Surgical Weight Loss Options to Maintain a Healthy Weight

By Ragui Sadek, M.D., FACS, SOEMBS, Director of Bariatric Surgery at the Bristol Myers-Squibb Children’s Hospital and Robert Wood Johnson University Hospital

Year after year, weight loss continues to be one of the most popular New Year’s resolutions, and year after year, most people let those resolutions slip to the wayside. This year, make your health a priority by committing to achieve a healthier weight and in turn, maximize your overall health. Obesity is a disease that affects one-third of the population in the United States. Take charge of your health by speaking with a medical specialist who can help you find the right weight loss plan or treatment.

For some patients, diet and exercise alone aren’t enough. In cases where patients have exhausted all other options, bariatric surgery may be the answer. If you feel like nothing else is working, it may be time to increase your awareness on qualifications for bariatric surgery, different types of weight loss surgery, and even surgical options for adolescents.

· Candidacy for bariatric surgery: In order to qualify for weight loss surgery, there are several criteria that you must meet. Some of the criteria involve your Body Mass Index or BMI, which is a measure of your body fat based on your height and weight. You are considered morbidly obese if you weigh 100 lbs. more than your ideal body weight, you have a BMI over 40, or if you have a BMI over 35 and a concurrent severe health condition like diabetes or high blood pressure.

Before considering bariatric surgery as an option, you should be dedicated to changing the way you live, have tried other medically managed weight-loss programs without success, be aware of the potentially serious complications involved with bariatric surgery, and have someone in your family to be a support person for you. You should also be free of psychological conditions and avoid the use of drugs and alcohol. If you meet all of most of these criteria, you could be a candidate for weight loss surgery.

· Types of Bariatric Surgery: There are three common weight loss procedures: gastric banding, gastric bypass, and sleeve gastrectomy. Each of these weight loss surgeries can be categorized in one of two ways: restrictive or malabsorptive. A restrictive procedure is when food is restricted but digestion and absorption remain normal. A malabsorptive procedure is when the size of the stomach is reduced and digestion is altered.

o Gastric Banding: Gastric banding is a restrictive, minimally-invasive procedure where a surgeon places a band around the stomach near the upper end to create a pouch. This limits the amount of food you can eat and slows the process of food getting to the rest of the stomach. An injection port is also implanted in the abdomen, which allows for the band to be adjusted after the operation. These adjustments can make you feel fuller and can be done right in your doctor’s office. Gastric banding patients typically lose about 40 percent of their excess body weight and recover quickly.

o Gastric Bypass: Gastric bypass is a combined restrictive and malabsorptive procedure that reduces the size of your stomach. A surgeon will create a small stomach pouch using surgical staples to restrict the amount of food that you can eat at one time. The small intestine is then attached to the new stomach pouch, which allows food to bypass the large part of the stomach and eliminates food absorption in the larger part of the stomach. Gastric bypass patients typically lose 70 percent of their excess body weight and face a moderate recovery time.

o Sleeve Gastrectomy: Sleeve gastrectomy is a restrictive procedure where a surgeon reduces the size of the stomach by creating a sleeve-shaped stomach and removing the excised portion. This procedure is typically performed on patients with a BMI of 35 or higher and is usually performed as the first part of a two-part treatment, with the second part being gastric bypass. Patients typically lose 60 percent of their excess weight.

· Adolescents and bariatric surgery: Obesity is an epidemic that affects more than 12.5 million children and adolescents in the United States. Bariatric surgery can be a key tool to help adolescents ages 15 to 21 who are suffering from obesity and have made several failed attempts at weight management. In order for adolescents to qualify for bariatric surgery, they must have a BMI of 50 or more, or have a BMI of 40 with physical and emotional obesity-associated problems, such as high blood pressure, diabetes, sleep apnea, high cholesterol, depression, asthma and more. They must also have reached skeletal maturity, have documentation of at least one physician-supervised diet plan in the last five years, have no history of drug or alcohol abuse within the past year, and must be committed to participating in post-operative exercise and support programs.

The Bristol-Myers Squibb Children’s Hospital (BMSCH) at Robert Wood Johnson University Hospital has been designated as the first Adolescent Center of Excellence for Bariatric and Metabolic Surgery in the world by the international Surgical Review Corporation. The designation recognizes that BMSCH and its surgeons are providing exceptional care and are dedicated to continuously improving patient safety and success. The doctors at BMSCH at RWJUH help adolescent patients every step of the way from pre-operative preparation and nutrition education to lifetime follow-up. For more information on BMSCH’s Adolescent Bariatric Surgery Program, please visit http://www.bmsch.org/clinical-services/adolescent-bariatric-surgery/.

If you are having trouble achieving a healthy weight, now is the time to make changes in your life to achieve ultimate health and happiness. Being a healthy weight will not only make you feel and look better, but it will also improve the longevity and quality of your life, and will reduce your risk of developing diabetes, heart disease and some types of cancers. If you are severely overweight, consider consulting a bariatric surgeon to determine what solutions would work best for you and look to your community and local hospital for information sessions of bariatric surgery.

Dr. Ragui Sadek is a Bariatric Surgeon at the Bristol Myers-Squibb Children’s Hospital and Robert Wood Johnson University Hospital.