after? Who can attend those? Is it just for the patients themselves, or are their families invited to these as well?
Cheryl: Everyone is invited to support group whether you’re just thinking about surgery or you had surgery ten years ago. Everyone is invited, and you also can bring your support people with you, your family with you, so they’re open to anyone. We have lots of different topics of discuss at a support group. We have guest speakers that come and talk about stress management, getting better sleep, maybe doing some cooking demonstrations. We also have success story nights where a former patient will come in and talk a little bit about their story after bariatric surgery and let you ask them questions.
We always meet the third Tuesday of every month, and it’s from 6 to 7pm at the Robinwood Medical Center in Room 122. That’s a standard time every month, and everyone is welcome to join us.
Melanie: What about life after surgery, and what do you tell them about supplements, Vitamins, and minerals – specifically if they had the malabsorption bypass surgery – and what their eating life is like? When you go to these support groups, or when you’re working individually with patients, Cheryl, what do you tell them to expect if they go to a restaurant about ordering, and the amounts and – speak about life after surgery.
Cheryl: Especially the first year after surgery, you’re going to use a lot of supplements like liquid protein supplements to help enhance your nutrition intake because your meal size is very very small when you first have surgery. You really rely on the liquid protein supplements through that first year to help get you that nutrition that you need.
You’ll also take vitamin and mineral supplements for both the sleeve surgery and the bypass surgery because you’re not getting enough nutrition through the food, and with the bypass, you still have a little bit of malabsorption of nutrients. Usually, there are multivitamins that you’re taking, calcium supplements that you’re taking, iron supplements, and B12 supplements. People really enjoy getting off some of their medications after surgery, but there are vitamins and minerals that you need to continue to take with regular bloodwork to make sure that your levels are normal.
After surgery, going to restaurants can be challenging. In the beginning, when your meal sizes are smaller, lots of people will share meals or grab a little food off of their husband’s plate or kid’s plate and just make meals out of that, or maybe order an appetizer for their meal. Sometimes they have to ask for their meal to be made in a certain – prepped in a certain way, not having a lot of butter or oils or those kinds of things. It’s definitely doable. A lot of restaurants in our area are very open to our patients and help them find foods that they’re able to tolerate in smaller amounts. Sometimes they allow them to order off the senior menu, or the kid's menu, or the appetizer menu for their meal, so they don’t have large portions sitting in front of them.
Melanie: What about lifestyle changes such as exercise or drinking liquids with meals? When can they begin exercise again, and what do you tell them about lifestyle modifications to go along with this tool so that they really get true success.
Cheryl: We really encourage exercise after surgery, and it starts almost right away after you have surgery. We have you up, walking about the hallways after surgery. Most of our patients are walkers after surgery, some do biking, some get into more extreme sports like triathlons, and running marathons, and those types of things, but the majority of patients are walkers. We recommend that you walk 30 to 60 minutes doing moderate walking most days of the week. Once you’re up and able to after surgery. Probably about 4 to 6 weeks after surgery, you can start getting into a regular exercise program, and just light walking right after surgery. We also, as the time goes on after surgery, try to get people to do things like strength training programs and to help preserve some of their lean muscle mass after surgery.
Other lifestyle changes that might happen after a sleeve or bypass surgery is can no longer drink with your meals because the stomach size is so small and because liquids and push foods through the pouches too quickly, you can’t drink with your meals after your surgery. All your fluids come in between your meals only, and you can’t drink things that are carbonated.
Melanie: This is such great information for people to hear. Wrap it up with your best advice, Cheryl, for people that are considering bariatric surgery, and what you would really like them to know about the Weight Loss Center at Meritus Health.
Cheryl: Bariatric surgery can help prevent or improve or resolve so many obesity-related conditions like type two diabetes, reflux disease, high blood pressure, high cholesterol, and sleep apnea. If you’re struggling with one of those conditions, or you’re struggling with your weight, you really want to consider a surgical option to help you with your weight loss. I really encourage people to discuss this with their primary care physician, see if they’re a candidate for surgery. Sometimes they don’t know that there’s a surgical option to help them with weight loss, and the primary care doctor can help them decide what surgery may be right for them, and get them to us.
The best thing about our program is that we are an accredited MBSAQIP Accredited center, which means that we – there’s national standards for bariatric surgery centers, with the goal of advancing safe, and high-quality care for bariatric surgery patients. Meritus Medical Center is very proud to be an MBSAQIP Accredited Comprehensive Center. When you’re looking for a bariatric surgery program, you want to make sure it’s an accredited center. That way you’re getting the best, safe, quality surgery available.
Melanie: Thank you, so much, Cheryl, for being with us today. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much, for listening.