More than weight loss: What to know about bariatric surgery

This content is sponsored by MedStar Washington Hospital Center.

Bariatric surgery can help patients lose weight and reduce the risk of potentially life-threatening weight-related health problems. Patients who are considering weight-loss surgeries should know their options and find out what could work best for their long-term health.

Bariatric surgeries involve making changes to the digestive system to help patients lose weight. It’s done when diet and exercise haven’t worked or when there are serious health problems because of weight. Bariatric surgery has the potential to help extend patient’s lifespans, said Dr. Timothy Shope, Director of Bariatric Surgery at MedStar Washington Hospital Center.

“Given the safety of today’s surgical techniques and the well-proven long-term health benefits to be gained, I tell patients who are considering it not to wait. Find out all you can. Today, there are a variety of options for you to consider and some additional options on the horizon,” Dr. Shope said. “At MedStar Washington Hospital Center, these surgeries are done with minimally invasive techniques—meaning laparoscopically or robotically—to speed recovery and maximize safety for patients. And our team offers in-depth support before, during, and after surgery to help ensure that patients experience enduring health benefits.”

Patients who are good candidates for bariatric surgery have a BMI greater than 35 or 40, certain medical conditions like diabetes or sleep apnea, or have excess weight of 100 pounds or more from their ideal body weight, said Dr. Shope.

There are several types of bariatric surgery for patients to consider. Patients should consult with their doctor, medical team and insurance provider about what option would be best for them.

The gastric sleeve procedure is the most popular bariatric surgery technique nationwide and is selected by three out of four patients at MedStar Washington Hospital Center, Dr. Shope said. It involves sectioning off about 80% of the stomach with a stapling device, removing it, and creating a smaller, vertical “sleeve” of stomach.

“Not only does this reduce the amount of food you can ingest at any given time, it also decreases the level of hunger-signaling hormone that the stomach sends to the brain—so you have less of an appetite, amongst other metabolic changes,” Dr. Shope said.

Gastric bypass is the second most popular technique, and involves changing both the stomach and the intestines. With this technique, the surgeon uses a stapling device to section off a small egg-size pouch of stomach; the rest of the stomach remains. Then, part of the small intestine is rerouted and connected to the stomach pouch. As a result, the food you eat goes into the small stomach pouch, then directly into the connected lower section of small intestine, bypassing most of your stomach and the top portion of the small intestine.

Other types of procedures include biliopancreatic diversion with duodenal switch — which is similar to gastric bypass, but the stomach pouch is larger and allows patients to eat a little more. Another option is gastric band – which involves placing a flexible silicone band around the top part of the stomach and tightening it to create a narrowed passageway to limit how much food you can eat at any given time.

Several new alternatives are being evaluated at MedStar Washington Hospital Center including some endoscopic bariatric therapies, performed through a flexible tube inserted through a patient’s mouth rather than via abdominal incisions like traditional bariatric surgeries, Dr. Shope said.

With all surgeries, MedStar Washington Hospital Center prepares patients to make the best decision based on consultations with doctors, dieticians and counselors. Patients also need to understand their eating habits will change after the surgery, Dr. Shope said.

“Patients will have pretty substantially reduced plate sizes – their portion sizes will be much smaller; they will be eating less at any one time. It’s important that we make it possible for them to get enough calories in one day and that dietitian counseling makes it certain they understand that, of those calories that they take in, a certain portion should be proteins first, some fats and some carbohydrates as well. And there’s a significant emphasis we place on fluid intake,” Dr. Shope said.

Life after surgery will take some getting used to, Dr. Shope pointed out.

“There will be times, not only early on but throughout the rest of their lives, where perhaps they eat too fast or they haven’t chewed their food as well as they thought they did. Maybe they’re at a meal with their family and they’re not consciously aware of what they’re doing. Where they may actually have some trouble with feeling like their food is stuck or perhaps needing to excuse themselves to run to the bathroom. This is something that they learn to adapt to over time. Perhaps after months or certainly after years, they can go out to dinner with their family. They can go out to social events. They can live their lives like they otherwise would be able to. They just have to pay more attention to their pace of eating and types of food they are eating, as well as the quantity.”

Bariatric surgery can lead some patients to scale back or stop using medications for other health issues, Dr. Shope said.

“I tell my patients, ‘I care what the scale says, but I care so much more about what’s happening with their overall health.’ These operations should not be done just for weight loss purposes. The patients have, in many cases, resolved or improved diabetes, high blood pressure, and sleep apnea,” he said.

Patients must have realistic goals after their surgeries and understand that permanent healthy changes to diet and regular exercise help ensure the long-term success of bariatric surgery. The surgery itself will not solve all problems, Dr. Shope noted.

“These operations should be thought of as a tool and nothing else. There’s no operation that is going to make them achieve their goals in life. The operation can be used to help them get to those goals. But in and of itself it’s not going to make them do anything,” he said. “If they combine the tools they have been provided with their new lifestyle of healthy eating, more appropriate choices, and exercise, then they ought to see a rapid improvement in their medical troubles, weight loss and certainly a better quality of life.”

MedStar Washington Hospital Center is a top choice for patients seeking bariatric surgery.

“We have a fully comprehensive surgical weight loss program here and the people are really what drive it,” Dr. Shope said. “When you come to see us, you are a patient for life.”

Read more about bariatric surgery in a blog post on MedStar Washington Hospital Center’s website.

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