Bariatric Surgery Seminars

Dr. Sidney Hu: I want to congratulate you for taking the first step towards a new and healthier future. You have a long road ahead, but it is a journey well worth taking. This informational seminar is not simply a mandatory step in the weight-loss surgery process. It is a valuable, informational tool for you to reference throughout your journey. This seminar covers the following topics, facts about obesity, weight-loss surgery procedures and risks, life after surgery and planning the next steps toward surgery. So please, continue on, feel free to take notes, and share any questions you may have with our team. We look forward to working with you throughout this incredible journey.

Facts about obesity

Dr. Jennifer McAllaster: Obesity is a severe, extremely difficult to treat disease that affects and more people every single year. Nearly 78 million adults and 13 million children in the United States deal with the health and emotional effects of obesity every day. Obesity is defined as an excess of body weight when compared to height. The formula is called the body mass index, or BMI. A BMI value of 25 to 30 is considered overweight, a BMI of 30 to 40 is defined as obesity, and a BMI over 40 is morbid obesity. There are many biological and sociological factors contributing to today's obesity epidemic. But the main culprit is the Western diet.

Our Western diet is full of processed foods containing high amounts of fat, sugar and salt. In the United States, we are surrounded and even bombarded by the elements of the Western diet. Big meals, refined grains, red meat, unhealthy fats and sugary drinks are all readily available and often times more affordable than healthy diet choices. When we eat these unhealthy foods, we're filling our bodies with empty calories. Consuming too many calories on a regular basis will result in obesity, especially when a high-calorie diet is paired with a sedentary, or nonactive, lifestyle.

I want to be clear about one thing. Obesity is not a personality defect, it is not a lack of willpower and it is not a choice. Living with obesity can feel frustrating and hopeless, but there is hope. There is no cure for obesity and no easy fix. Bariatric surgery is not a cure. Bariatric surgery is a tool for you to use to help you achieve your weight-loss goals. The decision to undergo bariatric surgery is not an easy decision to make and it may not be the right choice for everyone. Educating yourself on the various types of bariatric surgery and the lifestyle afterwards can help you decide if bariatric surgery is the right solution for you.

If you fall within the following nationally recognized criteria, it's probably time to consider weight-loss surgery to improve your health. If you are 100 pounds over your ideal body weight, or have a BMI of more than 40. If you are suffering from comorbidities or complications of obesity, such as diabetes, and have a BMI of more than 35. And if you have a history of failed medical treatment for obesity.

To qualify for our program, you must undergo a psychological evaluation and receive clearance to proceed with surgery. You must be a nonsmoker. Smoking not only causes terrible damage to your body, but it can also put you at terrible risk during and after surgery. Smokers who undergo surgery are more likely than nonsmokers to experience anesthesia related complications, infections, heart attack, stroke, pneumonia or even death. If you are smoking now, whether you take part in our program or not, please consider quitting.

Weight-loss surgery procedures and risks

Dr. Bernita Bernsten: Weight-loss surgery offers the possibility of some remarkable changes to your overall health. In most patients, 50 to 80% of excess body weight is lost. With the gastric bypass, 77% of patients are no longer diabetic and 80 to 95% of weight related conditions are either improved or resolved. This includes conditions like hyperlipidemia, hypertension and obstructive sleep apnea. There are 4 bariatric surgeries that are offered through our program. Laparoscopic adjustable gastric banding, also known as a LAP-BAND*, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass and biliary pancreatic diversion with duodenal switch, also known as BPD with DS.

Understanding the difference with each procedure will help you determine which one will be right for you. The laparoscopic adjustable gastric banding, or LAP-BAND*, is a procedure in which a soft and adjustable silicone band is placed around the upper part of the stomach creating 2 chambers. A small upper stomach chamber with a restricted opening created by the band that restricts food passing to the lower stomach chamber. The upper stomach can only hold approximately 4 ounces of food and thus limits food intake. The smaller chamber of the stomach slowly allows food to pass into the larger chamber of the stomach. The process of food digestion in the stomach will be greatly slowed and will cause patients to feel full faster and for a longer period of time.

The band around the stomach can be adjusted by adding or removing saline solution from the band via a port placed within the patient's body. The LAP-BAND* is a minimally invasive surgery which is performed through multiple small incisions. Most LAP-BAND* procedures result in shorter hospital stays, quicker recoveries and less pain than open surgical procedures. The saline level within the band will be adjusted as needed at our clinic during routine visits. This procedure is reversible but is intended for long term use. Most patients who have had the band removed have regained weight. The LAP-BAND* is a low risk procedure that is adjustable and removable. It requires no rearranging of intestinal anatomy and is nutritionally safer as well as having the lowest initial mortality risk of the weight loss surgeries we perform.

But there are risks related to this procedure. Stomach prolapse due to band slippage, balloon leakage or injection site infection and infection of the banded area are all possible risks. The LAP-BAND* also has a higher potential for revision or removal in the future as it is a mechanical device that is prone to failure and infection. Long term results show that 20% or more of LAP-BANDs* may erode and may require eventual removal. Also remember that the LAP-BAND* requires regular follow up for long term success and has the added expense of the multiple fills and adjustments. Because of these reasons, the LAP-BAND* is less commonly performed today than the years following its initial release. 

The laparoscopic sleeve gastrectomy, or gastric sleeve, is a procedure where the majority of the stomach is removed. This leaves a long, narrow sleeve of stomach, roughly the size of a banana. This results in limited food intake and helps patients feel full faster. In this laparoscopic procedure, the surgeon creates multiple incisions to access the patient's stomach. The surgeon creates a smaller stomach sleeve by using a stapling device to remove the outer portion of the stomach. The procedure increases weight loss due to the restricted amount of food that can be eaten by the patient. With the restricted amount of food, fewer calories are absorbed into the body.

The gastric sleeve may be a safer procedure for patients with a higher BMI as it is technically easier to perform and requires no prosthetic or adjustments after the surgery. This procedure is recommended for patients with medical issues preventing them from having open surgery and the amount of weight loss is generally greater than patients who choose the LAP-BAND*. The gastric sleeve is nonreversible and has a potential risk of creating or worsening acid reflux in patients. Patients with persistent reflux that is systematic in spite of medication should probably not consider a sleeve gastrectomy.

The most extensive procedure is biliary pancreatic diversion with duodenal switch, or BPD with DS. The BPD with DS is both a bariatric and metabolic procedure that helps patients lose weight by creating both physical and chemical changes to the digestive tract. The procedure results in limited food intake and the chemical changes affect the way the body controls blood sugar levels, feelings of hunger and how the body processes calories from food.

The BPD with DS procedure physically changes the upper portion of the digestive tract. The surgeon creates a small banana shaped stomach which is shaped like a tube. This makes the stomach size smaller and is the identical procedure as the gastric sleeve. The surgeon then divides the small intestine into 2 parts. The lower part is then attached to the newly created smaller stomach. The change in bypassing the digestive tract forces food to go past most of the small intestine and does not allow the food to mix with digestive enzymes until is it very far down in the digestive tract. The BPD with DS reduces the amount of food the patient can eat as well as limits the absorption in most of the food eaten.

Patients who choose the BPD with DS procedure report the highest weight-loss results and experience the same direct and positive effects on diabetes and metabolic syndrome as with the Roux-en-Y gastric bypass. There is a much higher risk of metabolic complications because of the length of the intestine bypassed and the resulting malabsorption. BPD with DS patients are required to take expensive special extra vitamin supplementation and B12 for the rest of their lives. These are not ordinary off the shelf vitamins. Patients have complained about loose stools and excessive gas with the BPD with DS procedure, but this problem is usually controllable with appropriate diet.

This procedure is the most difficult to perform and comes with the highest risk for surgery and may result in a significant vitamin-protein malnourishment long term. Patients who have undergone BPD with DS may complain about dumping syndrome if they eat foods that are too high in sugars or carbohydrates, or if they consume too much food. Dumping syndrome is a feeling of a rapid heart rate, sweating and discomfort in both the stomach and intestine and is often accompanied by diarrhea.

Historically, the most recently performed procedure for morbid obesity in the United States is the Roux-en-Y gastric bypass, or gastric bypass. This method restricts the patient's food intake and also reduces the amount of calories and nutrients the body absorbs. The gastric bypass can be performed through open surgery or by laparoscopic surgery. In almost all cases, the laparoscopic approach is performed because it is minimally invasive and results in faster recovery and less pain for the patient.

In this procedure, the surgeon creates a small stomach pouch that will greatly reduce the amount of food it can hold. The small stomach pouch is surgically attached to the middle of the small intestine and bypasses the rest of the stomach and upper portion of the small intestine. The bypass of the remaining stomach and the first part of the small intestine limits the amount of calories absorbed into the body. The gastric bypass will produce rapid and generally better weight loss in patients than the gastric sleeve.

After the initial healing phase is over, there is very low risk of complications. This is a permanent nonreversible procedure that will create a vitamin, possible mineral deficiency in patients who do not take their vitamins. The patient will be required to undergo lab testing annually for the remainder of their life and will need to take vitamin B12 daily.

The patient will no longer be allowed to take NSAIDs like ibuprofen, also known as Motrin, Meloxicam, Naproxen, also known as Aleve, and aspirin, as these drugs may cause ulcers and perforations in the small stomach pouch. Nicotine from chewing or smoking may also cause ulcers and perforations, so smoking is definitely not an option.

Life after surgery

Dr. Carlyle Dunshee: I wanted to tell you about what to expect after your surgery. First, I wanted to make sure you understand the risks involved with weight-loss surgery. All 4 bariatric procedures offer life-changing results, but all come with risks that you should take very seriously. Short-term risks include leaks, blood clots, bleeding, infection and standard surgical risks like problems with heart, lungs, kidneys, et cetera. While the short-term risks will be reduced as you heal, there are other risks that you will have to be aware of for the rest of your life. Risks like ulcers, gallstones, protein malnutrition, vitamin deficiencies, osteoporosis, obstructions and adhesions. Our team will monitor you and ensure that you are not only progressing in weight loss, but also ensure that you are healthy as you progress.

Immediately after surgery, you will be hospitalized for 23 hours to 3 days, depending on which surgery is performed. While the laparoscopic procedures we provide are minimally invasive, they still involve disrupting your anatomy. We want to monitor you and ensure that you are setting off on the road to recovery nicely. After surgery, you will also be placed on a strict postoperative diet regimen, which will be outlined in detail in your surgical binder. This is a diet which advances you slowly from liquids to soft ground foods up to solid foods over a period of 6 weeks. This slow advancement allows your new tools to adjust to increasing amounts and different textures of foods while also allowing time to heal from surgery.

You may be eager to get back to work after surgery, but a conversation with your surgeon and your workplace should take place to ensure you are ready to return to work. As you know, there are different types of bariatric surgery and the recovery time for each varies. There is no standard recovery time and each person heals at their own rate. Generally it can take anywhere from 1 week to 3 weeks for the average patient to return to work after bariatric surgery.

Weight loss is your turning point. Your life will never be the same as it was before the procedure. While the weight loss is a welcome result, you may find talking to someone along the way will help your journey be a smooth one. We have a support group that meets monthly and offers a great way to meet people who can relate to what you are going through and help you navigate your way. All patients who have had weight-loss surgery, or have been scheduled to have the surgery, are welcome to attend the support group meetings.

Pregnancy is completely safe for patients who have had weight-loss surgery, but we strongly recommend not becoming pregnant for 1 year after surgery. After surgery your body goes through rapid weight loss and significant nutritional changes. This could be problematic for a growing baby. Waiting until a year after surgery is recommended to protect both mother and child from malnutrition. Once the year has gone by, the mother should be at a stable enough point in her weight loss journey to take on a pregnancy. Patients with the LAP-BAND* have the option to have the band deflated during pregnancy, but that is not necessary. The gastric bypass procedure has shown good results in fertility after the first year of weight loss has stabilized.

One of the biggest changes to your lifestyle after surgery will be your diet. Initially after surgery, you will eat very tiny meals frequently, and most of those meals will be liquids. After a few weeks, you will be able to eat most normal foods, but in small amounts. Your goal will be 3 small healthy meals each day. You will be required to supplement your diet with a multivitamin and calcium each day. Vitamin B12 and iron will be required for patients who've had the sleeve gastrectomy, gastric bypass or duodenal switch. And for patients that have had the duodenal switch procedure, an additional multivitamin A, D, E and K will be required.

Next steps

Dr. James Hamilton: Making the decision to undergo weight-loss surgery is the first step towards your new, healthier life. I'm going to give you the information you need to safely prepare for surgery and your new life. First and foremost, if you are a smoker or use tobacco, you must stop smoking and chewing now. Smoking and chewing will increase your chance of blood clots, pneumonia, heart attack, leaks and sudden death after surgery. Tobacco use also causes an increased risk of ulcer formation after surgery, which can lead to death. If you are a recent tobacco user, you will be tested for nicotine prior to your consultation with your surgeon. The nicotine test is very sensitive and may detect nicotine from any nicotine use, as well as second hand smoke in the months prior to the test. If your nicotine test is positive on 2 separate occasions, you will be dismissed from the weight-loss surgery program. We care about you and your health and we will not allow you to undergo weight-loss surgery if you cannot stop smoking.

A sleep study may be required as many bariatric patients suffer from sleep apnea. Not everyone has been diagnosed and treated. You will be asked to complete a short questionnaire. Depending on your responses, you may be sent for a sleep study to determine if you have sleep apnea. Failure to diagnose and treat this condition can lead to postoperative problems including death. Sleep apnea will need to be under treatment before you have the surgery.

Many insurance companies require you to meet with a dietitian before your surgery. The dietitian will talk with you about your current eating habits. The dietician may also recommend a diet to follow before you are approved for surgery. Many insurance companies also require a supervised diet for a designated length of time before approving bariatric surgery. Often, the dietitian may provide this supervision. Sometimes, the insurance company requires your diet to be supervised by a physician. You will need to meet the requirements of your specific insurance provider or they will not approve the surgery.

Every patient meets with a mental healthcare provider before surgery. Weight-loss surgery has lifelong implications, demands behavioral change and will be a source of life stress at some point. A psychological evaluation will give you and your care team the tools to help you be successful in your weight loss. A list of mental health professionals may be obtained at the surgeon's office.

Exercise is a key component of weight loss. Try a few different types of exercise before your surgery. Walking is great exercise that is easily modified as your strength and endurance improve. Swimming or water exercise is great for those who have arthritis and cannot tolerate high impact forms of exercise.

As you lose more weight, you will need to add weight or resistance training to your routine to help recondition your muscles. A local YMCA or YWCA is a great resource. Our website contains a link leading you to informational resources. You can never do too much research and we have provided you with the resources that we feel are the most helpful and educational for you. The more informed you are about weight-loss surgery, the better you will be able to decide which procedure is right for you. Take your time and go through them all.

There is a honeymoon period after surgery that lasts around 18 months. During this time, you will experience rapid weight loss. This is a great time to learn your limits and reestablish your relationship with food. This is your time to get as much weight off as you can and achieve your lowest weight. When the honeymoon period ends you will be a smaller, healthier you, but that isn't going to eliminate past struggles. If you are an emotional eater, you will need to monitor your weight during difficult times. Your appetite will return and patients can and do regain weight if they do not follow the dietary practices they learned during the honeymoon.

It is important to choose high protein foods that fill you up and to avoid carbohydrates and excess fats so you may continue to do well. You're going to experience plateaus during your weight loss, and that is completely normal. Use a plateau as a challenge to ramp up your workout schedule or to look closely at your eating habits.

After you have finished this video, you will be asked to acknowledge that you have completed the entire video. Once you have successfully completed the quiz, you will be directed to a page to fill out and submit forms that will be submitted to our office. All information is transmitted through a secure website, and once we receive it we will contact you to schedule your first appointment.

Most insurance companies provide benefits for weight loss surgery. You will need to call your insurance company to discuss what coverage your plan offers.