Bariatric surgery leads to life-long change and should be contemplated only after considerable research and after all other available options have been discussed with your primary care physician.
One of the most important decisions you will make about your weight-loss surgery is choosing your surgeon and clinical staff.
Before you decide where to have your surgery and before you decide on a surgeon, visit the American Society for Metabolic and Bariatric Surgery (ASMBS) website to find a board certified bariatric surgeon. Review your options and be sure to choose a surgeon from an ASMBS Center of Excellence.
Dr. Jeffrey Lord, founder and Director of Sacred Heart Surgical Weight Loss Center is board certified in Minimally Invasive Bariatric Surgery and an active member of the ASMBS. Dr. Lord and Sacred Heart Center for Surgical Weight Loss have a proven track record for excellent outcomes and compassionate patient care. Their dedication to excellent care and patient safety is reflected in its Center of Excellence status with the ASMBS.
"Obesity is a life-long, progressive, life-threatening, costly, genetically-related, multi-factorial disease of excess fat storage." – Dr. Jeffrey Lord
According to the National Institute for Health (NIH), obesity is defined as having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat and/or body water. Both terms mean that a person's weight is greater than what is considered healthy for his or her height.
Obesity is a chronic, life-threatening disease, not a cosmetic problem. It occurs over time when you eat more calories than you use. More than two-thirds of the adult population in the United States is overweight or obese, and nearly 8 million of those people are considered morbidly obese. Obesity is the second leading cause of preventable death, with 400,000 deaths per year.
What is Severe Obesity?
Severe or morbid obesity is often defined as being 100 pounds or more overweight and/or at least twice your ideal body weight. A better way to determine obesity is by calculating your Body Mass Index, or BMI. This index combines your weight and height into a single number. This will help you determine whether or not you are a candidate for weight loss surgery.
What Are Co-Morbidities?
Co-morbidities are additional conditions that may have an adverse affect on the primary condition that you are being treated for. If you are morbidly obese, you are at a much greater risk for many medical, psychological and social problems. By losing this excess weight, you can lower your risks of these conditions.
Common co-morbidities associated with obesity include:
• Adult Onset or Type II Diabetes
• Congestive Heart Failure
• Coronary Artery Disease
• Degenerative Arthritis (Osteoarthritis)
• Gallbladder Disease (Cholelithiasis)
• Heart and Vascular Problems
• High Blood Pressure
• Increased Intra-Abdominal Pressure
• Kidney Problems
• Obesity Hypoventilation Syndrome and Sleep Apnea Syndrome
• Pseudotumor Cerebri
• Pulmonary Embolism
• Respiratory Insufficiency of Obesity (Pickwickian Syndrome)
• Stasis Ulcers
• Stress Overflow Urinary Incontinence
• Venous Disease
Adult Obesity Facts* 1. Obesity is common, serious and costly
• More than one-third of U.S. adults (35.7%) are obese.
• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, which are some of the leading causes of death.
• In 2008, medical costs associated with obesity were estimated at $147 billion
2. Obesity prevalence varies across states and regions
• During the past 20 years, there has been a dramatic increase in obesity in the United States. The animated map below shows the United States obesity prevalence from 1985 through 2010.
• The South has the highest prevalence of obesity (29.4%) followed by the Midwest (28.7%), Northeast (24.9%) and the West (24.1%).
3. Obesity affects some groups more than others
• Non-Hispanic blacks have the highest rates of obesity (44.1%) compared with Mexican Americans (39.3%), all Hispanics (37.9%) and non-Hispanic whites (32.6%).
• Among non-Hispanic black and Mexican-American men, those with higher incomes are more likely to be obese than those with low income.
• Higher income women are less likely to be obese than low-income women.
• There is no significant relationship between obesity and education among men. Among women, however, there is a trend—those with college degrees are less likely to be obese compared with less educated women.
Click here to see maps showing the increased prevalence of obesity in the United States. (Source: http://www.cdc.gov/obesity/data/adult.html)
Surgical weight loss is a life-changing procedure that can both increase longevity and improve quality of life. At Sacred Heart Surgical Weight Loss Center, our goal is to help you create a “new you” from the inside-out. Our unique program takes into account your individual physical, mental and emotional needs to create a treatment plan that works best for you.
Several major benefits of weight-loss surgery include:
Significant, Sustainable Weight Loss One of the most obvious benefits of surgery is significant, sustainable, rapid weight loss. Following surgery, most patients lose weight rapidly and continue to do so for 18 to 24 months. The lap-band procedure provides more gradual weight loss, as compared to gastric bypass, but weight loss is maintained after two years without any nutritional problems. Approximately 75 percent of patients will lose and keep off 50-80 percent of their excess weight.
Improvement or Resolution of Co-Morbidities Besides weight loss, one of the most important benefits of surgery is the improvement, and sometimes the resolution of, many adverse medical conditions that existed prior to surgery. Once patients begin to lose weight, they can usually cut down, or stop taking altogether, medications for these various conditions.
Surgical Weight Loss Can Resolve: • Adult-Onset or Type II Diabetes • Hypertension (High Blood Pressure)
Improved Quality of Life Not only does physical health remarkably improve, but most patients have significantly improved energy levels for daily exercise and a positive sense of hope and increased self-confidence. As you lose significant amounts of weight, you'll find that you have more energy and everyday activities will no longer leave you short of breath.Because of your significant weight loss, your self-confidence, body image, self-esteem, mood and energy level may drastically improve. Many surgical weight -loss patients feel that they are perceived as performing better in their jobs and being more competent in all areas of life than they were prior to surgery. New jobs, educational opportunities, insurance policies, and personal relationships suddenly become possible where they never were before.
It is important to remember that weight-loss surgery is not an easy cure for obesity. It is a tool to be used in conjunction with diet and exercise to achieve a healthier and fuller life.
Surgery to produce weight loss is a serious undertaking, and you should clearly understand what the proposed operation involves. No major surgery is without risk, and you should carefully consider the following possible complications before deciding to undergo any surgical weight-loss procedure.
Mortality Rate Nationally, there is a 1 percent mortality (death) rate for obesity surgery. The national rate for complications for this surgery is about 10 percent. This means that one in 10 patients will experience a complication related to the surgery.
Thankfully, Dr. Lord has had no weight loss surgery-related deaths to date, but this does not mean that this surgery should be taken lightly, and some risks may still occur.
Potential Post-Surgical Complications As with any major surgery, there are some common potential complications that may occur, such as bleeding, blood clots, infection, pneumonia and breathing problems, and/or injury to internal organs.The most serious complications related specifically to weight loss surgery include leakage and peritonitis. When the intestines are sewn together, this connection normally heals quickly. If not, a leak of intestinal contents can occur, and this can cause peritonitis and possible death. Other potential complications include stoma blockage, narrowing of the stomach pouch outlet, and, in the case of Lap Band surgery, band slippage or erosion.
In addition to these immediate post-surgical complications, surgical weight-loss patients may develop several other problems three to 12 months after surgery. These problems may include:
• Abdominal hernias (in one in four patients with the open technique)
• Certain nutritional deficiencies.
• Increased risk of developing gallstones
Side Effects Many patients notice changes during this period of rapid weight loss. Some of these changes or side effects may include: loss of appetite, hair loss and skin dryness. These conditions should resolve themselves as your weight stabilizes, but, if they continue, please contact our bariatric program manager.
Pregnancy After Surgery Because rapid weight loss and nutritional deficiencies can harm a developing fetus, it is strongly recommended that women of childbearing age should avoid pregnancy for 18 months or until their weight becomes stable. In anticipation of pregnancy, taking needed supplements for protein, folate, calcium, zinc, iron, and vitamin B12 at all times are essential, even before pregnancy occurs.
The Roux-en-Y Gastric Bypass is considered the "gold standard" of bariatric surgical procedures, and it is the most commonly performed weight-loss operation in the United States. It has the most proven, long-term results compared with other bariatric procedures, because the effects have been documented for more than 20 years. Roughly 70 percent of American weight-loss surgeons use it as their primary weight loss operation.
The Roux-en-Y Gastric Bypass is a combined restrictive/malabsorptive operation, which restricts both food intake and the amount of calories and nutrients the body absorbs.
During this procedure, the stomach is partitioned with a stapler, creating a small pouch (15mls), and stomach capacity is reduced from the size of a football to the size of an egg. This smaller capacity produces a feeling of fullness with small amounts of food.
Next, the pouch is connected to a Y-shaped section of the small intestine (called the Roux limb), allowing food to bypass the lower stomach and the first two parts of the small intestine. Because of this, food bypasses most of the stomach and duodenum and empties directly into the Roux limb. Most patients do not experience significant malabsorption of food. The ability to consume fluids is not affected, as liquids pass through the pouch very quickly.
The operation can be performed either laparoscopically, through five or six very small incisions in the abdominal wall, or open, through a traditional midline abdominal incision. In general, Dr. Lord prefers the laparoscopic approach because of its many patient benefits, including decreased pain, faster recovery, quicker return to normal activities, and a lower incidence of incision-related problems like infection or hernia.
• Weight loss ranges from 60 to 80 percent of excess body weight within two years.
• Most co-morbidities such as diabetes, high blood pressure, sleep apnea and high cholesterol improve after the surgery, and some are even cured.
• Roux-en-Y surgery is generally safe, but it can lead to serious and potentially fatal complications. In a gastric bypass, the stomach and intestines are cut and then reconnected using staples and stitches, which have the potential to tear in the first few weeks after surgery. This can lead to peritonitis and bleeding.
• Intestinal blockage, due to scar tissue or intestinal twisting, is a possibility.
• After two years, some patients regain 10 to 30 pounds of weight they previously lost due to stretching of the pouch and its outlet. This results in return of appetite and loss of fullness.
• The Roux-en-Y operation causes food to bypass areas of the small intestine that are responsible for absorbing protein, calcium, and certain vitamins. In addition, less iron is absorbed because of the small size of the new stomach pouch. To avoid nutritional deficiencies, you will need to take daily vitamin and mineral supplements every day for the rest of your life.
Laparoscopic Adjustable Banding (Lap-Band)
Adjustable Gastric Banding (Lap-Band) The second, newer approach performed at Sacred Heart is adjustable gastric banding or Lap-Band. Lap-Band surgery is a "restrictive" operation, which means that it limits food intake and does not interfere with the normal digestive process.
Using a laparoscope, the surgeon places an inflatable band around the stomach, creating a small upper pouch at the top, with restricted passage to the rest of the stomach. This pouch fills quickly and creates a feeling of fullness. The band is adjustable by injecting saline into a small port placed underneath the skin, so that the band can be tightened or loosened over time depending on the progress and needs of the patient. This is accomplished by using a fine needle to gain access to a small reservoir that is positioned well under the skin and fat of the abdomen at the time of surgery. The reservoir, in turn, is connected by a thin tube to the saline-filled band. It is not visible from the outside, and it can be felt only when you push on your abdomen.
At first, the pouch holds about 1 ounce of food, and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ½-inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness.
After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ½ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and chewed well. As with any bariatric surgery, to be successful long-term, patients must be compliant with proper eating.
• Gastric banding is the safest form of bariatric surgery, with a rapid recovery time.
• Weight loss ranges from 50 to 65 percent of excess body weight during the first two years, and it is maintained for up to five years.
• It is the least-invasive operation of all the weight loss surgeries available. Since there is no cutting or re-connecting of stomach or intestines, there is no risk of intestinal leak, dumping syndrome, or food intolerance.
• Patients who have the Lap-Band do not feel hungry, most likely because a small amount of food stretches the uppermost part of the stomach, signaling a sense of fullness.
• There is no malabsorption of medication or protein, which means that you absorb every nutrient that you eat. This is particularly important in young women who want to get pregnant.
• The majority of existing obesity-related health problems are improved, or even cured, such as diabetes, high blood pressure, sleep apnea and high cholesterol.
• Since the band is an implantable device, its effect can be completely reversed just by taking it out.
• The surgery takes approximately one hour to perform and requires only an overnight hospital stay. Patients can return to work in three to five days.
• It is adjustable - without the need for more surgery – with just a ten minute visit to the surgeon's office. As you lose weight, the band needs to be tightened every six to eight weeks. You will need to see your surgeon frequently during your first year after surgery, and then once annually thereafter to ensure that everything is working properly. Sometimes, if you are pregnant or become ill, you may need to have the band loosened to allow you to eat more.
• You must re-learn how to eat. If you eat too fast or too much, or if you don't chew your food enough, you will get sick. Some foods - such as steak, white meat chicken, and doughy bread - will not pass through the opening.
• Weight loss is slower, with 70 percent of patients achieving significant weight loss. Your success depends on your commitment to keeping follow-up visits with your surgeon every six to eight weeks for at least the first year and perhaps longer to have your band adjusted. If you do not follow-up with your surgeon, you will not lose weight.
• Because the Lap-Band is an implantable device, it does carry a small risk of slippage or erosion into the stomach. In either case, another laparoscopic surgery would be required to re-position or remove the band.
• Other technical problems can arise. In a few cases, the tube may kink or the reservoir may twist, which may require minor surgery.
• The Lap-Band is not a perfect solution, and it will not result in weight loss if you start eating an excess amount of chocolate or high-calorie drinks, such as ice cream, milk shakes and soda.
Laparoscopic Sleeve Gastrectomy Gastric sleeve surgery (also known as gastrectomy) is a weight loss procedure that purposely restricts the amount of food that you can eat because you feel full more quickly.
In this procedure, a thin, vertical sleeve of stomach (approximately eight inches long) is created using a stapling device and the rest of the stomach is removed. Food passes through the digestive tract as usual and is fully absorbed into the body.
Patients who have elected this approach have been shown to experience significant weight loss and improvements in their health. Weight loss outcomes are comparable to gastric bypass.
Revisional Surgery What is Revisional Bariatric Surgery? In some instances, patients may need another surgery to revise a previous bariatric surgery. This usually occurs for those patients who may have had an outmoded operation performed many years ago. In the past, many patients underwent "stomach stapling," another term for the Vertical Banded Gastroplasty, or VBG.
Although this operation may work for some individuals, a large proportion of VBG patients do not lose as much weight as they would like to, and they may experience unpleasant side effects such as excessive vomiting.
A VBG procedure may be converted to a gastric bypass, and it can be performed open, laparoscopically, or orally with the new StomaphyX procedure.
Traditional Revision Surgery Traditional revision surgery is performed using the Roux-en-Y gastric bypass technique, the “gold standard” of bariatric surgery. It can be performed open or laparoscopically. It is important to understand that any revisional procedure is a very major operation, with risks that are greater than for a primary procedure. Nonetheless, many patients may benefit substantially from a conversion of their VBG.
StomaphyX Revision Surgery The StomaphyX procedure is a new, endoscopic bariatric surgery technique that was approved by the FDA in 2007. It helps to further shrink the size of the stomach. When compared to traditional revisional bariatric surgery, the new technique provides advantages such as no incisions or scars, less pain, a lower rate of complications, little or no hospital stay and a much quicker recovery.
During the procedure, a flexible endoscope is passed through the mouth and advanced into the stomach, carrying a fiber-optic camera and a tubular surgical tool. Stomach tissue is then pulled by suction into the tubular device and 10 to 20 fasteners are placed strategically into the inside lining of the stomach, creating pleats in the tissue and reducing the size of the stomach’s pouch. The smaller stomach capacity allows the patient to feel full and satisfied with less food, promoting further weight loss.
Patients should expect to experience some discomfort in their chest, nose, and/or throat for the first few days to a week after the procedure. *Physical activity should be restricted for a week and appropriate dietary guidelines will be given to maximize success.
Please note: Most insurance policies do not cover the StomaphyX procedure at this time.
Who is Eligible for Weight Loss Surgery? Generally, patients whose BMI is 40 or greater are considered morbidly obese and are candidates for weight-loss surgery. In addition, patients whose BMI is between 35 and 40 with several co-morbidities may also be considered for surgery.
The NIH has recommended surgical weight loss for severely overweight individuals who have not been successful with dieting and exercise alone. You may be eligible for weight loss surgery if you:
• Have failed attempts at weight loss in a medically supervised weight-loss program that have been documented.
• Have a BMI greater than 40 without associated co-morbidities.
• Have a BMI greater than 35 with one or more of the co-morbidities.
• Are able to demonstrate a clear understanding of the principles involved with surgical options, long- and short-term risks, complications, and what is required after surgery.
Surgery is not recommended for patients who have been diagnosed with alcoholism, overt psychosis, excessive somatization, and major cardiopulmonary disease, as these conditions can lead to greater risks during and after surgery.
For many patients, some of the most important and frustrating questions about weight-loss surgery are about insurance and costs. To help answer some of those questions, our financial team has created a list of frequently asked insurance and payment questions.
Q:Will my insurance pay for Weight-Loss Surgery? A: Because there are many different insurance carriers, each patient’s coverage will depend on the exact criteria that are mandated by his or her insurance company or employer. A patient may have to meet certain guidelines, such as a physician-supervised weight-loss trial which can last in duration from 6 to 12 months. In addition, a minimum body mass index (BMI) of 35 with co-morbidities (diabetes, hypertension, sleep apnea, etc.) or a BMI of 40 or greater with no co-morbidities is required by our Center to proceed with surgery.
Q:Does Medicare cover Weight-Loss Surgery? A:In some cases, Medicare will cover bariatric surgery. However, to qualify for coverage, you will need to participate in a physician-supervised weight-loss trial for 6 months before surgery can be considered.
Q:What is a physician-supervised weight-loss trial? A: A physician-supervised weight-loss trial is mandated for most insurance carriers and is used to help document that you are unable to lose weight without the help of surgery. The trial period and can last anywhere from three to 12 months and requires you to visit your primary care physician or our Nutrition and Weight-Management specialist once a month. During the trial period, the physician will document your attempts to lose weight and your success or failure to do so.
Q:What does my physician need to provide for my insurance company? A: The following four items must be documented on each of your physician-supervised weight-loss trial visits:
1. Office Visit Note – Your insurance company will require a note from your physician’s office that includes your height, weight, and body mass index and the number of pounds lost or gained. A comment should be included if there is failure to lose weight or a weight gain is recorded.
2. Low-Calorie Diet – There must be documentation of a low-calorie diet with the number of calories listed on the office visit note (ex. 1,000-1,200 calories per day).
3. Exercise – The type and duration of exercise the patient is attempting must be recorded (ex., Walking 30 minutes per day; swimming 10 laps in pool; stretching for 20 minutes if patient is wheelchair bound, etc).
4. Behavior Modification – Your attempts to alter your lifestyle to lose weight must be documented (ex., Parking further away from store; putting fork down between bites, chewing each bite 20 times before swallowing; using stairs instead of elevator; walking instead of taking the shuttle bus, etc).
Read more about Physician-Supervised Weight-Loss Trials under the "What to Expect" tab.
Q:How long will it take to get authorization from my insurance company? A: The length of time it takes to process an insurance authorization is specific to each patient and their insurance’s requirements. We are dedicated to working with all of our patients and their insurance carriers to expedite pre-approval of the procedure. Although the process from initial consult to surgery may seem lengthy due to insurance criteria, we recognize the end result will mean a safe, healthy, and satisfying outcome for our patients.
Q:What if my insurance will not pay or I don’t have insurance coverage? A: For patients who wish to proceed with surgery and do not have insurance that will cover the procedure, funding options are available. Please call us at 850-416- 7546 to discuss various lending sources.
Q:I still have questions. A: We’re here for you. Please call our office at (850) 416-7546, or send us an e-mail. Please note that we answer e-mails within 72 hours.